Cargando…

Paraneoplastic Cerebellar Degeneration Secondary to BRAF Mutant Melanoma Metastasis from an Occult Primary Cancer

Melanoma metastasis from an unknown primary cancer has an incidence of 3.2% among melanoma patients. Furthermore, paraneoplastic neurological syndromes (PNS) are rare, occurring in 1–3% of patients with malignancies. Paraneoplastic cerebellar degeneration (PCD) is one of the classic PNS and is chara...

Descripción completa

Detalles Bibliográficos
Autores principales: Jiménez-Zarazúa, Omar, Vélez-Ramírez, Lourdes Noemí, Alcocer-León, María, Hernández-Domínguez, Diego Armando, Tadeo-González, Juana Elizabeth, Martínez-Rivera, María Andrea, López-González, Martín Daniel Alejandro, Tafoya-Rojas, Sandra Xaviera Lizeth, Mondragón, Jaime Daniel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: S. Karger AG 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383163/
https://www.ncbi.nlm.nih.gov/pubmed/32774248
http://dx.doi.org/10.1159/000507729
_version_ 1783563391449694208
author Jiménez-Zarazúa, Omar
Vélez-Ramírez, Lourdes Noemí
Alcocer-León, María
Hernández-Domínguez, Diego Armando
Tadeo-González, Juana Elizabeth
Martínez-Rivera, María Andrea
López-González, Martín Daniel Alejandro
Tafoya-Rojas, Sandra Xaviera Lizeth
Mondragón, Jaime Daniel
author_facet Jiménez-Zarazúa, Omar
Vélez-Ramírez, Lourdes Noemí
Alcocer-León, María
Hernández-Domínguez, Diego Armando
Tadeo-González, Juana Elizabeth
Martínez-Rivera, María Andrea
López-González, Martín Daniel Alejandro
Tafoya-Rojas, Sandra Xaviera Lizeth
Mondragón, Jaime Daniel
author_sort Jiménez-Zarazúa, Omar
collection PubMed
description Melanoma metastasis from an unknown primary cancer has an incidence of 3.2% among melanoma patients. Furthermore, paraneoplastic neurological syndromes (PNS) are rare, occurring in 1–3% of patients with malignancies. Paraneoplastic cerebellar degeneration (PCD) is one of the classic PNS and is characterized by acute or subacute onset of ataxia and/or presence of onconeural antibodies. A 61-year-old male with ataxia, vertigo, and headache later developed dysarthria, multidirectional nystagmus, hyperactive delirium, auditory hallucinations, psychomotor agitation, and myoclonus. Toxicological, metabolic, infectious, and autoimmune etiologies were assessed and reported negative. An osteolytic lesion was observed in the right iliac crest via computed tomography (CT). A positron emission tomography-CT reported increased fluorodeoxyglucose uptake of a right iliac and right inguinal ganglion. After biopsy of the right inguinal ganglion, a BRAF mutation-positive melanoma metastasis from an occult primary cancer was diagnosed. Dermatologic, ophthalmologic, and endoscopic gastrointestinal assessment did not reveal a primary malignant melanoma. The patient's movement disorders and neuropsychiatric symptoms improved with quetiapine, prednisone, azathioprine, and cyclophosphamide. Oncological management was conducted with MAPK pathway inhibitors (i.e., dabrafenib and trametinib). Movement disorders associated with neuropsychiatric symptoms are complex to diagnose. PNS are rare and often associated with antibodies against neural antigens expressed by the tumor. The case presented above describes a patient with a BRAF-positive malignant melanoma metastasis from an occult primary associated with PCD – to the best of our knowledge, the first reported in the literature.
format Online
Article
Text
id pubmed-7383163
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher S. Karger AG
record_format MEDLINE/PubMed
spelling pubmed-73831632020-08-07 Paraneoplastic Cerebellar Degeneration Secondary to BRAF Mutant Melanoma Metastasis from an Occult Primary Cancer Jiménez-Zarazúa, Omar Vélez-Ramírez, Lourdes Noemí Alcocer-León, María Hernández-Domínguez, Diego Armando Tadeo-González, Juana Elizabeth Martínez-Rivera, María Andrea López-González, Martín Daniel Alejandro Tafoya-Rojas, Sandra Xaviera Lizeth Mondragón, Jaime Daniel Case Rep Oncol Case Report Melanoma metastasis from an unknown primary cancer has an incidence of 3.2% among melanoma patients. Furthermore, paraneoplastic neurological syndromes (PNS) are rare, occurring in 1–3% of patients with malignancies. Paraneoplastic cerebellar degeneration (PCD) is one of the classic PNS and is characterized