A Case of Paraneoplastic Neurological Syndrome Improved Following Pancreatoduodenectomy for Cholangiocarcinoma

Abstract

Introduction: When patients with neoplasm have neurological symptoms, we must consider invasion or metastasizing of the tumors to the neurological system or drug side effects. But it is called paraneoplastic neurological syndrome (PNS) when we deny them. It is said that PNS develops by autoimmune mechanism with anti-tumor antibodies. Immunotherapy is not effective and a removal of the antigen stimulation by treating the tumor becomes the basic treatment. Still it is said that the effect of treatment is poor. Here we report a rare case of PNS with cholangiocarcinoma whose neurological symptoms improved after surgery. Methods: Case report. Results: A 67-year old male visited our outpatient hospital with symptoms of right homonymous hemianopsia, scintillating scotoma, and headache. Magnetic resonance imaging indicated encephalitis. Hepatobiliary enzymes increased by blood data at admission and diabetes was getting worse. Computed tomography showed the mass in the pancreatic head. After being hospitalized, he came to present with disturbance of consciousness, a convulsive seizure. Although immunoglobulin therapy was given, the improvement was poor. PNS due to cholangiocarcinoma of the distal bile duct was considered and he underwent pancreatoduodenectomy on 14 days after hospitalized. After that operation the neurologic symptoms promptly improved and he was discharged on the 19th hospitalized day. The pathological diagnosis was cholangiocarcinoma invading the pancreas and we achieved curative resection. Conclusion: We should consider surgical resection for the patient with PNS when curative resection can be expected.