Paraneoplastic syndrome

Question 1

A 45-year-old woman, para 2, has been hospitalized with symptoms of diplopia, vertigo, and dizziness for the past 10 days. Three days ago, she had a contrast magnetic resonance imaging (MRI) scan of the head, which was negative for mass effect, lesions, and plaques. She has an elevated platelet count of 800,000/mm3. A body computed tomography scan is negative except for a 6-cm complex lesion in the left ovary. Mammography was negative 1 month ago. On physical examination, you confirm the neurologic deficits. Analysis of serum and cerebrospinal fluid samples show elevated anti-Yo antibody levels. The best explanation for these findings is:

(A) hemorrhagic stroke
(B) embolic stroke
(C) paraneoplastic syndrome
(D) multiple sclerosis

Answer 1

(C) paraneoplastic syndrome

Question 2

What paraneoplastic syndrome is commonly associated with ovarian or breast cancer? How does it manifest?

Answer 2

Anti-Yo progressive cerebellar degeneration

Causes direct toxicity to Purkinje cells: unable to walk, dysarthria

Only treatment is to try to treat the tumor (then have option to try plasmapheresis)

Question 3

What are some paraneoplastic manifestations of ovarian cancer?

Answer 3

Anti-Yo progressive cerebellar degeneration, elevated platelet count (d/t increased thrombopoietic cytokines in the tumor/host tissues), TTP/HUS