Paraneoplastic neurologic syndromes associated to nasopharyngeal carcinoma. Systematic review
Abstract
Introduction and objectives: Paraneoplastic syndromes (PS) are a heterogeneous group of cancer-associated disorders caused by mechanisms other than metastases, metabolic, nutritional deficits, infections, or side effects of cancer treatment PS appear in 1-7.4 % of all cancer patients. Paraneoplastic neurological syndromes (PNS) associated with nasopharyngeal carcinoma (NC) are very rare. The objective of this review is to characterize the PNS associated with NC. Methods: A systematic review of cases of PNS associated to NC was carried out. The following databases were used for the search: Pubmed, Web of Science and Cochrane library. As search terms we used the keywords: “paraneoplastic syndrome” and “nasopharyngeal carcinoma”. Results: We included a total of 11 patients in the review. The PNS most frequently identified were cerebellar degeneration, limbic encephalitis, and opsoclonus-myoclonus syndrome. Auto antibodies against neural structures were identified in 5 cases (anti-Yo, anti-Hu and anti-RI). Regarding neurological prognosis, neurological symptoms did not improve or improved only partially after both primary tumor and steroids and immunoglobulins. Conclusions: Clinicians should consider the possibility of a paraneoplastic etiology when caring for patients with NC who present with subacute neurological symptoms. The prognosis of PNS after treatment is poor.
- Referencias
- Cómo citar
- Del mismo autor
- Métricas
Ferlito A, Elsheikh MN, Manni JJ, Rinaldo A. Paraneoplastic syndromes in patients with primary head and neck cancer. Eur Arch Otorhinolaryngol 2007; 264:211-22.
Zuffa M, Kubancok J, Rusnák I, Mensatoris K, Horváth A. Early paraneoplastic syndrome in medical oncology: clinicopathological analysis of 1694 patients treated over 20 years. Neoplasma 1984; 31:231-6.
Morales-Angulo C, Megia LR, Rubio SA, Rivera HF, Rama J. Carcinoma of the nasopharynx in Cantabria. Acta Otorrinolaringol Esp 1999; 50:381-386.
Chan AT, Teo PM, Johnson PJ. Nasopharyngeal carcinoma. Ann Oncol 2002; 13:1007-15.
Toro C, Rinaldo A, Silver C, Politi M, Ferlito A. Paraneoplastic syndromes in patients with nasopharyngeal cancer. Auris Nasus Larynx 2009; 36: 513-520.
Maalej M, Ladgham A, Ennouri A, Ben Attia A, Cammoun M, Ellouze R. The paraneoplastic syndrome in nasopharynx cancer: 32 cases. Presse Med 1985; 14:471-4.
Yang K, Zhang T, Chen J, Fan L, Yin Z, Hu Y, et al. Immune throbocytopenia as a paraneoplastic syndrome in patients with nasopharyngeal cancer. Head Neck 2012; 34:127-30.
Urrútia G, Bonfilll X. La declaración prisma: Un paso adelante en la mejora de las publicaciones de la revista Española de salud pública. Rev Esp Salud Publica 2013; 87(2):99-102. https://doi.org/10.4321/S1135-57272013000200001
Graus F, Vogrig A, Muñiz-Castrillo S, Antoine JG, Desestret V, Dubey D, et al. Updated Diagnostic Criteria for Paraneoplastic Neurologic Syndromes. Neurol Neuroimmunol Neuroinflamm 2021 May 18; 8(4):e1014. https://doi.org/10.1212/NXI.0000000000001014.PMID: 34006622; PMCID: PMC8237398.
Phanthunchinda K, Hemachudha T, Locharoenkul C. Paraneoplastic syndrome of the nervous system. Chula Med J 1990; 34:457-465.
Chan KH, Leung SY, Cheung RTF, Ho SL, Mak W. Paraneoplastic motor neuropathy and inflammatory myopathy associated with nasopharyngeal carcinoma. J Neurooncol 2007; 81:93-96. https://doi.org/10.1007/s11060-006-9204-3
Taib BG, Kinshuck AJ, Milburn-McNulty P, Fratalia L, Forsyth L, Husband D, et al. Opsoclonus-myoclonus syndrome associated with a nasopharyngeal tumor in an adult: a case report. J Med Case Rep 2015; 9:128. https://doi.org/10.1186/s13256-015-0605-9
Yu ZM, Li W, Yang CQ, Song Y, Wang DY, Liu FG, Gong T. Paraneoplastic Limbic Encephalitis in a Male with Nasopharyngeal Carcinoma. Chin Med J 2016; 129:1253-4.
