Science News: Clinicopathologic Findings in Patients With Paraneoplastic Neuropathies and Antibodies Strongly Associated With Cancer

Submitted by: Milvia Y. Pleitez, MD 
Edited by: Rebecca O'Bryan, MD

Citation: Granger A, Rajnauth T, Lahoria R, et al. Clinicopathologic findings in patients with paraneoplastic neuropathies and antibodies strongly associated with cancer. Neurology. 2024;102(2):e207982. doi:10.1212/WNL.0000000000207982

Summary: This is a retrospective review of the electronic medical record over a 27-year period of patients with paraneoplastic neurological syndromes (antibody positive) and clinicopathological findings on nerve biopsies. A total of 19 patients were identified to have paraneoplastic antibodies and included those that were positive for Amphyiphysin (4 patients), ANNA-1 (6 patients), ANNA-1 and CRMP 5 (3 patients), ANNA-2 (2 patients), and CRMP-5 (4 patients) were included. Neuropathy phenotypes noted were sensorimotor peripheral neuropathy (6), sensory neuropathy (3), lumbosacral radiculoplexus neuropathy (3), polyradiculopathy (2), and multifocal sensorimotor neuropathy (2). Nerve biopsies all showed axonal degeneration with three showing a mixed axonal and demyelinating type of neuropathy. Three nerve biopsies were normal. All biopsies showed reduced nerve fiber density with 16/19 showing subperineural edema. Epineural/perivascular inflammation was found in three.

These findings suggest that patients with sensorimotor and sensory neuropathies, especially if subacute, should be considered for paraneoplastic antibody testing. Additionally, patients who have reduced nerve fiber density, absent inflammation and subperineurial edema on nerve biopsy should also undergo paraneoplastic antibody testing.