Cited by 501Autoimmune Neurological Disorders and TreatmentsLung Cancer Research StudiesSystemic Lupus Erythematosus Research

Paraneoplastic and oncologic profiles of patients seropositive for type 1 antineuronal nuclear autoantibodies

Lucchinetti, Claudia F., Kimmel, David W., Lennon, Vanda A.·1998·Neurology

Abstract

Type 1 antineuronal nuclear autoantibody (ANNA-1, also known as "anti-Hu") is a marker of neurologic autoimmunity that is highly associated with small-cell lung carcinoma (SCLC). To determine the spectrum of symptoms and signs as well as the frequency of cancer in adult patients who are seropositive for ANNA-1, we reviewed 162 sequential patients (67% female) identified as ANNA-1-positive in a comprehensive immunofluorescence screening test. In 21% of these patients, the antibody test requested by the physician was not ANNA-1. By the end of the follow-up period, cancer had been found in 142 patients (88%). Ten of these lacked evidence of SCLC (4 had prostate carcinoma, 3 breast carcinoma, 1 both prostate carcinoma and melanoma, 1 lymphoma, and 1 squamous-cell lung carcinoma). Of the 132 patients (81%) with proven SCLC, 17 had one or more coexisting malignant neoplasms (6 had renal carcinoma, 4 another lung primary carcinoma, 3 prostate carcinoma, 3 breast carcinoma, and 4 assorted neoplasms). The diagnosis of SCLC in 128 patients (97%) followed the onset of paraneoplastic symptoms. SCLC was identified in 10 patients by chest MRI after an equivocal chest radiograph or CT; in 28 by bronchoscopy, mediastinoscopy, or thoracotomy; and in 7 at autopsy. Neurologic signs in decreasing frequency were neuropathy (sensory > mixed somatic > autonomic > cranial [especially cranial nerve VIII] > motor), cerebellar ataxia, limbic encephalitis, polyradiculopathy, associated Lambert-Eaton myasthenic syndrome, myopathy, myelopathy, opsoclonus/myoclonus, motor neuronopathy, brachial plexopathy, and aphasia. Nineteen patients had a solely gastrointestinal initial presentation, including gastroparesis, pseudo-obstruction, esophageal achalasia, or other dysmotility. We conclude that seropositivity for ANNA-1 can expedite the diagnosis and treatment of otherwise occult cancer in patients, especially tobacco abusers, with varied neurologic and gastroenterologic presentations. The search for SCLC should not end on discovering a different neoplasm.

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Crossref · 10.1212/wnl.50.3.652

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  • Seropositivity for any of the above-mentioned antibodies may prompt further investigation for occult malignancy.

    “Seropositivity for any of the above-mentioned antibodies may therefore prompt further investigation for occult malignancy (e.g. whole-body fluorodeoxyglucose-positron emission tomography).”

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Authors
Lucchinetti, C. F., Kimmel, D. W., & Lennon, V. A.
Affiliations
Mayo Clinic (US)
Venue
Neurology
Published
1998-03
Volume
50
Issue
3
Pages
652-657
ISSN
  • 0028-3878 (ISSN-L)
  • 1526-632X
OpenAlex
W2130696458
Cited by
499
References
50
Citations by year
2026: 10 · 2025: 1 · 2024: 19 · 2023: 13 · 2022: 11 · 2021: 25 · 2020: 20 · 2019: 19 · 2018: 11 · 2017: 18 · 2016: 22 · 2015: 16 · 2014: 12 · 2013: 23 · 2012: 22
FWCI
10.26
Type
journal article
Language
en
Open access
closed
Locations
  • Neurology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01ca037343-11)
  • National Cancer Institute (CA-37343)
Topics
  • Health Sciences › Medicine › Neurology › Autoimmune Neurological Disorders and Treatments
  • Health Sciences › Medicine › Oncology › Lung Cancer Research Studies
  • Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
Keywords
anti-Hu antibodies, small cell lung cancer, paraneoplastic syndrome, multiple primary neoplasms, gastrointestinal motility disorders, Lambert-Eaton myasthenic syndrome, limbic encephalitis, opsoclonus-myoclonus syndrome, cancer screening, tobacco use, achalasia, gastroparesis
MeSH terms
Adult, Aged, Autoantibodies, Cerebrospinal Fluid Proteins, Female, Gastrointestinal Diseases, Gastrointestinal Motility, Humans, Lung Neoplasms, Male, Middle Aged, Neoplasms, Nerve Tissue Proteins, Nervous System Diseases, Paraneoplastic Syndromes, Incidence, RNA-Binding Proteins, Carcinoma, Small Cell, ELAV Proteins

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