内容紹介
Summary
A case complicated with colorectal and prostate cancers in paraneoplastic(subacute)cerebellar degeneration(PCD)is extremely rare. We report a retrospective case of rectal carcinoma with paraneoplastic cerebellar degeneration. A 79-year-old man with Parkinson's disease was unable to walk because of paralysis. Brain MRI showed cerebellar atrophy. He was admitted to our hospital for anal bleeding and was diagnosed with colon cancer. An associated diagnosis of PCD was made. After resection, his paralysis and dysarthria were resolved to the extent of being able to walk and speak fluently. Brain MP-RAGE showed no findings suggestive of metastasis or atrophy. He was treated surgically, which resulted in a transient improvement in PCD symptoms. Per blood testing, cytokines IL-6 and IL-10 were lower postoperatively. Immunosuppressive levels of myeloid-derived suppressor cells(MDSCs)were lower compared with the preoperative values. Thus, innate immunocompetence and resolution of paralysis followed the surgical intervention.
要旨
傍腫瘍性神経症候群(paraneoplastic neurological syndromes: PNS)とは,悪性腫瘍に対する免疫反応が自己の神経組織を傷害して生じる様々な神経徴候で,担癌患者の約1%程度に生じるとされている。傍腫瘍性(亜急性)小脳変性症[paraneoplastic(subacute)cerebellar degeneration: PCD]は,PNSの一病型で小脳失調を呈する。PCDに大腸癌と前立腺癌を合併する症例は極めてまれである。初期の歩行失調から始まった小脳変性症を呈した79歳の大腸癌患者に手術を施行し,ADLの改善を認め現在も健在である。また,magnetization prepared rapid acquisition with gradient echo(MP-RAGE)にて小脳変性の改善がみられた。さらに術前に高値であったIL-6,IL-10,myeloid derived suppressor cells(MDSCs)は術後に低値となり,液性免疫能と癌免疫能が改善されたと考えられた。
目次
A case complicated with colorectal and prostate cancers in paraneoplastic(subacute)cerebellar degeneration(PCD)is extremely rare. We report a retrospective case of rectal carcinoma with paraneoplastic cerebellar degeneration. A 79-year-old man with Parkinson's disease was unable to walk because of paralysis. Brain MRI showed cerebellar atrophy. He was admitted to our hospital for anal bleeding and was diagnosed with colon cancer. An associated diagnosis of PCD was made. After resection, his paralysis and dysarthria were resolved to the extent of being able to walk and speak fluently. Brain MP-RAGE showed no findings suggestive of metastasis or atrophy. He was treated surgically, which resulted in a transient improvement in PCD symptoms. Per blood testing, cytokines IL-6 and IL-10 were lower postoperatively. Immunosuppressive levels of myeloid-derived suppressor cells(MDSCs)were lower compared with the preoperative values. Thus, innate immunocompetence and resolution of paralysis followed the surgical intervention.
要旨
傍腫瘍性神経症候群(paraneoplastic neurological syndromes: PNS)とは,悪性腫瘍に対する免疫反応が自己の神経組織を傷害して生じる様々な神経徴候で,担癌患者の約1%程度に生じるとされている。傍腫瘍性(亜急性)小脳変性症[paraneoplastic(subacute)cerebellar degeneration: PCD]は,PNSの一病型で小脳失調を呈する。PCDに大腸癌と前立腺癌を合併する症例は極めてまれである。初期の歩行失調から始まった小脳変性症を呈した79歳の大腸癌患者に手術を施行し,ADLの改善を認め現在も健在である。また,magnetization prepared rapid acquisition with gradient echo(MP-RAGE)にて小脳変性の改善がみられた。さらに術前に高値であったIL-6,IL-10,myeloid derived suppressor cells(MDSCs)は術後に低値となり,液性免疫能と癌免疫能が改善されたと考えられた。