Neurological paraneoplastic syndromes in patients with breast and gynecological cancer—a case series and structured literature review

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Abstract Purpose Neurological paraneoplastic syndromes (PNS) occur in less than 1% of patients with cancer but carry a significant clinical burden. Prognosis strongly depends on timely diagnosis and treatment. This study presents an illustrative case series and a structured review of neurological PNS in a gynecological context. This case series describes four patients (ages 61–79) with neurological PNS with underlying breast or pelvic malignancies, diagnosed with anti-amphiphysin encephalitis, autoimmune myeloradiculitis, and paraneoplastic cerebellar ataxia. Methods A structured literature review focusing on neurological PNS in gynecological and breast oncology with at least two participants was conducted using PubMed and MEDLINE. The results are synthesized, focusing on diagnostic workup and clinical findings. Results The review identified 5 original studies comprising 72 patients. Most cases were associated with breast cancer; however, largely attributable to one large study. Neurological PNS should be considered once alternative etiologies have been excluded through appropriate diagnostic testing. Most often this includes neurologic imaging. Diagnosis requires antibody testing and subsequent malignancy investigation, guided by the specific antibody profiles. Main limitations were the influence of one large study with the remaining sample sizes being small, as well as the retrospective study designs. Conclusion Due to their rarity and complexity, neurological PNS pose significant diagnostic and treatment challenges. Since neurological symptoms often precede the cancer diagnosis, thorough diagnostics and prompt treatment are essential, as prognosis is time-sensitive. Multidisciplinary care is crucial, and further research is necessary to improve understanding and management of these syndromes.

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