Dataset Information

P/Q and N-type Voltage-gated Calcium Channel Binding Antibodies Associated with Paraneoplastic Chorea and Mixed Invasive Ductal and Lobular Carcinoma of the Breasts in an Elderly Patient.

ABSTRACT: Paraneoplastic neurologic syndromes are a group of immune-mediated, cancer-associated disorders affecting the nervous system. While these syndromes are not understood fully, they are reportedly caused by an immune response against common antigens expressed by the cancer and nervous system. We describe the course of a patient who suffered paraneoplastic chorea before being diagnosed with breast cancer. A 70-year-old female presented with complaints of "shaking" movements of her head. History, physical exam findings, and preliminary workup ruled out the hereditary, metabolic, and infectious causes of chorea while brain computed tomography (CT) ruled out chorea due to a basal ganglia lesion. A paraneoplastic antibody panel identified N-type and P/Q-type voltage-gated (V-G) calcium channel binding antibodies. Subsequent age-appropriate cancer screening, which included a colonoscopy and screening mammograms, identified breast cancer. The patient had bilateral total mastectomies. Histopathology confirmed mixed invasive ductal and lobular carcinoma that was estrogen receptor positive, progesterone receptor positive, and human epidermal growth factor receptor 2 negative. In addition to mastectomies, the patient received adjuvant anastrozole. The appearance of choreiform movements before the diagnosis of breast cancer and the presence of paraneoplastic antibodies indicated that the chorea was most likely paraneoplastic in nature. Our patient continues to have choreiform movements despite undergoing bilateral mastectomies and receiving anastrozole, prednisone, and rituximab. We suspect the mastectomies and immune modulating therapies have not had an effect on her chorea because her P/Q and N-type V-G calcium channel binding antibodies may be intracellular. This case of paraneoplastic chorea associated with breast cancer is unusual. To the best of our knowledge, only one other case of paraneoplastic chorea associated with breast cancer has been reported in the English literature.

SUBMITTER: Chang K

PROVIDER: S-EPMC6175266 | biostudies-other | 2018 Aug

REPOSITORIES: biostudies-other

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Publications

P/Q and N-type Voltage-gated Calcium Channel Binding Antibodies Associated with Paraneoplastic Chorea and Mixed Invasive Ductal and Lobular Carcinoma of the Breasts in an Elderly Patient.

Chang Kevin K Lwanga Anita A Kaur Tanjeev T Helgason Cathy C

Cureus 20180804 8

Paraneoplastic neurologic syndromes are a group of immune-mediated, cancer-associated disorders affecting the nervous system. While these syndromes are not understood fully, they are reportedly caused by an immune response against common antigens expressed by the cancer and nervous system. We describe the course of a patient who suffered paraneoplastic chorea before being diagnosed with breast cancer. A 70-year-old female presented with complaints of "shaking" movements of her head. History, phy ...[more]

PMID: 30338173

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Project description:Mixed ductal-lobular carcinomas (MDLs) show both ductal and lobular morphology, and constitute an archetypal example of intratumoural morphological heterogeneity. The mechanisms underlying the coexistence of these different morphological entities are poorly understood, although theories include that these components either represent 'collision' of independent tumours or evolve from a common ancestor. We performed comprehensive clinicopathological analysis of a cohort of 82 MDLs, and found that: (1) MDLs more frequently coexist with ductal carcinoma in situ (DCIS) than with lobular carcinoma in situ (LCIS); (2) the E-cadherin-catenin complex was normal in the ductal component in 77.6% of tumours; and (3) in the lobular component, E-cadherin was almost always aberrantly located in the cytoplasm, in contrast to invasive lobular carcinoma (ILC), where E-cadherin is typically absent. Comparative genomic hybridization and multiregion whole exome sequencing of four representative cases revealed that all morphologically distinct components within an individual case were clonally related. The mutations identified varied between cases; those associated with a common clonal ancestry included BRCA2, TBX3, and TP53, whereas those associated with clonal divergence included CDH1 and ESR1. Together, these data support a model in which separate morphological components of MDLs arise from a common ancestor, and lobular morphology can arise via a ductal pathway of tumour progression. In MDLs that present with LCIS and DCIS, the clonal divergence probably occurs early, and is frequently associated with complete loss of E-cadherin expression, as in ILC, whereas, in the majority of MDLs, which present with DCIS but not LCIS, direct clonal divergence from the ductal to the lobular phenotype occurs late in tumour evolution, and is associated with aberrant expression of E-cadherin. The mechanisms driving the phenotypic change may involve E-cadherin-catenin complex deregulation, but are yet to be fully elucidated, as there is significant intertumoural heterogeneity, and each case may have a unique molecular mechanism. © 2018 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.

Dataset Information

P/Q and N-type Voltage-gated Calcium Channel Binding Antibodies Associated with Paraneoplastic Chorea and Mixed Invasive Ductal and Lobular Carcinoma of the Breasts in an Elderly Patient.

Publications

P/Q and N-type Voltage-gated Calcium Channel Binding Antibodies Associated with Paraneoplastic Chorea and Mixed Invasive Ductal and Lobular Carcinoma of the Breasts in an Elderly Patient.

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