Ng SY, Kong MH, Mohamad Yunus MR. Paraneoplastic neurological disorder in nasopharyngeal carcinoma. Malays J Med Sci 2017; 24(1):113-116. https://doi.org/10.21315/mjms2017.24.1.12
Bhardwaj S, Khasani S, Benasher D, Stein EG, Meghal T, Jacoby N, et al. Paraneoplastic Cerebellar Degeneration in Nasopharyngeal Carcinoma: a Unique Association. Cerebellum 2019; 18:1126-1129. https://doi.org/10.1007/s12311-019-01045-1
Ozozen Ayas Z, Kotan D, Oguz Akarsu E, Demiryurek BE, Analysis of the Patients with Autoimmune Neurological Syndromes in a Single Center in Turkey. Osmangazi J Med 2021;43(1):62-69. https://doi.org/10.20515/otd.740327
Tosunoğlu B, Süleymanoğulları F, Inci ET, Çokal BG. Paraneoplastic Limbic Encephalitis with Nasopharyngeal Carcinoma: Case Report. Asian J Med Case Reps 2022; 4:9-12.
Stewart KE, Zeidler M, Srinivasan D, Yeo JCL Opsoclonus-myoclonus paraneoplastic syndrome in nasopharyngeal carcinoma. BMJ Case Rep 2022 Oct 26; 15(10):e250871. https://doi.org/10.1136/bcr-2022-250871.
Riancho J, Rodríguez-Rodríguez E, Martínez-Camerano A, Morales-Angulo C. Mielitis y anticuerpos anti-Yo: un síndrome paraneoplásico asociado al carcinoma nasofaríngeo detectado por tomografía por emisión de positrones. Descripción de un caso. Rev ORL 16(1):e32012. Disponible en: https://doi.org/10.14201/orl.32012
Hanağası H, Çakar A, Hanağası F, Samancı B, Tüfekçioğlu Z, Bilgiç B, et al. Emre M. Anti-Ri Associated Paraneoplastic Cervical Dystonia and Laryngospasm in a Patient with Nasopharyngeal Carcinoma. Arch Neuropsychiatry 2025; 15;62(1):94-96. https://doi.org/10.29399/npa.28517
Darnell RB, Posner JB. Paraneoplastic syndromes involving the nervous system. N Engl J Med 2003; 49(16):1543-1554.
Posner J. Anti-Yo and anti-Hu. Laboratory Medicine 1999; 30(12):770.
Peterson K, Rosenblum MK, Kotanides H, Posner JB. Paraneoplastic cerebellar degeneration. I. A clinical analysis of 55 anti-Yo antibody-positive patients. Neurology 1992; 42:1931-1937.
Matschke J, Kromminga A, Erbersdobler A, Lamszus K, Anders S, Kofuncu E. Paraneoplastic cerebellar degeneration and anti-Yo antibodies in a man with prostatic adenocarcinoma. J Neurol Neurosurg Psychiatry 2007; 78:775-777.
Flanagan EP. Paraneoplastic Disorders of the Nervous System. Continuum (Minneap Min) 2020; 26:1602-1628. https://doi.org/10.1212/CON.0000000000000941.
Shams’ili S. Paraneoplastic cerebellar degeneration associated with antineuronal antibodies: analysis of 50 patients. Brain 2003; 126: 1409-18.
Sutton IJ, Barnett MH, Watson JDG, Ell JJ, Dalmau J. Paraneoplastic brainstem encephalitis and anti-Ri antibodies. J Neurol 2002; 249:1597-8.
Velazquez Y, Kaur D, Ahmed A. Anti-Ri antibody paraneoplastic syndrome without opsoclonus-myoclonus. J Neurol Res 2014; 4:31-3.
Oh SY, Kim JS, Dieterich M. Update on opsoclonus-myoclonus syndrome in adults. J Neurol 2019, 266:1541-8. https://doi.org/10.1007/s00415-018-9138-7
Dalmau JO, Posner JB. Paraneoplastic syndromes. Arch Neurol 1999; 56:405-8.
Corsellis JA, Goldberg JG, Norton AR. Limbic encephalitis and its association with carcinoma. Brain 1968; 91:481-496.
