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Orchiectomy for suspected microscopic tumor in patients with anti-Ma2-associated encephalitis.
Neurology. 2007 Mar 20; 68(12):900-5.Neur

Abstract

OBJECTIVE

To report the presence of microscopic neoplasms of the testis in men with anti-Ma2-associated encephalitis (Ma2-encephalitis) and to discuss the clinical implications.

METHODS

Orchiectomy specimens were examined using immunohistochemistry with Ma2 and Oct4 antibodies.

RESULTS

Among 25 patients with Ma2-encephalitis younger than 50 years, 19 had germ-cell tumors, and 6 had no evidence of cancer. These 6 patients underwent orchiectomy because they fulfilled five criteria: 1) demonstration of anti-Ma2 antibodies in association with MRI or clinical features compatible with Ma2-encephalitis, 2) life-threatening or progressive neurologic deficits, 3) age < 50 years, 4) absence of other tumors, and 5) new testicular enlargement or risk factors for germ-cell tumors, mainly cryptorchidism or ultrasound evidence of testicular microcalcifications. All orchiectomy specimens showed intratubular-germ cell neoplasms unclassified type (IGCNU) and other abnormalities including microcalcifications, atrophy, fibrosis, inflammatory infiltrates, or hypospermatogenesis. Ma2 was expressed by neoplastic cells in three of three patients examined. Even though most patients had severe neurologic deficits at the time of orchiectomy (median progression of symptoms, 10 months), 4 had partial improvement and prolonged stabilization (8 to 84 months, median 22.5 months) and two did not improve after the procedure.

CONCLUSIONS

In young men with Ma2-encephalitis, 1) the disorder should be attributed to a germ-cell neoplasm of the testis unless another Ma2-expressing tumor is found, 2) negative tumor markers, ultrasound, body CT, or PET do not exclude an intratubular germ-cell neoplasm of the testis, and 3) if no tumor is found, the presence of the five indicated criteria should prompt consideration of orchiectomy.

Authors+Show Affiliations

Department of Neurology, Division Neuro-oncology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17151337

Citation

Mathew, R M., et al. "Orchiectomy for Suspected Microscopic Tumor in Patients With anti-Ma2-associated Encephalitis." Neurology, vol. 68, no. 12, 2007, pp. 900-5.
Mathew RM, Vandenberghe R, Garcia-Merino A, et al. Orchiectomy for suspected microscopic tumor in patients with anti-Ma2-associated encephalitis. Neurology. 2007;68(12):900-5.
Mathew, R. M., Vandenberghe, R., Garcia-Merino, A., Yamamoto, T., Landolfi, J. C., Rosenfeld, M. R., Rossi, J. E., Thiessen, B., Dropcho, E. J., & Dalmau, J. (2007). Orchiectomy for suspected microscopic tumor in patients with anti-Ma2-associated encephalitis. Neurology, 68(12), 900-5.
Mathew RM, et al. Orchiectomy for Suspected Microscopic Tumor in Patients With anti-Ma2-associated Encephalitis. Neurology. 2007 Mar 20;68(12):900-5. PubMed PMID: 17151337.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Orchiectomy for suspected microscopic tumor in patients with anti-Ma2-associated encephalitis. AU - Mathew,R M, AU - Vandenberghe,R, AU - Garcia-Merino,A, AU - Yamamoto,T, AU - Landolfi,J C, AU - Rosenfeld,M R, AU - Rossi,J E, AU - Thiessen,B, AU - Dropcho,E J, AU - Dalmau,J, Y1 - 2006/12/06/ PY - 2006/12/8/pubmed PY - 2007/4/17/medline PY - 2006/12/8/entrez SP - 900 EP - 5 JF - Neurology JO - Neurology VL - 68 IS - 12 N2 - OBJECTIVE: To report the presence of microscopic neoplasms of the testis in men with anti-Ma2-associated encephalitis (Ma2-encephalitis) and to discuss the clinical implications. METHODS: Orchiectomy specimens were examined using immunohistochemistry with Ma2 and Oct4 antibodies. RESULTS: Among 25 patients with Ma2-encephalitis younger than 50 years, 19 had germ-cell tumors, and 6 had no evidence of cancer. These 6 patients underwent orchiectomy because they fulfilled five criteria: 1) demonstration of anti-Ma2 antibodies in association with MRI or clinical features compatible with Ma2-encephalitis, 2) life-threatening or progressive neurologic deficits, 3) age < 50 years, 4) absence of other tumors, and 5) new testicular enlargement or risk factors for germ-cell tumors, mainly cryptorchidism or ultrasound evidence of testicular microcalcifications. All orchiectomy specimens showed intratubular-germ cell neoplasms unclassified type (IGCNU) and other abnormalities including microcalcifications, atrophy, fibrosis, inflammatory infiltrates, or hypospermatogenesis. Ma2 was expressed by neoplastic cells in three of three patients examined. Even though most patients had severe neurologic deficits at the time of orchiectomy (median progression of symptoms, 10 months), 4 had partial improvement and prolonged stabilization (8 to 84 months, median 22.5 months) and two did not improve after the procedure. CONCLUSIONS: In young men with Ma2-encephalitis, 1) the disorder should be attributed to a germ-cell neoplasm of the testis unless another Ma2-expressing tumor is found, 2) negative tumor markers, ultrasound, body CT, or PET do not exclude an intratubular germ-cell neoplasm of the testis, and 3) if no tumor is found, the presence of the five indicated criteria should prompt consideration of orchiectomy. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/17151337/Orchiectomy_for_suspected_microscopic_tumor_in_patients_with_anti_Ma2_associated_encephalitis_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&amp;pmid=17151337 DB - PRIME DP - Unbound Medicine ER -