Breast cancer-associated opsoclonus-myoclonus syndrome: a case report

Abstract Background Paraneoplastic neurological syndromes constitute rare neurological complications of malignant disease, manifesting in <1% of patients with cancer. Opsoclonus-myoclonus syndrome (OMS) presents with chaotic ocular saccades (opsoclonus), spontaneous muscular jerking (myoclonus) t...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Aikaterini Kostoglou, Dimitrios Vlastos, Athanasios Bakalis, Debashis Ghosh
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Paraneoplastic syndrome Breast cancer Anti-Ri Opsoclonus-myoclonus syndrome Surgery RD1-811 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/0b61d1953e3c4dc1b417b1c26a17783d
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:0b61d1953e3c4dc1b417b1c26a17783d
record_format	dspace
spelling	oai:doaj.org-article:0b61d1953e3c4dc1b417b1c26a17783d2021-11-21T12:33:37ZBreast cancer-associated opsoclonus-myoclonus syndrome: a case report10.1186/s12957-021-02436-71477-7819https://doaj.org/article/0b61d1953e3c4dc1b417b1c26a17783d2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12957-021-02436-7https://doaj.org/toc/1477-7819Abstract Background Paraneoplastic neurological syndromes constitute rare neurological complications of malignant disease, manifesting in <1% of patients with cancer. Opsoclonus-myoclonus syndrome (OMS) presents with chaotic ocular saccades (opsoclonus), spontaneous muscular jerking (myoclonus) that may be accompanied by ataxia, strabismus, aphasia, or mutism. Its paraneoplastic variant in the adult is most commonly associated with small-cell lung cancer, followed by breast cancer. Importantly, neurological symptoms usually precede the diagnosis of breast cancer and tend to recure after its treatment. Case presentation A 43-year-old premenopausal Caucasian woman with a medical history of hypertension was admitted following an episode of focal seizure. This progressed to generalised tonic-clonic seizures and she was subsequently loaded with phenytoin, valproate, and levetiracetam. Initial workup included whole body CT scan, viral and autoimmune serology. The CT scan revealed an enhancing right axillary lymph node, which in combination with Anti-Ri antibody positivity raised the spectre of paraneoplastic OMS. MRI of the head revealed subtle nonspecific white matter signal change within the centrum semiovale without any mass lesions, while MRI of the spine was unremarkable. An uncomplicated right mastectomy and axillary lymph node clearance was performed: histopathology revealed a 9-mm, grade 2, oestrogen receptor-positive, progesterone receptor-negative (ER8, PR0), Her2-negative invasive ductal carcinoma, and 4/6 positive lymph nodes (T1b N2 M0). Two months later, she was readmitted with vertigo, diplopia, facial weakness, and ataxia, setting the diagnosis anti-Ri syndrome recurrence. MDT recommended mammogram and ultrasound of the left breast, which were normal. Subsequently, four months after initial discharge, she suffered another neurological recurrence; due to concomitant abdominal pain, PET-CT was performed demonstrating a hypermetabolic right ovarian focus. Bilateral salpingo-oophorectomy was performed as per gynaecology MDT and final histology showed normal tubes and ovaries. She has remained on remission since then, with a negative annual mammogram follow-up. Conclusions In conclusion, we report a case of OMS associated with breast cancer anti-Ri onconeural antibody. Its manifestations preceded the diagnosis of malignancy and it persisted after cancer treatment, underlining the importance for high clinical suspicion in cases of classical paraneoplastic neurological syndromes as well as the need for long-term clinical follow-up.Aikaterini KostoglouDimitrios VlastosAthanasios BakalisDebashis GhoshBMCarticleParaneoplastic syndromeBreast cancerAnti-RiOpsoclonus-myoclonus syndromeSurgeryRD1-811Neoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENWorld Journal of Surgical Oncology, Vol 19, Iss 1, Pp 1-5 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Paraneoplastic syndrome Breast cancer Anti-Ri Opsoclonus-myoclonus syndrome Surgery RD1-811 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Paraneoplastic syndrome Breast cancer Anti-Ri Opsoclonus-myoclonus syndrome Surgery RD1-811 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Aikaterini Kostoglou Dimitrios Vlastos Athanasios Bakalis Debashis Ghosh Breast cancer-associated opsoclonus-myoclonus syndrome: a case report
