Case Challenge Part 3 (Conclusion): A Woman with Ataxia and Abnormal Uterine Bleeding

Abstract

Figure 3: Hematoxylin and eosin stain showed a poorly differentiated endometrioid adenocarcinoma of the ovary. Patient representative permission granted. The 46-year-old woman presenting with ataxia and bilateral adnexal masses (NEJM JW Neurol Mar 29 2016; [e-pub] and (NEJM JW Neurol Apr 5 2016; [e-pub]) had normal levels of carcinoembryonic antigen (CEA) and CA-19.9 but increased levels of serum CA-125 (2107 U/mL), and serum antibody testing was positive for anti-Yo antibodies. A bilateral pelvic mass resection was performed. Pathological examination revealed a poorly differentiated endometrioid adenocarcinoma of the ovary (see Figure 3). The patient then received consecutive adjuvant chemotherapy. On postoperative day 25, her slurred speech improved significantly but she continued having an ataxic gait. In this patient, subacute cerebellar ataxia accompanied by endometrioid adenocarcinoma and positive Anti-Yo antibodies are evidence of definite paraneoplastic cerebellar degeneration (PCD; J Neurol Neurosurg Psychiatry 2004; 75:1135). This rare immune-mediated condition is a nonmetastatic complication of cancer ( J Neuroimmunol 2004; …