Mesothelioma and anti-Ma paraneoplastic syndrome; heterogeneity in immunogenic tumours increases

Our plain-English summary of Mesothelioma and anti-Ma paraneoplastic syndrome; heterogeneity in immunogenic tumours increases, by H.A. Archer, A. Panopoulou, N. Bhatt, et al (Practical Neurology, 2014).

The study

• Authors: H.A. Archer, A. Panopoulou, N. Bhatt, A.J. Edey, N.J. Giffin
• Journal: Practical Neurology
• Published: 2014;14(1):33-5
• Type of article: Case report
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We present a patient with opsoclonus and diffuse cerebellar signs who had an anti-Ma2 antibody-associated paraneoplastic syndrome secondary to a sarcomatoid mesothelioma. This case highlights the importance of early tumour detection, instigation of therapeutic measures, and the heterogeneity of underlying malignancies in neurological paraneoplastic syndromes.

In plain English

This case report described one patient, a 66-year-old man who had worked as a carpenter. He had two months of oscillopsia (the visual world seeming to move), vertigo, and changes in speech and walking. Examination found eye movements consistent with opsoclonus and cerebellar signs. He could not stand unaided. A CT scan showed a mass in the front of the chest and calcified pleural plaques, which the authors attributed to previous asbestos exposure. The removed mass was a localised sarcomatoid mesothelioma arising from the parietal pleura. Testing found anti-Ma2 antibodies, indicating a paraneoplastic syndrome, a nervous-system disorder linked to a tumour. Testicular ultrasound and PET scanning found no other tumour. After steroids and intravenous immunoglobulin his symptoms improved only marginally, and plasma exchange brought no significant change; overall, the authors wrote, his symptoms did not improve despite tumour removal and these treatments. Planned chemotherapy was cancelled because of his rapid physical decline. The authors knew of no previous descriptions of anti-Ma antibodies with sarcomatoid mesothelioma. They concluded that the case highlights early tumour detection, starting treatment, and the variety of tumours behind such syndromes.

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 66-year-old right-handed man who worked as a carpenter
• Exposure: Previous asbestos exposure, inferred by the authors from bilateral calcified pleural plaques seen on CT. The patient's occupation was carpenter. No fiber type, source or dose was reported.
• Main results:
  • The patient had a 2-month history of oscillopsia, vertigo and altered speech and gait.
  • Eye movements were consistent with opsoclonus.
  • The patient could not stand unaided.
  • Cerebrospinal fluid had no cells, and its protein was raised at 1.0 g/L (reference range 0.15 to 0.45). MR brain scan with contrast was normal.
  • CT scan of the chest, abdomen and pelvis showed an anterior mediastinal mass.
  • After biopsy and resection, the mass was a localised sarcomatoid mesothelioma arising from the parietal pleura.
  • Antineuronal antibody screening found positive anti-Ma2 (Ma2/Ta) antibodies.
  • Testicular ultrasound and PET scanning found no other abnormalities. Repeat CT imaging 6 months after presentation found no second malignancy.
  • After 3 days of intravenous methylprednisolone followed by intravenous immunoglobulin, symptoms improved only marginally.
  • Five days of plasma exchange brought no significant change.
  • In the authors' overall assessment, the patient's symptoms did not improve despite tumour resection, intravenous methylprednisolone, immunoglobulins and plasma exchange.
  • Planned chemotherapy was cancelled because of rapid physical decline, and the patient was being treated supportively.
  • The authors knew of no previous descriptions of anti-Ma antibodies in association with sarcomatoid mesothelioma.
• The authors' conclusion: The authors concluded that the case highlights the importance of early tumour detection, starting therapeutic measures, and the variety of underlying cancers in neurological paraneoplastic syndromes. They suggested that the patient's failure to respond to treatment likely mirrored the progression of mesothelioma.

Topics

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

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

Related studies

• The Constellation of Risk Factors and Paraneoplastic Syndromes in Cholangiocarcinoma: Integrating the Endocrine Panel Amid Tumour-Related Biology (A Narrative Review) — M.L. Ciobica, B.A. Sandulescu, et al. (2024)
• Anti-Yo antibody-mediated paraneoplastic cerebellar degeneration in a female patient with pleural malignant mesothelioma — O. Tanriverdi, N. Meydan, et al. (2013)
• Malignant mesothelioma presenting as pulmonary metastasis ahead of growth of primary tumour — U. Heki, M. Fujimura, et al. (1999)
• Mediastinal germ cell tumour with an uncommon micropapillary architecture on histology — A. von Rohr, A. Zimmermann, et al. (1991)
• Synergistic anti-tumor efficacy of immunogenic adenovirus ONCOS-102 (Ad5/3-D24-GM-CSF) and standard of care chemotherapy in preclinical mesothelioma model — L. Kuryk, E. Haavisto, et al. (2016)
• Mediastinal and pleuropulmonary myeloid sarcoma with HBME1 and podoplanin expression. A diagnostic pitfall — D. Suárez-Vilela, F.M. Izquierdo (2020)

Browse return to medical research.