EC Gynaecology

Introduction: A remote underlying tumor causes neurologic impairments known as paraneoplastic neurological syndromes (PNS). PNSs arise from a tumor-elicited immune response against onconeural antigens that are shared by tissues of nervous system, muscle, and tumor cells. It has been revealed that PNS may precede the diagnosis of cancer in 50 - 80% of cases [1]. We describe a patient with subacute cerebellar degeneration whose fallopian tube serous adenocarcinoma was retrospectively diagnosed.

Case Report: A 51-year-old lady with bilateral lower limb weakness with imbalance and giddiness since 3 months; and was evaluated elsewhere diagnosed with right parafalcine meningioma - could not be operated due to bridging veins. On further evaluation the anti-Yo antibodies was detected in this case report which are almost exclusively associated with gynaecological tumours (Breast cancer and ovarian cancer) [3].

The discovery of onconeuronal antibodies, whose detection has been linked to certain tumor entities, was suggestive for the subsequent diagnosis of a paraneoplastic condition.

MRI brain showed cerebellar atrophy. The tumour markers CEA, CA 125 and AFP were in the normal ranges. Mammography and thorax CT were also unremarkable; on transvaginal sonography the internal genitals were inconspicuous except altered echotexture and increased vascularity in right ovary measuring 2.1 x 1 cm. On PET CT there was hypermetabolism in right ovary with metabolically active enlarged retroperitoneal lymph nodes, prominent left inguinal lymph nodes and marrow hyperplasia. Inguinal lymph node excision biopsy was negative for malignancy and bone marrow aspiration showed hemophagocytosis.

After consensual agreement a bilateral laparoscopic adnexectomy was performed but with unremarkable abdominal findings. The histological examination confirmed a high grade serous carcinoma of right fallopian tube. After a stage-related staging operation, the final classification was found to be the FIGO-IIIA1(ii) (2014) stage on account of positive retroperitoneal lymph nodes. Thus, adjuvant chemotherapy with 6 cycles of carboplatin and paclitaxel was planned and given.

Conclusion: The necessity of identifying the underlying malignancy in individuals with subacute neurological impairment is highlighted by this example, which also demonstrates that fallopian tube cancer can potentially cause PNS.

Keywords: Paraneoplastic Syndrome; Fallopian Tube Cancer; Anti Yo Antibodies; Onconeural Antibodies

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