PARANEOPLASTIC CEREBELLAR DEGENERATION (PCD) IN EXTENSIVE STAGE SCLC IN REMISSION

Abstract

SESSION TITLE: Lung Cancer 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: PCD in the setting of small cell lung cancer (SCLC) is a rare association with less than 300 cases reported at the time of diagnosis and not when in remission. The common presenting symptoms and signs are diplopia, gait instability, scanning speech, intentional tremors, nystagmus, dysdiadochokinesia and pendular knee jerk. Causes of cerebellar signs in malignancy are tumor invasion, compression and PCD. Here a case is described of PCD in extensive stage SCLC post therapy in clinical and radiological remission. Literature review does not identify a similar case. CASE PRESENTATION: 58 year old male with extensive stage small cell lung cancer with brain metastases diagnosed a year ago, received six cycles of carboplatin and etoposide and cranial radiation. Radiological imaging after the therapy did not show any evidence of residual disease. Post-therapy imaging established remission. Subsequent to this imaging patient developed decline in his ability to walk, slurring of speech, double vision, nausea and vomiting. Cerebellar signs including diplopia, nystagmus, intentional tremor, past pointing, dysdiadochokinesia were noted. PET scan did not show any new lesions, CSF analyses showed elevated protein with no tumor cells and serology for PCD showed indeterminate results for anti-YO antibodies. Plasma exchange (PEX) was initiated and continued for five sessions. Clinically significant improvement in cerebellar signs after the completion of therapy was noted. DISCUSSION: PCD is associated with ovarian, lung, lymphoma, breast, uterine, colon and sarcoma. Two sub types of PCD are anti-YO positive and anti-YO negative. Diagnosis of PCD is an early indication of tumor progression or presence of occult malignancy. Treatment of PCD include managing cerebellar degeneration and treating malignancy. Treatment options for PCD include IVIG and plasmapheresis. Steroids can be used as an adjunctive therapy. A treated patient with extensive stage small cell cancer in remission presenting with PCD is reported. CONCLUSIONS: Diagnosis of PCD is an early indication of tumor progression or presence of occult malignancy. Even though there was no residual lesions found on presentation, periodic surveillance for relapse is recommended. Reference #1: J Neurol Neurosurg Psychiatry. 2006 Apr; 77(4): 562–563. https://doi.org/10.1136/jnnp.2005.073379 Reference #2: Mayo Clin Proc. 1990 Nov;65(11):1423-31 DISCLOSURES: No relevant relationships by koyamangalath krishnan, source=Web Response No relevant relationships by Nagaishwarya Moka, source=Web Response No relevant relationships by Sakshi Singal, source=Web Response