Debes JD, Lagarde SM, Hulsenboom E, Sillevis Smitt PA, ten Kate FJ, Sulter GA, et al. Anti-Yo-associated paraneoplastic cerebellar degeneration in a man with adenocarcinoma of the gastroesophageal junction. Dig Surg 2007; 24:395-7. https://doi.org/10.1159/000107782
Meglic B, Graus F, Grad A. Anti-Yo associated paraneoplastic cerebellar degeneration in a man with gastric adenocarcinoma. J Neurol Sci 2001; 185:135-8.
Rojas I, Graus F, Keime-Guibert F, Reñé R, Delattre JY, Ramón JM, et al. Long-term clinical outcome of paraneoplastic cerebellar degeneration and anti-Yo antibodies. Neurology 2000; 55:713-5.
Hoh ST, The M, Chew SJ. Paraneoplastic optic neuropathy in nasopharyngeal carcinoma--report of a case Singapore Med J 1991; 32:170-3.
Prasad U, Doraisamy S. Optic nerve involvement in nasopharyngeal carcinoma. Eur J Surg Oncol 1991; 17:536–540.
Tsai CC, Ho HC, Kau HC, Kao SC, Hsu WM. Optic neuritis: a rare manifestation of nasopharyngeal carcinoma Eye 2002;16:501–503. https://doi.org/10.1038/sj.eye.6700003
Zuffa M, Kubancok J, Rusnák I, Mensatoris K, Horváth A. Early paraneoplastic syndrome in medical oncology: clinicopathological analysis of 1694 patients treated over 20 years. Neoplasma 1984; 31:231-6.
Morales-Angulo C, Megia LR, Rubio SA, Rivera HF, Rama J. Carcinoma of the nasopharynx in Cantabria. Acta Otorrinolaringol Esp 1999; 50:381-386.
Chan AT, Teo PM, Johnson PJ. Nasopharyngeal carcinoma. Ann Oncol 2002; 13:1007-15.
Toro C, Rinaldo A, Silver C, Politi M, Ferlito A. Paraneoplastic syndromes in patients with nasopharyngeal cancer. Auris Nasus Larynx 2009; 36: 513-520.
Maalej M, Ladgham A, Ennouri A, Ben Attia A, Cammoun M, Ellouze R. The paraneoplastic syndrome in nasopharynx cancer: 32 cases. Presse Med 1985; 14:471-4.
Yang K, Zhang T, Chen J, Fan L, Yin Z, Hu Y, et al. Immune throbocytopenia as a paraneoplastic syndrome in patients with nasopharyngeal cancer. Head Neck 2012; 34:127-30.
Urrútia G, Bonfilll X. La declaración prisma: Un paso adelante en la mejora de las publicaciones de la revista Española de salud pública. Rev Esp Salud Publica 2013; 87(2):99-102. https://doi.org/10.4321/S1135-57272013000200001
Graus F, Vogrig A, Muñiz-Castrillo S, Antoine JG, Desestret V, Dubey D, et al. Updated Diagnostic Criteria for Paraneoplastic Neurologic Syndromes. Neurol Neuroimmunol Neuroinflamm 2021 May 18; 8(4):e1014. https://doi.org/10.1212/NXI.0000000000001014.PMID: 34006622; PMCID: PMC8237398.
Phanthunchinda K, Hemachudha T, Locharoenkul C. Paraneoplastic syndrome of the nervous system. Chula Med J 1990; 34:457-465.
Chan KH, Leung SY, Cheung RTF, Ho SL, Mak W. Paraneoplastic motor neuropathy and inflammatory myopathy associated with nasopharyngeal carcinoma. J Neurooncol 2007; 81:93-96. https://doi.org/10.1007/s11060-006-9204-3
Taib BG, Kinshuck AJ, Milburn-McNulty P, Fratalia L, Forsyth L, Husband D, et al. Opsoclonus-myoclonus syndrome associated with a nasopharyngeal tumor in an adult: a case report. J Med Case Rep 2015; 9:128. https://doi.org/10.1186/s13256-015-0605-9
Yu ZM, Li W, Yang CQ, Song Y, Wang DY, Liu FG, Gong T. Paraneoplastic Limbic Encephalitis in a Male with Nasopharyngeal Carcinoma. Chin Med J 2016; 129:1253-4.
