Abstract Details

Title Positive Acetylcholine Receptor Antibody - A Subtle Sign of An Occult Endometrial Cancer

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 1-004

Objective Nicotinic Ganglionic Acetylcholine receptor antibody (α3-AchR Ab) is a known marker of neurological autoimmunity and cancers. We report the first case of endometrial adenocarcinoma diagnosed prospectively after a positive α3-AchR Ab.

Background NA

Design/Methods 72 year old woman with history of Trigeminal neuralgia presented to the Neuromuscular clinic with complaints of painful muscle weakness and exertional fatigue in bilateral lower extremities with associated balance problems. Her examination revealed 4/5 strength in bilateral hip flexors and sensory deficits in a stocking and glove pattern. Initial laboratory workup revealed normal creatine kinase, aldolase, lactate, Vitamin B12, and negative myositis autoantibody panel, lyme, lupus, rheumatoid factor, angiotensin converting enzyme. Paraneoplastic panel revealed positive α3-AchR Ab. Computed Tomography of the abdomen was suspicious for a sub-endometrial mass and a transvaginal ultrasound revealed thickened endometrium with contiguous mass and increased vascularity. An endometrial biopsy was done which was positive for Grade 1 endometrial adenocarcinoma. Patient underwent hysterectomy and bilateral salphingo-oopherectomy with sentinel node mapping. Her weakness completely resolved post operatively. She is asymptomatic now receiving brachytherapy and is under surveillance.

Results The α3-Acetylcholine Receptor (α3-AChR) is not only confined to autonomic ganglia but found throughout the nervous system including the sensory dorsal root ganglia, trigeminal ganglia. Neurological manifestations include dysautonomia, peripheral neuropathy, myasthenia gravis, encephalopathy and extrapyramidal syndrome. Associations with multiple cancers including adenocarcinoma of the breast, lung, prostate, colon and thyroid have been observed. However association with endometrial adenocarcinoma is not yet been reported. Our patient had peripheral neuropathy and weakness in hip flexors with no obvious etiology which prompted the paraneoplastic workup and hence led to the diagnosis of the cancer.

Conclusions We report the first ever case of endometrial adenocarcinoma prospectively diagnosed after a positive α3-AchR Ab tested to establish the etiology of peripheral neuropathy and muscle weakness.

Authors/Disclosures
Abinayaa Purushothaman Ravichandran, MBBS PRESENTER	Dr. Purushothaman Ravichandran has nothing to disclose.
Alissa E. Romano, DO (LEhigh Valley Physician Group)	Dr. Romano has nothing to disclose.

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Abstract Details