PARANEOPLASTIC CEREBELLAR DEGENERATION AND GYNECOLOGIC MALIGNANCIES

Paraneoplastic subacute cerebellar degeneration is a rare syndrome ass ociated with a variety of malignancies, most commonly lung and ovarian . The syndrome is typically identified by signs and symptoms of cerebe llar ataxia and the presence of anti-Purkinje cell antibodies in the s erum and cerebrospinal fluid, specifically anti-lie antibodies when a gynecologic cancer is responsible. A common observation is the presenc e of advanced stage disease but a remarkably small volume of metastati c cancer. Neurologic symptoms precede the diagnosis of cancer in most cases. Clinical findings consistent with cerebellar degeneration and t he presence of anti-Yo antibodies require an aggressive search for an occult breast or gynecologic malignancy; surgical exploration may be n ecessary. Paraneoplastic syndromes involving the nervous system are no t commonly seen in association with a gynecologic malignancy. Two case s are presented in which the patient's neurologic complaints preceded and led to the diagnosis of an advanced but yet occult gynecologic mal ignancy. The literature was also reviewed in an effort to explain the relevance of anti-Purkinje cell antibodies in relationship to gynecolo gic cancer and paraneoplastic cerebellar degeneration.