description	Abstract Background Paraneoplastic neurological syndromes constitute rare neurological complications of malignant disease, manifesting in <1% of patients with cancer. Opsoclonus-myoclonus syndrome (OMS) presents with chaotic ocular saccades (opsoclonus), spontaneous muscular jerking (myoclonus) that may be accompanied by ataxia, strabismus, aphasia, or mutism. Its paraneoplastic variant in the adult is most commonly associated with small-cell lung cancer, followed by breast cancer. Importantly, neurological symptoms usually precede the diagnosis of breast cancer and tend to recure after its treatment. Case presentation A 43-year-old premenopausal Caucasian woman with a medical history of hypertension was admitted following an episode of focal seizure. This progressed to generalised tonic-clonic seizures and she was subsequently loaded with phenytoin, valproate, and levetiracetam. Initial workup included whole body CT scan, viral and autoimmune serology. The CT scan revealed an enhancing right axillary lymph node, which in combination with Anti-Ri antibody positivity raised the spectre of paraneoplastic OMS. MRI of the head revealed subtle nonspecific white matter signal change within the centrum semiovale without any mass lesions, while MRI of the spine was unremarkable. An uncomplicated right mastectomy and axillary lymph node clearance was performed: histopathology revealed a 9-mm, grade 2, oestrogen receptor-positive, progesterone receptor-negative (ER8, PR0), Her2-negative invasive ductal carcinoma, and 4/6 positive lymph nodes (T1b N2 M0). Two months later, she was readmitted with vertigo, diplopia, facial weakness, and ataxia, setting the diagnosis anti-Ri syndrome recurrence. MDT recommended mammogram and ultrasound of the left breast, which were normal. Subsequently, four months after initial discharge, she suffered another neurological recurrence; due to concomitant abdominal pain, PET-CT was performed demonstrating a hypermetabolic right ovarian focus. Bilateral salpingo-oophorectomy was performed as per gynaecology MDT and final histology showed normal tubes and ovaries. She has remained on remission since then, with a negative annual mammogram follow-up. Conclusions In conclusion, we report a case of OMS associated with breast cancer anti-Ri onconeural antibody. Its manifestations preceded the diagnosis of malignancy and it persisted after cancer treatment, underlining the importance for high clinical suspicion in cases of classical paraneoplastic neurological syndromes as well as the need for long-term clinical follow-up.
format	article
author	Aikaterini Kostoglou Dimitrios Vlastos Athanasios Bakalis Debashis Ghosh
author_facet	Aikaterini Kostoglou Dimitrios Vlastos Athanasios Bakalis Debashis Ghosh
author_sort	Aikaterini Kostoglou
title	Breast cancer-associated opsoclonus-myoclonus syndrome: a case report
title_short	Breast cancer-associated opsoclonus-myoclonus syndrome: a case report
title_full	Breast cancer-associated opsoclonus-myoclonus syndrome: a case report
title_fullStr	Breast cancer-associated opsoclonus-myoclonus syndrome: a case report
title_full_unstemmed	Breast cancer-associated opsoclonus-myoclonus syndrome: a case report
title_sort	breast cancer-associated opsoclonus-myoclonus syndrome: a case report
publisher	BMC
publishDate	2021
url	https://doaj.org/article/0b61d1953e3c4dc1b417b1c26a17783d
work_keys_str_mv	AT aikaterinikostoglou breastcancerassociatedopsoclonusmyoclonussyndromeacasereport AT dimitriosvlastos breastcancerassociatedopsoclonusmyoclonussyndromeacasereport AT athanasiosbakalis breastcancerassociatedopsoclonusmyoclonussyndromeacasereport AT debashisghosh breastcancerassociatedopsoclonusmyoclonussyndromeacasereport
_version_	1718418926264647680

Breast cancer-associated opsoclonus-myoclonus syndrome: a case report

Ejemplares similares