An uncommon manifestation of paraneoplastic cerebellar degeneration in a patient with high grade urothelial, carcinoma with squamous differentiation: A case report and literature review.

Yaofeng Zhu,Zhenhua Shang,Jing Song,Hu Guo,Songyu Chen,Benkang Shi,Fan Chen,Changkuo Zhou,Yong Wang,Shouzhen Chen

doi:10.1186/s12885-016-2349-3

Abstract

BackgroundParaneoplastic neurological syndromes (PNS) are rare disorders associated with malignant tumours, which are triggered by autoimmune reactions. Paraneoplastic cerebellar degeneration (PCD) is the PNS type most commonly associated with ovarian and breast cancer. Two bladder cancers manifesting in PCD were previously reported. However, the cancers in these cases had poor outcomes.Case presentationHere, we present a 68-year old man with history of high-grade papillary urothelial carcinoma of the bladder. The patient suffered from persistent cerebellar ataxia accompanied by bladder cancer recurrence five months after transurethral resection of the bladder tumour (TURBt). Laboratory screening for the specific antibodies of paraneoplastic neurological syndromes revealed no positive results. Symptoms were not remitted after a 7-day-course of high-dose glucocorticoid therapy. To our surprise, the patient recovered fully after laparoscopic radical cystectomy. Postoperative pathology revealed that surgical specimens were urothelial carcinoma in situ (CIS) and squamous cell carcinoma of the bladder. The patient remained asymptomatic and there was no evidence of recurrence after the followup period of 11 months.ConclusionTo our knowledge, this is the third report of PCD in a patient with bladder cancer. This case showed that tumour resection cured the PCD. To assist clinical evaluation and management, literature regarding basic PNS characteristics and bladder cancers was reviewed.

Highlights

Paraneoplastic neurological syndromes (PNS) are rare disorders associated with malignant tumours, which are triggered by autoimmune reactions
The neurological syndromes associated with bladder cancer could be clinically diagnosed as Paraneoplastic cerebellar degeneration (PCD)
PNS is commonly associated with ovarian cancer, breast cancer, SCLC, or Hodgkin’s disease

Summary

Introduction

Paraneoplastic neurological syndromes (PNS) are rare disorders associated with malignant tumours, which are triggered by autoimmune reactions. Two bladder cancers manifesting in PCD were previously reported. Paraneoplastic neurological syndromes (PNS) are rare disorders associated with malignant tumours that are not directly caused by tumour invasion and metastasis. Paraneoplastic cerebellar degeneration (PCD) is the type of PNS most commonly associated with ovarian and breast cancer [9]. Bladder cancers presenting with PCD have rarely been reported. Greenlee JE [11] and Tetsuka S [12] reported PCD and its causal antibody in bladder cancer patients. We discuss a patient with urothelial CIS of the bladder who suffered from PCD.

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Discussion

Conclusion