Paraneoplastic Syndromes Associated with Gynecologic Neoplasms: Experience from a Tertiary Care Center in South India

Abstract

Surabhi Sudhakaran

Paraneoplastic syndromes associated with gynecologic neoplasms are rare and can involve various organ systems including the central nervous system, hematopoietic system, musculoskeletal, dermal and endocrine systems. They can result from cancer-associated immune reactions or the production of ectopic substances by the tumor tissue. This study retrospectively reviews the clinical presentations, management and outcome of patients who presented with paraneoplastic syndromes associated with gynecologic malignancies. Retrospective data were collected from medical records of patients who exhibited paraneoplastic symptoms associated with gynecologic neoplasms and were managed by department of gynecologic oncology at a tertiary care hospital in South India between 2014 and 2021. Medical case records of all eligible patients were reviewed, identifying eight women with gynecological neoplasms who presented with associated paraneoplastic symptoms. Among them, two cases pesented with paraneoplastic neurologic syndromes, four cases with paraneoplastic dermatologic syndromes, including three cases of dermatomyositis and one case with multicentric reticulohistiocytosis, and two cases with hypercalcemia. Paraneoplastic syndromes are rare manifestations that can precede or develop following the diagnosis of a malignancy. They require integrated management by a multidisciplinary team including physicians and oncologists. Early recognition of these symptoms and prompt evaluation have the potential to improve the prognosis and quality of life, at least in a small fraction of patients.

Keywords

paraneoplastic syndrome - paraneoplastic cerebellar degeneration - dermatomyositis - ovarian cancer - multicentric reticulohistiocytosis - paraneoplastic hypercalcemia

Publication History

Article published online:
11 August 2023

• References

• 1 Guichard A, Vignon G. [Metastatic cancer polyradiculoneuritis; multiple paralysis of the cranial and spinal nerves by microscopic generalization of an epithelioma of the colutein]. J Med Lyon 1949; 30 (700) 197-207
• 2 Oken MM, Creech RH, Tormey DC. et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5 (06) 649-655
• 3 Prat J. FIGO Committee on Gynecologic Oncology. Staging classification for cancer of the ovary, fallopian tube, and peritoneum. Int J Gynaecol Obstet 2014; 124 (01) 1-5
• 4 Olawaiye AB, Cotler J, Cuello MA. et al. FIGO staging for carcinoma of the vulva: 2021 revision. Int J Gynaecol Obstet 2021; 155 (01) 43-47
• 5 Graus F, Delattre JY, Antoine JC. et al. Recommended diagnostic criteria for paraneoplastic neurological syndromes. J Neurol Neurosurg Psychiatry 2004; 75 (08) 1135-1140
• 6 Cecchi E, Giannini A, Gadducci A, Simoncini T. Paraneoplastic cerebellar degeneration associated with ovarian carcinoma: case report and review of literature. Eur Gynaecol Obstet. 2020; 2 (02) 94-97
• 7 Viau M, Renaud MC, Grégoire J, Sebastianelli A, Plante M. Paraneoplastic syndromes associated with gynecological cancers: a systematic review. Gynecol Oncol 2017; 146 (03) 661-671
• 8 Frutiger J, Liapi A, Hastir D, Hottinger A, Sarivalasis A. Anti-GD1b and anti-GM1 positive, acute inflammatory demyelinating polyneuropathy associated with advanced ovarian carcinoma: a case report. Int J Case Rep Imag 2021; 12: 1
• 9 Vigliani MC, Magistrello M, Polo P, Mutani R, Chiò A. Piemonte and Valle d'Aosta Register for Guillain-Barré Syndrome. Risk of cancer in patients with Guillain-Barré syndrome (GBS). A population-based study. J Neurol 2004; 251 (03) 321-326
• 10 Liapi A, Herrera Gómez R, Sakeliades E, Sarivalasis A. EP974 Review of three cases of high grade serous ovarian cancer associated with cerebellar atrophy and acute inflammatory demyelinating polyneuropathy. In: EPoster. BMJ Publishing Group Ltd; 2019: A516.2-A517
• 11 Venkatraman A, Opal P. Paraneoplastic cerebellar degeneration with anti-Yo antibodies - a review. Ann Clin Transl Neurol 2016; 3 (08) 655-663
• 12 Rojas I, Graus F, Keime-Guibert F. et al. Long-term clinical outcome of paraneoplastic cerebellar degeneration and anti-Yo antibodies. Neurology 2000; 55 (05) 713-715
• 13 Peterson K, Rosenblum MK, Kotanides H, Posner JB. Paraneoplastic cerebellar degeneration. I. A clinical analysis of 55 anti-Yo antibody-positive patients. Neurology 1992; 42 (10) 1931-1937
• 14 Shams'ili S, Grefkens J, de Leeuw B. et al. Paraneoplastic cerebellar degeneration associated with antineuronal antibodies: analysis of 50 patients. Brain 2003; 126 (Pt 6) 1409-1418
• 15 Hansen KB, Yi F, Perszyk RE. et al. Structure, function, and allosteric modulation of NMDA receptors. J Gen Physiol 2018; 150 (08) 1081-1105
• 16 Thiyagarajan M, Sebastian A, Thomas DS, Thomas A, Peedicayil A, Mathew V. Ovarian teratoma and N-methyl-D-aspartate receptor autoimmune encephalitis: insights into imaging diagnosis of teratoma and timing of surgery. J Clin Gynecol Obstet 2021; 10 (01) 22-27
• 17 Dalmau J, Tüzün E, Wu HY. et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol 2007; 61 (01) 25-36
• 18 Requena C, Alfaro A, Traves V. et al. Paraneoplastic dermatomyositis: a study of 12 cases. Actas Dermosifiliogr 2014; 105 (07) 675-682
• 19 Cheng H, Huo L, Wang D, Xiang Y. Concurrence of ovarian cancer and dermatomyositis: a propensity score analysis. J Gynecol Oncol 2019; 30 (06) e99
• 20 Levine D, Miller S, Al-Dawsari N, Barak O, Gottlieb AB. Paraneoplastic dermatoses associated with gynecologic and breast malignancies. Obstet Gynecol Surv 2010; 65 (07) 455-461
• 21 Kishikawa T, Miyashita T, Fujiwara E. et al. Multicentric reticulohistiocytosis associated with ovarian cancer. Mod Rheumatol 2007; 17 (05) 422-425
• 22 Brown A, McKenna S, Forbes D, Harley I. Paraneoplastic syndrome associated with gynaecological malignancy: a review of the evidence. Obstet Gynaecol 2022; 24 (02) 137-142
• 23 Sükür YE, Gözüküçük M, Berker B. Hypercalcemia associated with early recurrence of vulvar cancer. Arch Gynecol Obstet 2010; 281 (01) 117-118