A Case of Paraneoplastic Peripheral Neuropathy Preceding Plasma Cell Tumor

Abstract

A Thirty seven year old female patient was evaluated for complaint of walking difficulty more prominent in right leg that increase whenever she climbed up stairs. Patient was previously evaluated for particularly for polyneuropathy etiology. Protein value was found 313 mg/dl in cerebrospinal fluid (CSF) examination. Monoclonal gammopathy was detected in serum and CSF of patient. IgG value in CSF of patient was 39.0 mg/dl. A mass consistent with medullary infiltration was detected in thoraco-lumbar CT. Patient was operated for lytic lesion and pathologic examination of excisional biopsy material was reported as ‘'plasma cell tumor''. As a result of detailed clinical and electrophysiologic evaluations the patient was diagnosed with paraneoplastic sensory motor mixed type polyneuropathy. Consequently, paraneoplastic processes should be considered in etiology of acute and progressive onset polyneuropaties and if possible, detailed studies for etiology should be performed in these patients.

Keywords

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Plazma Hücreli Tümöre Öncülük Eden Paraneoplastik Periferik Nöropati Olgusu

Abstract

Otuzyedi yaşında kadın hasta sağ ayakta belirgin olan ve merdiven çıkarken artan yürüme güçlüğü ile değerlendirildi. Olgunun polinöropati etyolojisine yönelik olarak ayrıntılı incelemeleri yapıldı. BOS incelemelerinde protein değeri: 313 mg/dl olarak saptandı. Hastanın BOS ve serum incelemelerinde monoklonal gamopati saptandı. Olgunun BOS IgG değeri 39.0 mg/dl idi. Torakolomber BT'de medüller infiltrasyon ile uyumlu kitle saptandı. Hasta litik lezyon nedeniyle opere edildi ve eksizyonel biyopsi materyalinin patolojik değerlendirme sonucu "plazma hücreli tümör " olarak bildirildi. Ayrıntılı elektrofizyolojik ve klinik değerlendirmeler neticesinde paraneoplastik sensorimotor mikst tip polinöropati tanısı aldı. Sonuç olarak akut ve progressif başlangıçlı polinöropatilerin etyolojisinde paraneoplastik süreçler göz önünde bulundurulmalı ve etyolojiye yönelik ayrıntılı incelemeler olanaklar dahilinde mutlaka yapılmalıdır.

Keywords

• Paraneoplastik polinöropati, plazma hücreli tümör, prognoz

References

1. Antoine JC, Camdessanché JP, Ferraud K, Caudie C. Antiganglioside antibodies in paraneoplastic peripheral neuropathies. J Neurol Neurosurg Psychiatry 2004; 75: 1765- 1767.
2. Dalmau J,GrausF,Rosenblum MK. Anti-Hu associated paraneoplastic encephalomyelitis/sensory neuronopathy. Aclinical study of 71 patients. Medicine 1992; 71: 59-72.
3. Sumi SM, Farrell DF, Knauss TA. Lymphoma and leukemia manifested by steroid-responsive polyneuropathy. Arch Neurol 1983; 40: 577-582.
4. Johnson PC, Rolak LA, Hamilton RH, Laguna F. Paraneoplastic vasculitis of nerve: a remote effect of cancer. Ann Neurol 1979; 5: 437-444.
5. Amato AA, Collins MP. Neuropathies associated with malignancy. Semin Neurol 1998; 18: 125-144.
6. Antoine JC, Mosnier JF, Absi L, Convers P, Honnorat J, Michel D. Carcinoma associated paraneoplastic peripheral neuropathies in patients with and without anti-onconeural antibodies. J Neurol Neurosurg Psychiatry 1999; 67: 7-14.
7. Van Der Meche FGA, Schmitz PIM. A randomized trial comparing IVIG and plasma exchange in GBS. N Eng J Med 1992; 326: 1123-1129.
8. Bosch EP, Smith BE. Neurology in Clinical Practice. Bradley WG, Daroff RB, Fenichel GM, Marsden CD (eds). Butterworth-Heinemann, Boston, 2008; 2045-2130.

9. Machkas H, Harati Y, Rolak LA. Clinical pharmacology of immunosupressants: guidelines for neuroimmunotherapy. Neuroimmunology for the clinician 1997: 77-104.
10. Dispenzieri A. POEMS syndrome. Hematology Am Soc Hematol Educ Program 2005: 360-367.
11. Gönderilme Tarihi: 01.08.2010