by acute or subacute onset of ataxia and/or presence of onconeural antibodies. A 61-year-old male with ataxia, vertigo, and headache later developed dysarthria, multidirectional nystagmus, hyperactive delirium, auditory hallucinations, psychomotor agitation, and myoclonus. Toxicological, metabolic, infectious, and autoimmune etiologies were assessed and reported negative. An osteolytic lesion was observed in the right iliac crest via computed tomography (CT). A positron emission tomography-CT reported increased fluorodeoxyglucose uptake of a right iliac and right inguinal ganglion. After biopsy of the right inguinal ganglion, a BRAF mutation-positive melanoma metastasis from an occult primary cancer was diagnosed. Dermatologic, ophthalmologic, and endoscopic gastrointestinal assessment did not reveal a primary malignant melanoma. The patient's movement disorders and neuropsychiatric symptoms improved with quetiapine, prednisone, azathioprine, and cyclophosphamide. Oncological management was conducted with MAPK pathway inhibitors (i.e., dabrafenib and trametinib). Movement disorders associated with neuropsychiatric symptoms are complex to diagnose. PNS are rare and often associated with antibodies against neural antigens expressed by the tumor. The case presented above describes a patient with a BRAF-positive malignant melanoma metastasis from an occult primary associated with PCD – to the best of our knowledge, the first reported in the literature. S. Karger AG 2020-06-11 /pmc/articles/PMC7383163/ /pubmed/32774248 http://dx.doi.org/10.1159/000507729 Text en Copyright © 2020 by S. Karger AG, Basel http://creativecommons.org/licenses/by-nc/4.0/ This article is licensed under the Creative Commons Attribution-NonCommercial-4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.
spellingShingle Case Report
Jiménez-Zarazúa, Omar
Vélez-Ramírez, Lourdes Noemí
Alcocer-León, María
Hernández-Domínguez, Diego Armando
Tadeo-González, Juana Elizabeth
Martínez-Rivera, María Andrea
López-González, Martín Daniel Alejandro
Tafoya-Rojas, Sandra Xaviera Lizeth
Mondragón, Jaime Daniel
Paraneoplastic Cerebellar Degeneration Secondary to BRAF Mutant Melanoma Metastasis from an Occult Primary Cancer
title Paraneoplastic Cerebellar Degeneration Secondary to BRAF Mutant Melanoma Metastasis from an Occult Primary Cancer
title_full Paraneoplastic Cerebellar Degeneration Secondary to BRAF Mutant Melanoma Metastasis from an Occult Primary Cancer
title_fullStr Paraneoplastic Cerebellar Degeneration Secondary to BRAF Mutant Melanoma Metastasis from an Occult Primary Cancer
title_full_unstemmed Paraneoplastic Cerebellar Degeneration Secondary to BRAF Mutant Melanoma Metastasis from an Occult Primary Cancer
title_short Paraneoplastic Cerebellar Degeneration Secondary to BRAF Mutant Melanoma Metastasis from an Occult Primary Cancer
title_sort paraneoplastic cerebellar degeneration secondary to braf mutant melanoma metastasis from an occult primary cancer
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383163/
https://www.ncbi.nlm.nih.gov/pubmed/32774248
http://dx.doi.org/10.1159/000507729
work_keys_str_mv AT jimenezzarazuaomar paraneoplasticcerebellardegenerationsecondarytobrafmutantmelanomametastasisfromanoccultprimarycancer
AT velezramirezlourdesnoemi paraneoplasticcerebellardegenerationsecondarytobrafmutantmelanomametastasisfromanoccultprimarycancer
AT alcocerleonmaria paraneoplasticcerebellardegenerationsecondarytobrafmutantmelanomametastasisfromanoccultprimarycancer
AT hernandezdominguezdiegoarmando paraneoplasticcerebellardegenerationsecondarytobrafmutantmelanomametastasisfromanoccultprimarycancer
AT tadeogonzalezjuanaelizabeth paraneoplasticcerebellardegenerationsecondarytobrafmutantmelanomametastasisfromanoccultprimarycancer
AT martinezriveramariaandrea paraneoplasticcerebellardegenerationsecondarytobrafmutantmelanomametastasisfromanoccultprimarycancer
AT lopezgonzalezmartindanielalejandro paraneoplasticcerebellardegenerationsecondarytobrafmutantmelanomametastasisfromanoccultprimarycancer
AT tafoyarojassandraxavieralizeth paraneoplasticcerebellardegenerationsecondarytobrafmutantmelanomametastasisfromanoccultprimarycancer
AT mondragonjaimedaniel paraneoplasticcerebellardegenerationsecondarytobrafmutantmelanomametastasisfromanoccultprimarycancer