J Gynecol Oncol | Volume 5, Issue 1 | Case Report | Open Access
Berger NF1*#, Kier MW2*#, Kim L2 and Tiersten A2
1Icahn School of Medicine at Mount Sinai, USA
2Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, USA
#Both the authors contributed equally to this work
*Correspondance to: Natalie F BergerFulltext PDF
Paraneoplastic syndromes occur in less than 0.1% of gynecological cancers. Paraneoplastic cerebellar disorders are a subgroup of these syndromes and predominantly involve three antibodies, including anti-Yo or Purkinje cell cytoplasmic antibody type 1. In this case report, we present a 71- year old woman with rapidly progressive cerebellar signs who was found to have metastatic serous ovarian carcinoma with anti-Yo antibody positive paraneoplastic cerebellar disorder and BRCA2 mutation on genetic testing. Interestingly, the patient’s serum paraneoplastic panel was negative; however, her CSF tested positive for anti-Yo antibody titers with a ratio of 1:512. The patient was started on carboplatin and nab-paclitaxel on a twenty-one day cycle. As the patient had no initial neurologic improvement to this treatment, she was also started on high-dose methylprednisolone for three days and then weekly for six weeks plus cyclophosphamide daily for three months. Her treatment course was complicated by periodic delays due to neutropenia that required holding and dose-reductions of cyclophosphamide as well as carboplatin/nab-paclitaxel. Interval measurements of CA-125 and CSF anti-Yo antibody titers showed treatment response with continuously down trending levels. Interval imaging demonstrated an excellent response with decreased adnexal mass size and resolution of lymphadenopathy and peritoneal/omental metastases. She underwent debulking surgery. She subsequently completed carboplatin and liposomal doxorubicin. She is currently on olaparib maintenance due to BRCA2 mutation. She has clinically improved, however, she continues to have issues with mobility, cerebellar head, and hand action tremors, which are managed by a movement disorder specialist.
Berger NF, Kier MW, Kim L, Tiersten A. A Case of Paraneoplastic Cerebellar Disorder in Ovarian Carcinoma with a Negative Serum Paraneoplastic Antibody Panel and a Positive CSF Anti-Yo Antibody Titer. J Gynecol Oncol. 2022; 5(1): 1075.