Neurology -- Correspondence for Linke et al., 63 (2) 282-286

Correspondence published:

The FDG-PET scan can be especially useful in males with Anti-Yo syndrome: Pedro J Serrano-Castro, Jose Rubí-Callejón, Antonio Arjona, Gema Alonso (14 September 2004)

Reply to Serrano-Castro: Raymond D. Voltz, Rainer Linke (14 September 2004)

The FDG-PET scan can be especially useful in males with Anti-Yo syndrome 14 September 2004

Pedro J Serrano-Castro,
Servicio de Neurologia. Hospital Torrecardenas. Almería. SPAIN
Hospital Torrecardenas. Almeria. E-04009. SPAIN,
Jose Rubí-Callejón, Antonio Arjona, Gema Alonso
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Re: The FDG-PET scan can be especially useful in males with Anti-Yo syndrome

pedro.serrano.c{at}terra.es Pedro J Serrano-Castro, et al.

We read with interest the recent article by Linke et [1] about the use of CT and FDG-PET in assessing primary tumors in neurological paraneoplasic syndromes with positive antineuronal antibodies. The authors conclude that the FDG-PET can detect hidden tumors with positive Anti-Yo and Anti-Tr antibodies compared to those that present anti-Hu inmunoreactivity.
It has been shown that the synthesis of Anti-Yo antibodies is related to tumors in the gynecological area in women. Nevertheless, sporadic cases have been described in men with adenocarcinomas of several origins [2,3].
We present the case of a 69-year-old man with subacute progressive cerebelous syndrome with positive Anti-Yo antibodies (title 1/480) and negative tracking of concealed tumors, including thoracic and abdominal CT, in which the FDG-PET scan showed a enhancing nodule in top lobe of right lung (Figures 1 and 2). After surgical resection, the pathological study identified the tumor as a lung adenocarcinoma.
We found another reported case of paraneoplastic cerebellar degeneration associated with adenocarcinoma of the esophagus and anti-Yo antibodies in a man where the PET scan showed intense uptake at the gastrointestinal junction, consistent with the patient's primary esophageal cancer [4]. Anti-Yo antibodies paraneoplastic syndrome in males may constitute a subgroup in which the utility of the FDG-PET studies could be especially high. In these cases, the locating of the primary tumor is more heterogeneous than in the Anti-Yo syndrome in women and, probably the FDG-PET should precede to invasive studies in search of hidden tumors. Further studies are needed to clarify this approach.
Figures
References
1.Linke R, Schroeder M, Helmberger T and Voltz R. Antibody-positive paraneoplastic neurologic syndromes: Value of CT and PET for tumor diagnosis. Neurology 2004 63: 282-286.
2.Felician O, Renard JL, Vega F. Paraneoplastic cerebellar degeneration with anti-Yo antibody in a man. Neurology. 1995;45:1226-1227.
3.Krakauer J, Balmaceda C, Torres Gluck J. Anti-Yo-associated paraneoplastic cerebellar degeneration in a man with adenocarcinoma of unknown origin. Neurology. 1996;46:1486-1487
4.Xia, K; Saltzman, JR and Carr-Locke, DL. Anti-Yo Antibody-Mediated Paraneoplastic Cerebellar Degeneration in a Man With Esophageal Adenocarcinoma. MedGenMed. 2003 Aug 5;5(3):18.

Reply to Serrano-Castro 14 September 2004

Raymond D. Voltz,
Department of Neurology
Klinikum Grosshadern, D-81366 München, Germany,
Rainer Linke
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Re: Reply to Serrano-Castro

rvoltz{at}nro.med.uni-muenchen.de Raymond D. Voltz, et al.

Serrano-Castro's case report is interesting and adds another report of a male anti-Yo patient with associated lung adenocarcinoma. This probably represents a small subgroup of anti- Yo patients. Their report on a positive FDG-PET scan leading to tumor diagnosis while CT was negative confirms our clinical experience. [1]
However, FDG-PET is “especially useful in males with anti-Yo syndrome” in comparison to females with anti-Yo is highly speculative due to the infrequency of this syndrome and low number of patients reported and the already high sensitivity in females with anti-Yo. [1]
Nevertheless, this case report underlines the significance of the FDG-PET whole body scan to find the associated tumor in a patient with an anti-Yo positive paraneoplastic syndrome.
References
1. Linke R, Schroeder M, Helmberger T and Voltz R. Antibody-positive paraneoplastic neurologic syndromes: Value of CT and PET for tumor diagnosis. Neurology 2004 63: 282-286