Article Text

PDF
POC19 Anti-Hu paraneoplastic sensory neuronopathy with underlying squamous cell carcinoma of the lung
  1. P Gozzard1,2,
  2. D Soon1,2,
  3. A Vincent1,2,
  4. B Lang1,2
  1. 1Division of Clinical Neurology, University of Nottingham, Nottingham, UK
  2. 2Department of Clinical Neurology, Oxford University, Oxford, UK
  1. Correspondence to p.gozzard{at}nhs.net

Abstract

Type 1 anti-neuronal nuclear antibody (ANNA-1), also known as anti-Hu, recognises a family of RNA binding proteins, expressed in neuronal nuclei throughout the human neuraxis. Its presence usually reflects immunity against neuroendocrine tumours, in particular small-cell-lung cancer (SCLC). When present with neurological symptoms, anti-Hu is diagnostic of a paraneoplastic syndrome according to published criteria. A 72-year-old woman with a 39 pack-year smoking history developed a subacute sensory neuronopathy and weight loss attributed to a nonmetastatic chest neoplasm. High titres of anti-Hu antibodies were detected. Her chest mass was completely resected and found immunohistochemically to be homogenous squamous cell carcinoma. PET imaging has not revealed a second tumour to date. We demonstrated Hu antigen positivity on immunoblot of patient sera before and after surgery. Sections of the patient's tumour were incubated with sera at 1:20 dilution for 1 h. We demonstrated immunoreactivity in sera from the patient, and a Hu-positive patient with SCLC; this was specific to the large nuclei of the patient's squamous cell tumour, indicating tumour anti-Hu immunoreactivity. Control sera (from a patient with SCLC and a healthy control) did not show any staining. In rare cases the tumour giving rise to anti-Hu antibody associated sensory neuronopathy may be the result of squamous metaplasia. This should be borne in mind when initial tumour surveillance fails to detect SCLC.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.