Anti-Yo antibody-mediated paraneoplastic cerebellar degeneration in a female patient with pleural malignant mesothelioma

Our plain-English summary of Anti-Yo antibody-mediated paraneoplastic cerebellar degeneration in a female patient with pleural malignant mesothelioma, by O. Tanriverdi, N. Meydan, S. Barutca, et al (Japanese Journal of Clinical Oncology, 2013).

The study

• Authors: O. Tanriverdi, N. Meydan, S. Barutca, N. Ozsan, D. Gurel, A. Veral
• Journal: Japanese Journal of Clinical Oncology
• Published: 2013;43(5):563-8
• Type of article: Case report
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Paraneoplastic cerebellar degeneration is a rare non-metastatic complication of malignancies. It presents with acute or subacute onset of ataxia, dysarthria and intention tremor. Paraneoplastic cerebellar degeneration is most commonly associated with malignancies of the ovary, breast and lung. The anti-Yo (anti-Purkinje cells) antibodies that specifically damage the Purkinje cells of the cerebellum are found in the serum and cerebrospinal fluid. Anti-Yo-related paraneoplastic cerebellar degeneration is most commonly found in women with gynecological and breast cancers, but it is reported in other malignancies. Patients with paraneoplastic syndromes most often present with neurologic symptoms before an underlying cancer is detected. We report a case of anti-Yo-related paraneoplastic cerebellar degeneration associated with pleural malignant mesothelioma in a 51-year-old female patient. She presented to our department with a 2-week history after the last chemotherapy of progressive dizziness related to head movement, nausea, vomiting, ataxia and unsteady gait. A western blot assay was negative for anti-Hu, anti-Ri, anti-Ma2, anti-CV2 and anti-amphiphysin paraneoplastic antibody markers but positive for anti-Yo. In conclusion, we report a case of paraneoplastic cerebellar degeneration in a patient with pleural malignant mesothelioma because of the rarity of this neurologic presentation after the diagnosis of malignant mesothelioma and of the association with anti-Yo antibodies.

In plain English

This article was a case report from Turkey describing one patient. A 51-year-old previously healthy woman with abdominal pain was diagnosed in 2009 with malignant mesothelioma originating from the pleura. Tumor was also found in the peritoneum. She had no smoking history, and the authors reported that neither she nor her husband had any history of direct asbestos exposure. She received nine cycles of carboplatin with pemetrexed, then three cycles of carboplatin with doxorubicin. In April 2010 she presented to the authors' department with a two-week history, after her last chemotherapy, of progressive dizziness, nausea, vomiting, loss of coordination (ataxia) and unsteady gait. Examination also found slurred speech. Brain MRI showed no tumor spread or shrinkage of the cerebellum. A blood test was positive for anti-Yo antibodies at high levels and negative for five other antibodies. The authors described this as paraneoplastic cerebellar degeneration, a nervous-system disorder linked to a cancer but not caused by its spread. She refused further chemotherapy and could not be reached again. The authors stated that this association had not been reported in the English literature. One similar case had been reported in Italian.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 51-year-old previously healthy Caucasian woman, a non-smoking housewife, first seen elsewhere in March 2009 and later at the authors' department in Turkey in April 2010
• Exposure: No asbestos exposure was identified. The authors reported that neither the patient nor her husband had a history of direct asbestos exposure. No fiber type was mentioned.
• Main results:
  • Based on imaging, thoracoscopy and laparoscopy, the patient was diagnosed with malignant mesothelioma originating from the pleura. Biopsies of both the pleura and the peritoneum showed malignant mesothelioma.
  • She was treated with nine cycles of carboplatin and pemetrexed. After the disease progressed, she received three cycles of carboplatin and doxorubicin.
  • In April 2010 she presented with a two-week history, after her last chemotherapy, of progressive dizziness, nausea, vomiting, ataxia and unsteady gait. On examination she also had dysarthria with scanning speech.
  • Contrast brain MRI showed no cerebellar mass, metastasis or atrophy. Head CT was also normal.
  • Her serum was positive for anti-Yo antibody and negative for anti-Hu, anti-Ri, anti-Ma2, anti-CV2 and anti-amphiphysin. The patient had high titres of anti-Yo antibody.
  • On re-examination, the tumor was a diffuse epithelioid type. It was negative for calretinin but strongly positive for cytokeratin 5/6 and mesothelin.
  • The patient refused chemotherapy with gemcitabine after the first treatment, left to seek alternative ozone treatment, and was lost to follow-up.
  • The authors stated that this association had not been reported in English. They compared their patient with one case of subacute cerebellar degeneration with pleural mesothelioma reported in Italian.
• The authors' conclusion: The authors reported the case because this neurologic presentation is rare after a diagnosis of malignant mesothelioma, as is its association with anti-Yo antibodies.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Chemotherapy.

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