Paraneoplastic Antibodies in Clinical Practice. Mohammed El lahawi New Cross Hospital Wolverhampton

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Marlene McKinney
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1 Paraneoplastic Antibodies in Clinical Practice Mohammed El lahawi New Cross Hospital Wolverhampton 1

2 Effects of Neoplasm Direct mass ( pressure ) effect Metastasis effect Remote effect 2

3 The Nervous System 1- Central NS : - Brain - Cranial Nerves - Cerebellum - Spinal Cord 2- Peripheral NS : - Peripheral nerves - Neuromuscular junctions 3

4 The Nervous System 4

5 The Brain 5

6 The Brain 6

7 Tumours presentations Directly from the tumour Remote effect from the tumour 7

8 Tumours of the Nervous System Primary tumours Secondary tumours ( metastatic ) 8

9 Spinal cord tumour 9

10 Paraneoplastic Syndromes - Definition (.. Are a group of a rare degenerative disorders that are triggered by a person s immune system response to a neoplasm.. ) 10

11 PNS - Definition (...Clinical manifestations or remote effect produced by a tumour at a site different from the tumour itself or its metastasis. ) 11

12 Neurological - PNSs ( These occur when cancer fighting antibodies or white blood cells T cells mistakenly attack normal cells in the nervous system ) 12

13 PNS First paraneoplastic anti-neural antibody was reported in 1965 Typically affect middle-aged to elderly people Neurological symptoms develop over a period of days to weeks 13

14 PNS : when it happens? Many months or years before the appearance of the symptoms or signs of the underlying cancer At the same time of the cancer During the course of the cancer When the cancer relapse Rarely after treatment 14

15 PNS - pathophysiology ( The tumour produce antibodies that create an immune reaction or an immune response in certain parts of the nervous system, leading to tissue damage and hence the clinical manifestation ) 15

in certain parts of the nervous system, leading to

16 PNS Which Tumours?? All tumours Commonest tumours are : ~ lung ~ Ovarian ~ Lymphatic ~ Breast 16

17 PNS Which parts of NS # The brain # The Cerebellum # The peripheral nerves # The Neuromuscular junction # The eyes 17

18 Neurological paraneoplastic diseases Cerebellar ataxia and C degeneration Lambert-Eaton myasthenic syndrome Stiff person syndrome Encephalomyelitis Myasthenia gravis Opsoclonus Sensory neuropathy 18

19 The Cerebellum 19

20 The Cerebellum 20

21 The Cerebellum Forms about 10% of the brain weight Responsible for co-ordination of almost all fine and sophisticated movements 21

22 The Cerebellum The cerebellum form about 10% of the brain volume and occupied the posterior fossa The main function is co-ordination of all fine movements Main symptoms : ataxia, lack of coordination and difficulty in speech 22

23 Cerebellar ataxia The cerebellum is commonly involved in the paraneoplastic process The commonest tumours are : lung, breast, genital and lympho- proliferative The symptoms and / or signs may precede the cancer by months or even years The cerebellum may appear normal in the scan May be isolated or with involvement of other parts of the nervous system 23

24 Cerebellar Ataxia Before neoplasm Gait disorder Rapid progression over weeks to months,then stabilization Small ca of the lung : Hu or Calcium channel antibodies Ovarian :Yo antibody Breast : Yo or Ri antibody Hodgkins lymphoma 24

25 Cerebellar ataxia May be from structural causes like : # tumours : primary or secondary # haemorrhage # infarction # multiple sclerosis # inflammation 25

26 Cerebellar ataxia 26

27 Cerebellar ataxia ( In any patient with cerebellar ataxia, specially elderly patients, when no obvious cause like : tumour, haematoma, infarction, genetic etc had been found paraneoplastic syndrome should be considered as the cause until proved otherwise.. ) 27

28 Neuromuscular junction disorders Myasthenia Gravis : - Neoplasm : Thymoma - Patients : > 25 years - Antibodies : * Antiacetylcholine receptors antibodies * Anti skeletal muscles antibodies 28

29 LEMS (Lambert( Lambert-Eaton)syndrome Very similar to MG Usually associated with small cell carcinoma of the lung Symptoms may precede the cancer by weeks or months Prognosis is not good 29

30 Stiffman Syndrome Tumour : usually breast Other tumours : lung and thymoma Antibodies : Amphiphysin 30

31 Encephalopathies Limbic and Brain stem encephaloparhy Male = Female Tumour : small cell lung Antibodies : Hu Progressive over days to weeks Memory loss, seizures, hallucinations lethargy, dysarthria and ataxia Onset : 3 years before to 1 year after Prognosis : poor 31

32 Opsoclonus/Myoclonus syndrome Tumour : breast and lung Onset age : May be associated with ataxia,myopathy and peripheral neuropathy In 15% of cases the tumour was discovered before the syndrome Good response to steroids 32

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