- Last Update On : 2013-01-27
Paraneoplastic syndromes are autoantibody-mediated neurologic disorders associated with underlying tumors. These syndromes arise when systemic tumors express antigens normally found only in neural tissues. The immune system recognizes the tumor antigen as non-self, leading to generic for cialis the production of buy generic brand advair diskus antibodies that recognize not only the tumor cells, but also any neural cells expressing the http://bloesemkinderopvang.nl/viagra-cost antigen. Neurologic symptoms often precede detection of the tumor. Detection of paraneoplastic syndrome antibodies should trigger a search for an underlying tumor, which often is rx generic cialis occult by standard imaging techniques. Cancers most commonly associated with paraneoplastic syndromes include:
- Small cell lung carcinoma
- Ovarian carcinoma
- Breast carcinoma
- Hodgkin’s lymphoma
These autoantibodies are rarely detected in serum or CSF of healthy individuals or patients who have cancer without neurologic dysfunction.
Antineuronal Nuclear Antibody, Type 1 (ANNA-1 or Anti-Hu)
Paraneoplastic encephalomyelitis is almost always associated with small cell lung carcinoma (SCLC). The relevant antibody (previously called anti- Hu) is termed anti-neuronal nuclear antibody type 1 (ANNA-1), and recognizes a 35-40 kD component found in neuronal cell nuclei.
ANNA-1 antibody is found almost exclusively in patients with a history of tobacco use or passive exposure. Women are affected twice as often as men. Cancer has been found in >90% of seropositive patients. Small cell lung carcinoma (SCLC) has been found in 83% of patients. A second malignant neoplasm is found in 13% of patients positive for ANNA-1 who have SCLC.
The most common clinical presentation of patients positive for ANNA-1 is peripheral neuropathy (sensory >sensorimotor>autonomic>>motor), but they can exhibit any element of encephalomyeloradiculopathy. Approximately 10% of patients present with gastroparesis or intestinal obstruction. ANNA-1 has also been detected in children with intestinal dysmotility, cerebellar ataxia, and brainstem encephalitis with and lowest price on non generic levitra without neuroblastoma.
It is detected in 5 to 10% of patients with small cell lung carcinoma who do not have a paraneoplastic syndrome. ANNA-1 is not recommended as a screening test for lung cancer.
Serum is the preferred specimen. Specimen requirement is one red top or SST tube of blood. CSF results are sometimes positive when serum results are negative. If a lumbar puncture is going to be performed as part of discount cialis online the diagnostic workup, CSF testing is televideocom.com recommended to improve the detection rate. Reference Range is <1:60 in serum and <1:2 in CSF.
Antineuronal Nuclear Antibody Type 2 (ANNA-2 or Anti-Ri)
Patients usually present with signs of midbrain, brain stem, cerebellar and/or spinal cord dysfunction. Ocular opsoclonus-myoclonus may be a prominent symptom. Paraneoplastic opsoclonus, characterized by involuntary rapid movement of the eyes in both vertical and horizontal planes, is most often associated with breast cancer and SCLC. The relevant antibody is termed anti-neuronal nuclear antibody type 2(ANNA-2), and recognizes a set of protein antigens of 55 and 80 kD found in neuronal cell nuclei.
This autoantibody has also been detected in patients with bladder and cervical cancer.
Specimen requirement is one red top or SST tube of blood or CSF. Reference Range is <1:60 for serum and <1:2 for spinal fluid.
Antineuronal Nuclear Antibody Type 3 (ANNA-3)
This autoantibody causes paraneoplastic syndromes associated with SCLC. Fifteen percent of patients with SCLC will have a second malignancy. Reference Range is <1:60 for serum.
Purkinje Cell Cytoplasmic Antibody Type 1 (anti-PCA 1 or anti-Yo)
Paraneoplastic cerebellar degeneration is associated with breast or gynecological (ovarian, fallopian, endometrial) tumors. Less commonly it is associated with lung (SCLC) cancer or Hodgkin lymphoma. More than 90% of seropositive patients present with subacute cerebellar ataxia and approximately 5% present with sensorimotor or motor neuropathy.
PCA-1 antibody is rarely found in patients with neurologic diseases without breast or gynecologic cancer. Conversely it is rarely found in patients with breast or gynecologic cancer without neurologic dysfunction. Reference range is <1:60 in serum and <1:2 in CSF.
Purkinje Cell Cytoplasmic Antibody Type 2 (anti-PCA 2)
This autoantibody is usually associated with lung cancer, especially SCLC. If lung cancer is not detected, an extrapulmonary primary SCLC should be considered. The antibody is seldom detected in patients with uncomplicated SCLC. Reference range is <1:60 in serum and <1:2 in CSF.
Purkinje Cell Cytoplasmic Antibody Tr (anti-PCA-Tr)
This autoantibody has only been detected in patients with Hodgkin’s disease and causes subacute cerebellar ataxia. Reference range is <1:60 in serum and <1:2 in CSF.
A positive result is viagra canada cheap consistent with neurologic autoimmunity, usually related to breast cancer or SCLC. Reference range is <1:60 in serum and <1:2 in CSF.
CRMP is also called CV2. CRMP is an oligodendrocyte cytoplasmic antigen. IgG autoantibody to this antigen causes a paraneoplastic syndrome in patients with SCLC or thymoma.Clinical manifestations include cerebellar degeneration, uveitis, and peripheral neuropathy, which is usually sensorimotor.
Antibody titer usually decreases after treatment of the neoplasm. A rising titer is indicative of pills store buy levitra tumor persistence or recurrence. Reference range is <1:60 in serum and <1:2 in CSF.
Antbodies to Ta are present in patients with testicular cancer who present with limbic and link for you brain stem encephalitis. These antibodies have also been reported in patients with breast and lung cancers.
Recoverin is a calcium binding protein that is expressed in photoreceptors in the retina. Antibodies to recoverin cause cancer associated retinopathy (CAR), which is most commonly associated with SCLC. CAR is characterized by sudden unexplained loss of vision associated with a high titer of antibody against recoverin.
P/Q Voltage-Gated Calcium Channel
Anti-P/Q VGCC antibodies are found in >90% of patients with Lambert-Eaton myasthenic syndrome (LEMS). SCLC is the tumor most commonly associated with LEMS.