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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...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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S. Karger AG
2020
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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 |
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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 |
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