Santillan Antonio, Bristow Robert E
Kelly Gynecologic Oncology Service, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Nat Clin Pract Oncol. 2006 Feb;3(2):108-12; quiz 1 p following 112. doi: 10.1038/ncponc0379.
A 52-year-old white female presented with sudden onset of light-headedness followed by diplopia, horizontal vertigo and severe nystagmus with oscillopsia. She had previously been in good health. MRI of the brain was normal. Lumbar puncture revealed monocytic pleocytosis. During her initial admission, the patient improved to some degree and was discharged with a possible diagnosis of viral meningitis. After a few weeks, the patient's condition worsened and further evaluation was initiated. Examination revealed an unsteady widespread gait, severe nystagmus and mild dysarthria. A general and gynecological examination was otherwise unremarkable.
General physical and gynecological examinations, MRI of the brain, lumbar punctures, electroencephalogram, transvaginal ultrasound, mammogram, tumor markers, anti-neuronal antibodies, colonoscopy, whole-body positron emission tomography scan, laparoscopy and biopsies.
Stage IIIC endometrioid adenocarcinoma of the ovary with paraneoplastic cerebellar degeneration.
Tumor cytoreduction, plasmapheresis, total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and para-aortic lymph-node dissection, total omentectomy, carboplatin and paclitaxel chemotherapy, rehabilitation, and speech therapy.
一名52岁白人女性，突发头晕，随后出现复视、水平性眩晕及严重眼球震颤伴视振荡。她既往身体健康。脑部MRI检查正常。腰椎穿刺显示单核细胞增多。在首次住院期间，患者病情有一定程度改善，出院时可能诊断为病毒性脑膜炎。几周后，患者病情恶化，遂展开进一步评估。检查发现步态不稳且广泛、严重眼球震颤及轻度构音障碍。其他方面的全身及妇科检查未见异常。
全身及妇科检查、脑部MRI、腰椎穿刺、脑电图、经阴道超声、乳房X线摄影、肿瘤标志物、抗神经元抗体、结肠镜检查、全身正电子发射断层扫描、腹腔镜检查及活检。
卵巢IIIC期子宫内膜样腺癌伴副肿瘤性小脑变性。
肿瘤细胞减灭术、血浆置换、全腹子宫切除术、双侧输卵管卵巢切除术、双侧盆腔及腹主动脉旁淋巴结清扫术、全网膜切除术、卡铂及紫杉醇化疗、康复治疗及言语治疗。
