Paraneoplastic Mononeuropathy Multiplex in a Patient with Primary Ovarian Cancer and Papillary Thyroid Cancer
Year: 2024
Type: article
Study design: Case Report
Abstract: Objective To describe a patient with paraneoplastic mononeuropathy multiplex (MNM) associated with ovarian and papillary thyroid cancer. Background MNM is typically associated with vasculitis. It rarely presents as a paraneoplastic disorder, commonly with neoplasms of the lung. Design/Methods N/A. Results A 65-year-old woman with no significant past medical history presented with progressive subacute weakness, numbness, and pain in both arms for 2.5 months. Neurological examination showed bilateral arm weakness, decreased sensation, and diminished reflexes in multiple nerve distributions. No upper motor neuron signs were seen. Serum tests showed elevated ESR at 92, positive ANA at 1:2560, elevated neurofilament light chain (NfL) at 2011, and elevated CA125 at 176.3. CSF studies were normal. Brain MRI showed corticospinal tract hyperintensity on DWI and FLAIR sequences. EMG/NCS showed findings consistent with MNM. Muscle and nerve biopsies were suggestive of a vascular or immune etiology. CT of the chest, abdomen, and pelvis was normal. PET scan showed increased uptake in the right ovary and omentum. Supraclavicular lymph node biopsy was suggestive of primary ovarian cancer and papillary thyroid cancer. Serum paraneoplastic panels were negative. The patient was treated with IVIG, IV methylprednisolone, and IV cyclophosphamide with minimal improvement of her symptoms. She then underwent chemotherapy with carboplatin and taxol, and tumor debulking surgery. At 3-month follow-up, she showed a slight improvement in her strength, and NfL and CA 125 levels were decreased. Conclusions MNM may present as a paraneoplastic disorder with ovarian and papillary thyroid cancer. Corticospinal tract hyperintensity may be seen in paraneoplastic disorders. CT screening alone may not detect the neoplasm. In suspected malignancy, PET scan should be performed.
Source: Neurology
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4403206665