Letter to the Editor
Paraneoplastic cerebellar degeneration associated with small cell neuroendocrine mediastinal carcinoma
Degeneración cerebelosa paraneoplásica asociada a carcinoma neuroendocrino mediastínico de células pequeñas
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array:3 [ "nombre" => "Mónica" "apellidos" => "Zamora-Pasadas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "María" "apellidos" => "Redondo-Orts" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cuidados Críticos y Urgencias, Hospital Universitario Virgen de las Nieves, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Degeneración cerebelosa paraneoplásica asociada a carcinoma neuroendocrino mediastínico de células pequeñas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 717 "Ancho" => 950 "Tamanyo" => 129514 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Histology slide at 30× amplification with chromogranin immune staining, showing tumor cell nests separated by fibrovascular tracts.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 69-year-old woman admitted with a 7-month history of anorexia and asthenia, along with unsteadiness, vomiting, tremor and double vision. She also reported a 1-month history of dyspnea and voice changes. On examination, she presented a bitonal voice, ataxic gait and dysmetria, with intention tremor in the left arm. Magnetic resonance imaging (MRI) of the head revealed a small lacunar infarction, which did not explain the clinical symptoms. Blood work, biochemistry, proteins, immunoglobulins, thyroid profile, vitamin B<span class="elsevierStyleInf">12</span>, vitamin E and folate were normal, and serologies for HIV, hepatitis, cytomegalovirus, Epstein–Barr virus, syphilis and <span class="elsevierStyleItalic">Borrelia</span> were all negative. Cerebrospinal fluid cytochemistry was also normal. Carcinoembryonic antigen and neurospecific enolase tumor markers were elevated at 30.4<span class="elsevierStyleHsp" style=""></span>ng/ml (0–5<span class="elsevierStyleHsp" style=""></span>ng/ml) and 21.7<span class="elsevierStyleHsp" style=""></span>ng/ml (0–16<span class="elsevierStyleHsp" style=""></span>ng/ml), respectively. Computed tomography (CT) of the chest and abdomen revealed a mass in the upper mediastinum, measuring 70<span class="elsevierStyleHsp" style=""></span>mm×40<span class="elsevierStyleHsp" style=""></span>mm, suggestive of clustered lymphadenopathy. An immune-mediated process was suspected, so antinuclear antibodies and onconeuronal antibodies were tested, but these were negative, with anti-glutamic acid decarboxylase antibodies (anti-GAD) 2.4<span class="elsevierStyleHsp" style=""></span>U/ml (0–5<span class="elsevierStyleHsp" style=""></span>U/ml) and anti-acetylcholine receptor antibodies 0.01<span class="elsevierStyleHsp" style=""></span>nmol/l (0–0.1<span class="elsevierStyleHsp" style=""></span>nmol/l). F-18 fluorodeoxyglucose uptake on a positron emission tomography scan suggested malignancy, so a biopsy was obtained by mediastinoscopy. The pathology report confirmed small cell neuroendocrine carcinoma of the thymus, positive for chromogranin and synaptophysin (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A scintigraphy (octreoscan) was then performed to complete the examination, showing <span class="elsevierStyleSup">111</span>indium-pentetreotide uptake in the tumor and supraclavicular lymph node metastases. The patient underwent surgical resection and received chemotherapy with carboplatin and etoposide. She achieved full remission of the cancer and almost complete resolution of her neurological symptoms, although tremor at rest did persist.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Neuroendocrine tumors (NET) are rare cancers, generally found in the gastrointestinal tract, although they may occur in the lung, thymus, ovaries and non-parenchymatous tissue. Thymic NETs account for less than 5% of mediastinal tumors.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Approximately 30% are malignant, although this rate rises to 82% if they are located in the thymus.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> They present as a mediastinal mass mainly in patients aged 30–50 years, and are 3 times more common in men.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Local clinical manifestations can range from dysphonia or dyspnea to superior vena cava syndrome, and one-third of patients have endocrine symptoms associated with multiple endocrine neoplasia syndrome. CT, MRI and <span class="elsevierStyleSup">123</span>I-metaiodobenzylguanidine scintigraphy are useful, but the octreoscan is the most sensitive procedure (71%–100%) for detecting NETs, depending on the somatostatin receptors expressed by the tumors. Histology examination shows cell nests with fibrovascular tracts, positive for neuroendocrine markers such as chromogranin, synaptophysin and neuroenolase. Paraneoplastic cerebellar degeneration (PCD) is the most common paraneoplastic neurological syndrome. In 18%–50% of cases, no antibodies are identified,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and in early stages of the disease, MRI is normal.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> It is associated with several neoplastic processes, including thymic NETs.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In view of the favorable response to specific cancer treatment, we classified our case as seronegative PCD associated with thymic NET.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Serrano-Martínez JL, Zamora-Pasadas M, Redondo-Orts M. Degeneración cerebelosa paraneoplásica asociada a carcinoma neuroendocrino mediastínico de células pequeñas. Arch Bronconeumol. 2015;51:659–660.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 717 "Ancho" => 950 "Tamanyo" => 129514 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Histology slide at 30× amplification with chromogranin immune staining, showing tumor cell nests separated by fibrovascular tracts.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carcinoids associated with multiple endocrine neoplasia syndromes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Q.Y. 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| 2020 July | 32 | 26 | 58 |
| 2020 June | 22 | 7 | 29 |
| 2020 May | 46 | 19 | 65 |
| 2020 April | 42 | 24 | 66 |
| 2020 March | 27 | 17 | 44 |
| 2020 February | 41 | 22 | 63 |
| 2020 January | 46 | 23 | 69 |
| 2019 December | 28 | 23 | 51 |
| 2019 November | 36 | 21 | 57 |
| 2019 October | 19 | 13 | 32 |
| 2019 September | 27 | 12 | 39 |
| 2019 August | 31 | 12 | 43 |
| 2019 July | 29 | 17 | 46 |
| 2019 June | 26 | 14 | 40 |
| 2019 May | 31 | 26 | 57 |
| 2019 April | 30 | 21 | 51 |
| 2019 March | 29 | 25 | 54 |
| 2019 February | 29 | 32 | 61 |
| 2019 January | 21 | 17 | 38 |
| 2018 December | 31 | 18 | 49 |
| 2018 November | 25 | 12 | 37 |
| 2018 October | 48 | 21 | 69 |
| 2018 September | 17 | 8 | 25 |
| 2018 May | 5 | 1 | 6 |
| 2018 April | 21 | 5 | 26 |
| 2018 March | 14 | 3 | 17 |
| 2018 February | 20 | 12 | 32 |
| 2018 January | 24 | 6 | 30 |
| 2017 December | 17 | 3 | 20 |
| 2017 November | 30 | 5 | 35 |
| 2017 October | 17 | 5 | 22 |
| 2017 September | 21 | 7 | 28 |
| 2017 August | 29 | 12 | 41 |
| 2017 July | 18 | 6 | 24 |
| 2017 June | 29 | 11 | 40 |
| 2017 May | 16 | 4 | 20 |
| 2017 April | 14 | 5 | 19 |
| 2017 March | 10 | 4 | 14 |
| 2017 February | 10 | 6 | 16 |
| 2017 January | 11 | 5 | 16 |
| 2016 December | 23 | 8 | 31 |
| 2016 November | 36 | 22 | 58 |
| 2016 October | 32 | 17 | 49 |
| 2016 September | 29 | 9 | 38 |
| 2016 August | 29 | 9 | 38 |
| 2016 July | 39 | 13 | 52 |
Show all
