Neuromuscular Clinic, Department of Neurology, University Hospitals of Leicester, Leicester LE5 4PW, UK.
Muscle Nerve. 2011 May;43(5):764-6. doi: 10.1002/mus.22036.
Breast cancer is exceptionally associated with anti-collapsin response mediator protein 5 (anti-CRMP5) antibody or demyelinating neuropathy. This paraneoplastic antibody is itself not associated with demyelinating neuropathy.
Herein we describe a patient with a predominantly sensory ataxic demyelinating neuropathy associated with an IgG-kappa monoclonal gammopathy of uncertain significance (MGUS). Further investigations led to identification of anti-CRMP5 antibodies. An initial search for a malignancy proved negative. No immunomodulatory therapy was administered.
The patient developed breast carcinoma 2 years after the initial neurological symptoms, which was effectively treated by surgery, chemotherapy, hormone therapy, and radiotherapy. At neurological follow-up, 16 months after cancer treatment, she remained in remission and had made substantial neurological recovery. Electrophysiology showed significant amelioration, and serum anti-CRMP5 antibodies were undetectable. MGUS paraprotein level was unchanged.
This case widens the range of paraneoplastic manifestations of breast carcinoma to include anti-CRMP5 antibody-positive sensory ataxic demyelinating neuropathy, which, in this patient, improved after cancer treatment.
乳腺癌与抗解旋蛋白反应介质蛋白 5（anti-CRMP5）抗体或脱髓鞘神经病密切相关。这种副肿瘤抗体本身并不与脱髓鞘神经病相关。
本文描述了一例以感觉性共济失调性脱髓鞘神经病为主的患者，伴有意义未明的单克隆丙种球蛋白病（MGUS）的 IgG-κ 型单克隆丙种球蛋白。进一步的检查导致了抗 CRMP5 抗体的鉴定。最初的癌症检查结果为阴性。未给予免疫调节治疗。
该患者在最初的神经症状出现后 2 年发展为乳腺癌，通过手术、化疗、激素治疗和放疗得到有效治疗。在癌症治疗后 16 个月的神经随访中，她仍处于缓解期，并有显著的神经恢复。电生理学显示明显改善，血清抗 CRMP5 抗体不可检测。MGUS 副蛋白水平无变化。
该病例扩大了乳腺癌的副肿瘤表现范围，包括抗 CRMP5 抗体阳性的感觉性共济失调性脱髓鞘神经病，在本例患者中，癌症治疗后有所改善。
