Paraneoplastic Neurological Syndrome in Fallopian Tube Cancer

Abstract

We report on a rare case of paraneoplastic syndrome (PS) that was discovered on completion of diagnostic work-up to be an undifferentiated fallopian tube carcinoma. A 49-year-old Caucasian woman was admitted to neurology with vertigo, gait ataxia and dysarthria, transient ischaemic attack (TIA) and stroke were quickly excluded. Indicative for the further diagnosis of a paraneoplastic syndrome was the identification of onconeuronal antibodies the detection of which can be associated with certain tumour entities. The strongly positive anti-Yo antibody that is formed above all by breast and lung cancers as well as ovarian cancer led to a corresponding staging. The tumour markers CEA, CA 125 and CA 15-3 were in the normal ranges. Mammography and thorax CT were also unremarkable; on transvaginal sonography the internal genitals were inconspicuous except for a follicular cyst on the left. On abdominal CT the only conspicuous finding was a 1.5 cm ovarian cyst. After consensual agreement a bilateral laparoscopic adenexectomy was performed but with unremarkable abdominal findings. The histological examination confirmed a right-sided undifferentiated tubal carcinoma with the provisional classification FIGO IIA. After a stage-related staging operation, the final classification was found to be the FIGO-IIIC stage on account of positive retroperitoneal lymph nodes. Thus adjuvant chemotherapy with 6 cycles of carboplatin and paclitaxel was performed. By means of a timely, guideline-conform therapy for tubal carcinoma, the neurological symptoms and, above all, the dysarthria could be improved after 10 months.

Zusammenfassung

Wir berichten über den seltenen Fall eines paraneoplastischen Syndroms (PS), das sich nach Abschluss der Diagnostik als undifferenziertes Tubenkarzinom herausstellte. Eine 49-jährige kaukasische Patientin wird mit Drehschwindel, Gangataxie und Dysarthrie neurologisch aufgenommen, eine transitorisch ischämische Attacke (TIA) und ein Apoplex können schnell ausgeschlossen werden. Wegweisend in der weiteren Diagnostik des paraneoplastischen Syndroms war die Bestimmung onkoneuronaler Antikörper, deren Nachweis mit bestimmten Tumorentitäten assoziiert sein kann. Der stark positive Anti-Yo-Antikörper, der v. a. von Mamma-und Lungenkarzinomen sowie Ovarialkarzinomen gebildet wird, veranlasste ein entsprechendes Staging. Die Tumormarker CEA, CA 125 und CA 15-3 waren normwertig. Ebenso die Mammografie und das Thorax-CT, in der Transvaginalsonografie stellte sich das innere Genitale bis auf eine Follikelzyste links unauffällig dar. In der Abdomen-CT verblieb eine ca. 1,5 cm große Ovarialzyste links als einziger auffälliger Befund. Nach konsensualer Einwilligung erfolgte die laparoskopische Adnexektomie beidseits bei makroskopisch unauffälligem intraabdominalem Situs. Die histologische Untersuchung bestätigte ein undifferenziertes Tubenkarzinom rechts mit der vorläufigen Klassifikation FIGO IIA. Nach stadiengerechter Staging-Operation ergab die endgültige Klassifikation aufgrund positiver retroperitonealer Lymphknoten ein FIGO-IIIC-Stadium. Somit wurde die adjuvante Chemotherapie mit 6 Zyklen Carboplatin und Paclitaxel durchgeführt. Mittels frühzeitiger leitliniengerechter Therapie des Tubenkarzinoms konnten die neurologischen Symptome, v. a. die Dysarthrie, nach 10 Monaten gebessert werden.

Key words

paraneoplastic syndrome - tubal carcinoma - onconeuronal antibodies

Schlüsselwörter

paraneoplastisches Syndrom - Tubenkarzinom - onkoneuronaler Antikörper

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