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Letter to the Editor| Volume 378, P91-93, July 15, 2017

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Neuroendocrine lung cancer in a patient with limbic encephalopathy due to anti-Hu antibodies: A rare association not to be missed

Published:April 20, 2017DOI:https://doi.org/10.1016/j.jns.2017.04.032
      Paraneoplastic neurological syndromes (PNSs) are conditions secondary to the production of autoantibodies against antigens expressed by the tumor cells for cross-reaction with the same antigens in normal cells. However, they are not directly related to the effect of primary tumor or its metastasis [
      • Kaltsas G.
      • Androulakis I.I.
      • de Herder W.W.
      • Grossman A.B.
      Paraneoplastic syndromes secondary to neuroendocrine tumours.
      ]. PNSs, which are often associated with lung cancer, usually precede the discovery of the neoplasm and can be reversed by its treatment. Therefore, early diagnosis is crucial for successful therapy [
      • Kaltsas G.
      • Androulakis I.I.
      • de Herder W.W.
      • Grossman A.B.
      Paraneoplastic syndromes secondary to neuroendocrine tumours.
      ]. Among recognized autoantibodies, anti-Hu antibodies (anti-Hu Ab) are usually related (>90% of cases) to small cell lung cancer (SCLC) [
      • Kanaji N.
      • Watanabe N.
      • Kita N.
      • Bandoh S.
      • Tadokoro A.
      • Ishii T.
      • Dobashi H.
      • Matsunaga T.
      Paraneoplastic syndromes associated with lung cancer.
      ,
      • Gultekin S.H.
      • Rosenfeld M.R.
      • Voltz R.
      • Eichen J.
      • Posner J.B.
      • Dalmau J.
      Paraneoplastic limbic encephalitis: neurological symptoms, imunological findings and tumour association in 50 patients.
      ,
      • Horacio Senties-Madrid M.D.
      • Felipe Vega-Boada M.D.
      Paraneoplastic syndromes associated with anti-Hu antibodies.
      ]. More rarely, anti-Hu Ab have been reported in association with other lung tumors, neuroblastoma, sarcoma, prostate cancer, lymphoma, and gynecological tumors [
      • Dalmau J.
      • Furneaux H.M.
      • Cordon-Cardo C.
      • Posner J.B.
      The expression of the Hu (paraneoplastic encephalomyelitis/sensory neuronopathy) antigen in human normal and tumor tissues.
      ,
      • Tschernatsch M.
      • Dierkes C.
      • Gerriets T.
      • Hosch J.
      • Stolz E.
      • Kaps M.
      • Krasenbrink I.
      • Claus D.
      • Blaes F.
      Paraneoplastic neurological syndromes in patients with carcinoid.
      ]. The association of anti-Hu Ab and neuroendocrine cancer has been found in a very few cases [
      • Tschernatsch M.
      • Dierkes C.
      • Gerriets T.
      • Hosch J.
      • Stolz E.
      • Kaps M.
      • Krasenbrink I.
      • Claus D.
      • Blaes F.
      Paraneoplastic neurological syndromes in patients with carcinoid.
      ]. Both benign and malignant neuroendocrine tumors (NETs) can produce traceable metabolic substances, such as chromogranin A or synaptophysin, which can be useful diagnostic and prognostic markers [
      • Kaltsas G.
      • Androulakis I.I.
      • de Herder W.W.
      • Grossman A.B.
      Paraneoplastic syndromes secondary to neuroendocrine tumours.
      ]. Octreotide scintigraphy (Octreo-Scan) can earlier and more precisely recognize NETs, due to its high affinity (o sensitivity) to somatostatin receptors expressed on neuroendocrine cells surface [
      • Kaltsas G.
      • Androulakis I.I.
      • de Herder W.W.
      • Grossman A.B.
      Paraneoplastic syndromes secondary to neuroendocrine tumours.
      ]. The utility of Octro-Scan in detecting endocrine paraneoplastic syndromes in bronchial carcinoid tumors or paraneoplastic syndromes secondary to neuroendocrine tumors (such as gastrinomas or Zollinger-Ellison syndrome) or in gastrointestinal tumors is described in literature, but its use in paraneoplastic neurological syndromes has not been reported.

      Abbreviations:

      anti-Hu Ab (anti-Hu antibodies), CSF (cerebrospinal fluid), CT (computed tomography), EEG (electroencephalogram), EMG (electromyography), IVIg (intravenous immunoglobulins), MRI (magnetic resonance imaging), NETs (neuroendocrine tumors), n.v. (normal value), Octreo-Scan (Octreotide scintigraphy), PNS (paraneoplastic neurological syndrome), SCLC (small cell lung cancer)
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      References

        • Kaltsas G.
        • Androulakis I.I.
        • de Herder W.W.
        • Grossman A.B.
        Paraneoplastic syndromes secondary to neuroendocrine tumours.
        Endocr. Relat. Cancer. 2010; 17 (Print 2010 Sep): R173-R193
        • Kanaji N.
        • Watanabe N.
        • Kita N.
        • Bandoh S.
        • Tadokoro A.
        • Ishii T.
        • Dobashi H.
        • Matsunaga T.
        Paraneoplastic syndromes associated with lung cancer.
        World J. Clin. Oncol. 2014; 5: 197-223
        • Gultekin S.H.
        • Rosenfeld M.R.
        • Voltz R.
        • Eichen J.
        • Posner J.B.
        • Dalmau J.
        Paraneoplastic limbic encephalitis: neurological symptoms, imunological findings and tumour association in 50 patients.
        Brain. 2000; 123: 1481-1494
        • Dalmau J.
        • Furneaux H.M.
        • Cordon-Cardo C.
        • Posner J.B.
        The expression of the Hu (paraneoplastic encephalomyelitis/sensory neuronopathy) antigen in human normal and tumor tissues.
        Am. J. Pathol. 1992; 141: 881-886
        • Tschernatsch M.
        • Dierkes C.
        • Gerriets T.
        • Hosch J.
        • Stolz E.
        • Kaps M.
        • Krasenbrink I.
        • Claus D.
        • Blaes F.
        Paraneoplastic neurological syndromes in patients with carcinoid.
        Eur. J. Neurol. 2008; 15: 1390-1394
        • Horacio Senties-Madrid M.D.
        • Felipe Vega-Boada M.D.
        Paraneoplastic syndromes associated with anti-Hu antibodies.
        IMAJ. 2001; 3: 94-103
        • Said S.
        • Cooper C.J.
        • Reyna E.
        • Alkkateeb H.
        • Diaz J.
        • Nahleh Z.
        Paraneoplastic limbic encephalitis, an uncommon presentation of a common cancer: Case report and discussion.
        Am. J. Case Rep. 2013; 14: 391-394
        • Graus F.
        • Titulaer M.J.
        • Balu R.
        • Benseler S.
        • Bien C.G.
        • Cellucci T.
        • Cortese I.
        • Dale R.C.
        • Gelfand J.R.M.
        • Geschwind M.
        • Glaser C.A.
        • Honnorat J.
        • Höftberger R.
        • Iizuka T.
        • Irani S.R.
        • Lancaster E.
        • Leypoldt F.
        • Prüss H.
        • Rae-Grant A.
        • Reindl M.
        • Rosenfeld M.R.
        • Rostásy K.
        • Saiz A.
        • Venkatesan A.
        • Vincent A.
        • Wandinger K.-P.
        • Waters P.
        • Dalmau J.
        A clinical approach to diagnosis of autoimmune encephalitis.
        Lancet Neurol. 2016; 15: 391-404