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. 2024 Nov;11(6):e200260.
doi: 10.1212/NXI.0000000000200260. Epub 2024 Oct 7.

Paraneoplastic Neurologic Syndromes Associated With Merkel Cell Carcinoma

Nicolás Lundahl Ciano-Petersen  1 , Sergio Muñiz-Castrillo  1 , Macarena Villagrán-García  1 , Antonio Farina  1 , Alberto Vogrig  1 , Valentin Wucher  1 , Le Duy  1 , Cristina Birzu  1 , David Goncalves  1 , Olivier Flabeau  1 , Coline Duwicquet  1 , Adrien Benard  1 , Fabien Nicole  1 , Veronique Rogemond  1 , Geraldine Picard  1 , Bastien Joubert  1 , Jerome Honnorat  1
Affiliations

Paraneoplastic Neurologic Syndromes Associated With Merkel Cell Carcinoma

Nicolás Lundahl Ciano-Petersen et al. Neurol Neuroimmunol Neuroinflamm. 2024 Nov.

Abstract

Background and objectives: To define the clinical and immunologic profile of patients with paraneoplastic neurologic syndromes (PNSs) associated with Merkel cell carcinoma (MCC).

Methods: Retrospective analysis was conducted on patients with suspected MCC-related PNS assessed at the French Reference Center, and cases were identified by a systematic review of the literature (MEDLINE, Embase) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: A total of 17 patients were identified in our center and 30 in the systematic review, resulting in an overall cohort of 47 patients. The median age was 65 years (range 41-90), and 30 of 46 (65%) were men. Lambert-Eaton myasthenic syndrome (LEMS) (14/47, 29%), rapidly progressive cerebellar syndrome (11/47, 23%), and encephalomyelitis (EM) (8/47, 17%) were the most common associated clinical phenotypes. The most frequently associated neural antibodies (Abs) were voltage-gated calcium channel (VGCC)-Abs (14/45, 31%), followed by Hu-Abs (8/45, 17%) and neurofilament (NF)-Abs (8/45, 17%). Patients with NF-Abs only exhibited CNS disorders (8/8, 100%) and often had antibodies against >1 NF subunit (6/8, 75%). At onset, 26 of 43 patients (60%) had no identifiable primary skin tumor but had lymph node metastasis; these patients were more frequently men (21/26, 80%, vs 7/17, 41%; p = 0.007), had more frequently VGCC-Abs (12/26, 46%, vs 2/17, 11%, p = 0.02) predominantly among those with LEMS, and presented reduced mortality than patients with a known primary tumor (5/25, 20%, vs 8/15, 53%; p = 0.02).

Discussion: MCC-related PNSs present as a heterogeneous clinical spectrum including central and/or peripheral nervous system disorders such as LEMS, RCPS, and EM, mainly associated with VGCC-Abs, NF-Abs, and Hu-Abs. NF-Abs were only seen among patients with CNS disorders. At onset, the absence of a primary skin tumor but presence of lymph node metastasis is frequently observed, and this particular clinical presentation is linked to reduced mortality, highlighting distinctive clinical and immunologic features of MCC-related PNS.

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Conflict of interest statement

The authors report no relevant disclosures. Go to Neurology.org/NN for full disclosures.

Figures

Figure
Figure. Flow Diagram Representing the Main Phases of the Systematic Review Detailing the Number of Studies Screened, Included, and Excluded
See this image and copyright information in PMC

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