Anti-Yo Antibody-Mediated Paraneoplastic Cerebellar Degeneration in a Man With Esophageal Adenocarcinoma

Authors: Kai Xia, MD, PhD; John R. Saltzman, MD; David L. Carr-Locke, MD, FRCP Series Editor: David L. Carr-Locke, MD, FRCP

Disclosures

August 05, 2003

Abstract and Introduction

Abstract

We report a case of paraneoplastic cerebellar degeneration (PCD) associated with adenocarcinoma of the esophagus and anti-Yo antibodies in a male patient. The patient presented with progressive ataxia, dysarthria, and significant weight loss. Extensive work-up suggested paraneoplastic neurologic syndrome. A wide search for a cancer was undertaken and a small mass was identified in the distal esophagus on upper endoscopy. Biopsies of this lesion revealed well-differentiated invasive adenocarcinoma of the esophagus. The endoscopic ultrasound staged the tumor as T3N1M0. Despite trials of multiple therapeutic modalities, the patient's cerebellar dysfunction progressed. This is only the second report of PCD caused by esophageal adenocarcinoma and the fourth report of anti-Yo antibodies occurring in a male patient.

Introduction

PCD is a remote effect of cancer presenting with acute or subacute onset of cerebellar dysfunction not ascribable to primary or metastatic involvement of cerebellum or to a history of chemotherapy. Serum antibodies to the Yo antigen are usually associated with this rare condition in female patients with gynecologic or breast malignancy.

Here we describe a case of acute cerebellar degeneration caused by esophageal adenocarcinoma and associated paraneoplastic anti-Yo antibodies in a male patient without preexisting Barrett's esophagus. Because it was an exceedingly rare case and there had been no anecdotal case series regarding management, multiple seemingly reasonable therapeutic modalities, adopted from other cases of paraneoplastic neurologic syndromes, were tried without significant success. This case illustrates an unusual presentation of esophageal adenocarcinoma and the challenges in managing nonresponding patients with PCD. It also alerts clinicians to the fact that although PCD may be an uncommon complication of cancer, cancer is a common cause of PCD.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....