Khanam Razwana, Fanous Ibrahim S, Fadhel Eman N, Hyder Tara, Brufsky Adam
Internal Medicine, University of Pittsburgh Medical Center, McKeesport, USA.
Family Medicine, University of Pittsburgh Medical Center, McKeesport, USA.
Cureus. 2021 Mar 3;13(3):e13677. doi: 10.7759/cureus.13677.
Paraneoplastic neurologic syndromes (PNS) are a group of disorders characterized by an autoimmune response against the nervous system due to cross-reactivity between malignant and normal neural tissue. The most commonly associated malignancies include small cell lung cancer, ovarian cancer, breast cancer, and lymphoma. Multiple PNS have been reported including paraneoplastic cerebellar degeneration, retinopathy, sensorimotor peripheral neuropathy, encephalopathy, opsoclonus-myoclonus syndrome, and stiff-person syndrome. We report a case of a 67-year-old woman with breast cancer who presented with a history of progressive oropharyngeal dysphagia as a paraneoplastic neurologic complication. She was diagnosed with invasive ductal carcinoma, nuclear grade 3 with moderate peritumoral lymphoid infiltrate. Hormone receptors were weakly positive for estrogen receptor (ER) (H score 15), weakly positive for progesterone receptor (PR) (H score 30), and negative for human epidermal growth factor receptor 2 (HER-2/NEU). The patient underwent a localized segmental mastectomy but declined any further adjuvant treatment. Three years after being diagnosed with invasive ductal carcinoma of the breast, she developed progressive oropharyngeal dysphagia that warranted percutaneous endoscopic gastrostomy (PEG) tube placement. Testing for onconeural antibodies was positive for voltage-gated calcium channel antibody. An extensive workup was negative for any alternative etiology that would explain her neurological symptoms. The patient declined further treatment and eventually succumbed to her illness.
副肿瘤性神经系统综合征（PNS）是一组由于恶性组织与正常神经组织之间的交叉反应导致针对神经系统的自身免疫反应而引发的疾病。最常相关的恶性肿瘤包括小细胞肺癌、卵巢癌、乳腺癌和淋巴瘤。已报告多种PNS，包括副肿瘤性小脑变性、视网膜病变、感觉运动性周围神经病、脑病、眼阵挛-肌阵挛综合征和僵人综合征。我们报告一例67岁患有乳腺癌的女性，她出现进行性口咽吞咽困难的病史，作为副肿瘤性神经并发症。她被诊断为浸润性导管癌，核分级为3级，肿瘤周围有中度淋巴细胞浸润。激素受体中雌激素受体（ER）弱阳性（H评分15），孕激素受体（PR）弱阳性（H评分30），人表皮生长因子受体2（HER-2/NEU）阴性。患者接受了局部节段性乳房切除术，但拒绝任何进一步的辅助治疗。在被诊断为乳腺浸润性导管癌三年后，她出现进行性口咽吞咽困难，需要放置经皮内镜胃造口术（PEG）管。检测肿瘤相关神经抗体，电压门控钙通道抗体呈阳性。全面检查未发现任何可解释其神经症状的其他病因。患者拒绝进一步治疗，最终因病死亡。
