臨床検査67巻11号

2023年11月発行

今月の特集 腫瘍随伴症候群 免疫学的機序によるもの

傍腫瘍性小脳変性症

著者： 東光久¹

所属機関： ¹地方独立行政法人 奈良県立病院機構 奈良県総合医療センター 総合診療科

ページ範囲：P.1266 - P.1270

Point

●傍腫瘍性小脳変性症（PCD）とは，癌に関連して発症する小脳失調を主体とした，まれな腫瘍随伴症候群の1つである．

●PCD診断時は，癌が顕在化していないことが多く，その場合は癌の存在の有無も精査する必要がある．

●PCDに免疫療法は無効であることが多く，他の治療可能な疾患を除外することが何より重要である．

参考文献

1）Dalmau J, Rosenfeld MR：Paraneoplastic cerebellar degeneration. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.（https://www.uptodate.com/contents/paraneoplastic-cerebellar-degeneration）（最終アクセス：2023年9月14日）

2）田中惠子：傍腫瘍性神経症候群と抗神経抗体．臨神経　50：371-378，2010

3）Verschuuren J, Chuang L, Rosenblum MK, et al：Inflammatory infiltrates and complete absence of Purkinje cells in anti-Yo-associated paraneoplastic cerebellar degeneration. Acta Neuropathol　91：519-525，1996

4）Greene M, Lai Y, Baella N, et al：Antibodies to Delta/notch-like epidermal growth factor-related receptor in patients with anti-Tr, paraneoplastic cerebellar degeneration, and Hodgkin lymphoma. JAMA Neurol　71：1003-1008，2014

5）Hammack J, Kotanides H, Rosenblum MK, et al：Paraneoplastic cerebellar degeneration. II. Clinical and immunologic findings in 21 patients with Hodgkin's disease. Neurology　42：1938-1943，1992

6）Lopez-Chiriboga AS, Komorowski L, Kümpfel T, et al：Metabotropic glutamate receptor type 1 autoimmunity: Clinical features and treatment outcomes. Neurology　86：1009-1013，2016

7）Mason WP, Graus F, Lang B, et al：Small-cell lung cancer, paraneoplastic cerebellar degeneration and the Lambert-Eaton myasthenic syndrome. Brain　120(Pt 8)：1279-1300，1997

8）Graus F, Lang B, Pozo-Rosich P, et al：P/Q type calcium-channel antibodies in paraneoplastic cerebellar degeneration with lung cancer. Neurology　59：764-766，2002

9）Shams'ili S, Grefkens J, de Leeuw B, et al：Paraneoplastic cerebellar degeneration associated with antineuronal antibodies: analysis of 50 patients. Brain　126(Pt 6)：1409-1418，2003

10）Le May M, Dent S：Anti-Yo antibody-mediated paraneoplastic cerebellar degeneration associated with cognitive affective syndrome in a patient with breast cancer: a case report and literature review. Curr Oncol　25：e585-e591，2018

11）Peterson K, Rosenblum MK, Kotanides H, et al：Paraneoplastic cerebellar degeneration. I. A clinical analysis of 55 anti-Yo antibody-positive patients. Neurology　42：1931-1937，1992

12）Dalmau J, Gonzalez RG, Lerwill MF：Case records of the Massachusetts General Hospital. Case 4-2007. A 56-year-old woman with rapidly progressive vertigo and ataxia. N Engl J Med　356：612-620，2007

13）Scheid R, Voltz R, Briest S, et al：Clinical insights into paraneoplastic cerebellar degeneration. J Neurol Neurosurg Psychiatry　77：529-530，2006

14）Widdess-Walsh P, Tavee JO, Schuele S, et al：Response to intravenous immunoglobulin in anti-Yo associated paraneoplastic cerebellar degeneration: case report and review of the literature. J Neurooncol　63：187-190，2003

15）Sillevis Smitt P, Kinoshita A, De Leeuw B, et al：Paraneoplastic cerebellar ataxia due to autoantibodies against a glutamate receptor. N Engl J Med　342：21-27，2000

16）Do LD, Gupton SL, Tanji K, et al：TRIM9 and TRIM67 Are New Targets in Paraneoplastic Cerebellar Degeneration. Cerebellum　18：245-254，2019

17）de la Sayette V, Bertran F, Honnorat J, et al：Paraneoplastic cerebellar syndrome and optic neuritis with anti-CV2 antibodies: clinical response to excision of the primary tumor. Arch Neurol　55：405-408，1998

18）Briani C, Vitaliani R, Grisold W, et al：Spectrum of paraneoplastic disease associated with lymphoma. Neurology　76：705-710，2011

19）Graus F, Dalmau J, Valldeoriola F, et al：Immunological characterization of a neuronal antibody (anti-Tr) associated with paraneoplastic cerebellar degeneration and Hodgkin's disease. J Neuroimmunol　74：55-61，1997

20）Honnorat J, Cartalat-Carel S, Ricard D, et al：Onco-neural antibodies and tumour type determine survival and neurological symptoms in paraneoplastic neurological syndromes with Hu or CV2/CRMP5 antibodies. J Neurol Neurosurg Psychiatry　80：412-416，2009

21）Rojas I, Graus F, Keime-Guibert F, et al：Long-term clinical outcome of paraneoplastic cerebellar degeneration and anti-Yo antibodies. Neurology　55：713-715，2000

22）Cao Y, Abbas J, Wu X, et al：Anti-Yo positive paraneoplastic cerebellar degeneration associated with ovarian carcinoma: case report and review of the literature. Gynecol Oncol　75：178-183，1999