Cancer And Paraneoplastic Phenomena

Question 1

How does NMDA-R encephalitis present?

Answer 1

In a young woman - psychosis, sympathetic/cholinergic storm (salivating like rabies) and clonus

Question 2

What paraneoplastic phenomenon should be considered in young women presenting with a rabies like picture?

Answer 2

NMDA-R encephalitis

Question 3

What tumour is NMDA-R encephalitis associated with?

Answer 3

Ovarian teratoma

Question 4

What paraneoplastic phenomenon is ovarian teratoma associated with?

Answer 4

NMDA-R

Question 5

What cancer is most commonly associated with limbic encephalitis?

Answer 5

SCLC

Question 6

What is the traditional presentation of paraneoplastic limbic encephalitis?

Answer 6

Short term memory disturbance initially, which makes way to global cognitive impairment 
Affective disturbance (anxiety/depression) +/- psychosis
Seizures common

Question 7

What CSF findings may suggest a limbic encephalitis?

Answer 7

Raised lymphocytes (e.g. Around 10)
Raised protein (Ig)
Oligoclonal bands may occur

Question 8

What are major antibodies responsible for paraneoplastic limbic encephalitis collectively known as?

Answer 8

Anti-Neuronal Nuclear Antibodies (ANNA)

Question 9

What is the typical presentation of anti-Hu receptor encephalitis and with what cancer is it most often associated?

Answer 9

Subacute sensory neuronopathy is characteristic
Gastroparesis/intestinal obstruction
Cerebellar ataxia or brainstem involvement
SCLC

Question 10

What is paradoxical and interesting about the anti-Hu paraneoplastic encephalitis and its associated cancer?

Answer 10

Seen almost exclusively in patients that smoke but is also characteristic of SCLC

Question 11

Which antibody is associated with paraneoplastic subacute sensory neuronopathy, cerebellar ataxia and brainstem features?

Answer 11

Anti-Hu

Question 12

What is the classical presentation of anti-Ri antibody paraneoplastic encephalitis?

Answer 12

Midbrain/brainstem/cerebellum or spinal cord degeneration

Paraneoplastic opsoclonus

Question 13

Which antibody might be responsible for paraneoplastic encephalitis in a patient with opsoclonus and brainstem/cerebellar/spinal cord degeneration?

Answer 13

Anti-Ri

Question 14

What 2 cancers are most strongly associated with anti-Ri Abs?

Answer 14

Breast

SCLC

Question 15

How might anti-Yo encephalitis present?

Answer 15

Cerebellar degeneration and sensorimotor neuropathy

Question 16

What tumours are most often associated with anti-Yo abs?

Answer 16

Breast and gynaecological

Question 17

What antibody might be responsible for paraneoplastic sensorimotor neuropathy and cerebellar degeneration?

Answer 17

Anti-Yo

Question 18

With what paraneoplastic syndrome and cancer is anti-Recoverin antibody associated?

Answer 18

Cancer-associated retinopathy (CAR)

SCLC

Question 19

What antibody encephalitis may be a differential for Whipple’s disease in a young male patient?

Answer 19

Anti-Ma2/Ta

Question 20

What antibody may be related to paraneoplastic optic neuropathy?

Answer 20

Anti-CV2

Question 21

What 2 pathologies are associated with anti-CV2 antibodies?

Answer 21

Paraneoplastic optic neuropathy

Mixed axonal and demyelinating peripheral neuropathy

Question 22

What antibody is associated with cancer associated retinopathy? (CAR)

Answer 22

Anti-Recoverin

Question 23

What syndrome is associated with SOX (1,2 etc.) Abs? What is the caveat/alternative use for these antibodies?

Answer 23

SCLC-LEMS

Often not paraneoplastic and may have use as a tumour marker

Question 24

What antibody may be associated with SCLC-LEMS?

Answer 24

SOX antibodies