Frackowiak M, Kowar M, Sippel Ch, Wilhelm K, Ko Y-D, Jacobs A H
Johanniter-Krankenhaus Bonn, Johanniterstr. 3-5, 53113, Bonn, Deutschland.
Nervenarzt. 2020 Feb;91(2):156-160. doi: 10.1007/s00115-019-00859-y.
Neurological disorders can occur before the diagnosis of a malignoma is set. These disorders are induced by a misguided immune response with antibodies against intracellular or cell surface antigens. One of the most common paraneoplastic diseases is the subacute degeneration of the cerebellum. In most of the cases antibodies against Anti Hu, CRMP5/CV2, Amphiphysin and Ma/Ta are found and small cell bronchial carcinoma, breast cancer and lymphoma are diagnosed. We report about a 67 years old man with cerebellar symptoms and a weight loss of 10 kg who was treated in our clinic. After our diagnostic work up we found a non small cell cancer and diagnosed a subacute degeneration of the cerebellum as a paraneoplastic disorder. We found a high positive titer for Anti-Tr3 antibodies while the rest of the paraneoplastic antibodies described as typically associated with the subacute degeneration of the cerebellum were negative. The Anti-Tr3 antibodies are usually found in patients with Hodgkin and less often Non-Hodgkin disease. After initiation of a tumor specific therapy and intravenous immunoglobulin therapy the cerebellar symptoms decreased. In future follow up examinations we will see if the anti-Tr3 antibodies were associated with the non small cell bronchial carcinoma or if a lymphoma will occur in our patient.
神经系统疾病可在恶性肿瘤确诊之前出现。这些疾病是由针对细胞内或细胞表面抗原的抗体引发的错误免疫反应所致。最常见的副肿瘤性疾病之一是小脑亚急性变性。在大多数病例中,可检测到抗Hu、CRMP5/CV2、抗 amphiphysin 和 Ma/Ta 抗体,且诊断为小细胞支气管癌、乳腺癌和淋巴瘤。我们报告了一名67岁男性,因小脑症状和体重减轻10千克前来我院就诊。经过诊断检查,我们发现了非小细胞癌,并诊断为小脑亚急性变性这一副肿瘤性疾病。我们发现抗Tr3抗体呈高阳性滴度,而其他通常与小脑亚急性变性相关的副肿瘤性抗体均为阴性。抗Tr3抗体通常见于霍奇金病患者,在非霍奇金病患者中较少见。在开始肿瘤特异性治疗和静脉注射免疫球蛋白治疗后,小脑症状有所减轻。在未来的随访检查中,我们将观察抗Tr3抗体是否与非小细胞支气管癌有关,或者我们的患者是否会发生淋巴瘤。