• Online Features  This Article  • Full text  • PDF  • Correction  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (26)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Neurology  • Neuro-ophthalmology  • Neuropathology  • Oncology  • Diagnosis  • Alert me on articles by topic  Social Bookmarking   What's this?

Sean J. Pittock, MD; Vanda A. Lennon, MD, PhD

Arch Neurol. 2008;65(5):629-632.

Background  The neuromyelitis optica IgG autoantibody (NMO-IgG) is a validated biomarker for NMO and an emerging spectrum of inflammatory central nervous system–demyelinating disorders. Its antigen is the astrocytic water channel aquaporin-4; NMO-IgG has not been described in a cancer context.

Objectives  To report (1) neurologic and oncologic correlates for patients incidentally identified as NMO-IgG seropositive in a blinded evaluation for paraneoplastic autoantibodies and (2) the frequency of cancer in NMO-IgG–seropositive patients.

Design  Observational, retrospective case series.

Setting  Neuroimmunology Laboratory and Neurology Clinical Practice, Mayo Clinic College of Medicine.

Patients and Methods  From 1998 to 2007, we detected NMO-IgG in 2 patient groups: (1) 31 patients (88% female) identified incidentally among 180 000 patients evaluated for paraneoplastic autoantibodies and (2) 141 patients identified through physician-requested serological evaluation for a suspected NMO-spectrum disorder.

Results  In the first group, clinical information was available for 28 patients (90%). An NMO-spectrum disorder was diagnosed in 26 patients (93%), of whom 6 had a neoplasm (5 carcinomas [2 breast, 1 lung, 1 thymic, and 1 uterine cervical] and 1 B-cell lymphoma) and 1 had monoclonal gammopathy. In 4 patients, NMO-related symptoms followed neoplasia detection (median, 14 [range 3-18] months), and in 2 patients, symptoms preceded neoplasia detection (by 5 and 3 months). Two patients had carcinoma (1 breast and 1 lung) without neurological evidence of an NMO-spectrum disorder. In the second group, neoplasms were recorded in 7 seropositive patients (5.0%) with a clinically diagnosed NMO-spectrum disorder: 3 carcinomas (all breast), 1 thyroid Hürthle cell, 1 carcinoid, 1 pituitary somatotropinoma, and 1 B-cell lymphoma. An eighth patient had monoclonal gammopathy.

Conclusions  Aquaporin-4–specific IgG in some cases of NMO may reflect a paraneoplastic immune response. The clinical utility of this autoantibody as a cancer marker warrants prospective investigation.

Author Affiliations: Departments of Neurology, Laboratory Medicine and Pathology (Drs Pittock and Lennon), and Immunology (Dr Lennon), Mayo Clinic College of Medicine, Rochester, Minnesota.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

This Month in Archives of Neurology
Arch Neurol. 2008;65(5):572-573.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Myasthenia Gravis-Associated Neuromyelitis Optica-Like Disease: An Immunological Link Between the Central Nervous System and Muscle?
Vaknin-Dembinsky et al.
Arch Neurol 2011;68:1557-1561.
ABSTRACT | FULL TEXT  

Azathioprine: Tolerability, efficacy, and predictors of benefit in neuromyelitis optica
Costanzi et al.
Neurology 2011;77:659-666.
ABSTRACT | FULL TEXT  

Familial neuromyelitis optica
Matiello et al.
Neurology 2010;75:310-315.
ABSTRACT | FULL TEXT  

Myelopathies in Patients With Cancer
Graber and Nolan
Arch Neurol 2010;67:298-304.
FULL TEXT