Paraneoplastic cerebellar degeneration and gynecologic malignancies

Paraneoplastic subacute cerebellar degeneration is a rare syndrome associated with a variety of malignancies, most commonly lung and ovarian. The syndrome is typically identified by signs and symptoms of cerebellar ataxia and the presence of anti-Purkinje cell antibodies in the serum and cerebrospinal fluid, specifically anti-Yo antibodies when a gynecologic cancer is responsible. A common observation is the presence of advanced stage disease but a remarkably small volume of metastatic cancer. Neurologic symptoms precede the diagnosis of cancer in most cases. Clinical findings consistent with cerebellar degeneration and the presence of anti-Yo antibodies require an aggressive search for an occult breast or gynecologic malignancy; surgical exploration may be necessary. Paraneoplastic syndromes involving the nervous system are not commonly seen in association with a gynecologic malignancy. Two cases are presented in which the patient's neurologic complaints preceded and led to the diagnosis of an advanced but yet occult gynecologic malignancy. The literature was also reviewed in an effort to explain the relevance of anti-Purkinje cell antibodies in relationship to gynecologic cancer and paraneoplastic cerebellar degeneration.