Ng SY, Kong MH, Mohamad Yunus MR. Paraneoplastic neurological disorder in nasopharyngeal carcinoma. Malays J Med Sci 2017; 24(1):113-116. https://doi.org/10.21315/mjms2017.24.1.12
Bhardwaj S, Khasani S, Benasher D, Stein EG, Meghal T, Jacoby N, et al. Paraneoplastic Cerebellar Degeneration in Nasopharyngeal Carcinoma: a Unique Association. Cerebellum 2019; 18:1126-1129. https://doi.org/10.1007/s12311-019-01045-1
Ozozen Ayas Z, Kotan D, Oguz Akarsu E, Demiryurek BE, Analysis of the Patients with Autoimmune Neurological Syndromes in a Single Center in Turkey. Osmangazi J Med 2021;43(1):62-69. https://doi.org/10.20515/otd.740327
Tosunoğlu B, Süleymanoğulları F, Inci ET, Çokal BG. Paraneoplastic Limbic Encephalitis with Nasopharyngeal Carcinoma: Case Report. Asian J Med Case Reps 2022; 4:9-12.
Stewart KE, Zeidler M, Srinivasan D, Yeo JCL Opsoclonus-myoclonus paraneoplastic syndrome in nasopharyngeal carcinoma. BMJ Case Rep 2022 Oct 26; 15(10):e250871. https://doi.org/10.1136/bcr-2022-250871.
Riancho J, Rodríguez-Rodríguez E, Martínez-Camerano A, Morales-Angulo C. Mielitis y anticuerpos anti-Yo: un síndrome paraneoplásico asociado al carcinoma nasofaríngeo detectado por tomografía por emisión de positrones. Descripción de un caso. Rev ORL 16(1):e32012. Disponible en: https://doi.org/10.14201/orl.32012
Hanağası H, Çakar A, Hanağası F, Samancı B, Tüfekçioğlu Z, Bilgiç B, et al. Emre M. Anti-Ri Associated Paraneoplastic Cervical Dystonia and Laryngospasm in a Patient with Nasopharyngeal Carcinoma. Arch Neuropsychiatry 2025; 15;62(1):94-96. https://doi.org/10.29399/npa.28517
Darnell RB, Posner JB. Paraneoplastic syndromes involving the nervous system. N Engl J Med 2003; 49(16):1543-1554.
Posner J. Anti-Yo and anti-Hu. Laboratory Medicine 1999; 30(12):770.
Peterson K, Rosenblum MK, Kotanides H, Posner JB. Paraneoplastic cerebellar degeneration. I. A clinical analysis of 55 anti-Yo antibody-positive patients. Neurology 1992; 42:1931-1937.
Matschke J, Kromminga A, Erbersdobler A, Lamszus K, Anders S, Kofuncu E. Paraneoplastic cerebellar degeneration and anti-Yo antibodies in a man with prostatic adenocarcinoma. J Neurol Neurosurg Psychiatry 2007; 78:775-777.
Flanagan EP. Paraneoplastic Disorders of the Nervous System. Continuum (Minneap Min) 2020; 26:1602-1628. https://doi.org/10.1212/CON.0000000000000941.
Shams’ili S. Paraneoplastic cerebellar degeneration associated with antineuronal antibodies: analysis of 50 patients. Brain 2003; 126: 1409-18.
Sutton IJ, Barnett MH, Watson JDG, Ell JJ, Dalmau J. Paraneoplastic brainstem encephalitis and anti-Ri antibodies. J Neurol 2002; 249:1597-8.
Velazquez Y, Kaur D, Ahmed A. Anti-Ri antibody paraneoplastic syndrome without opsoclonus-myoclonus. J Neurol Res 2014; 4:31-3.
Oh SY, Kim JS, Dieterich M. Update on opsoclonus-myoclonus syndrome in adults. J Neurol 2019, 266:1541-8. https://doi.org/10.1007/s00415-018-9138-7
Dalmau JO, Posner JB. Paraneoplastic syndromes. Arch Neurol 1999; 56:405-8.
Corsellis JA, Goldberg JG, Norton AR. Limbic encephalitis and its association with carcinoma. Brain 1968; 91:481-496.
Debes JD, Lagarde SM, Hulsenboom E, Sillevis Smitt PA, ten Kate FJ, Sulter GA, et al. Anti-Yo-associated paraneoplastic cerebellar degeneration in a man with adenocarcinoma of the gastroesophageal junction. Dig Surg 2007; 24:395-7. https://doi.org/10.1159/000107782
Meglic B, Graus F, Grad A. Anti-Yo associated paraneoplastic cerebellar degeneration in a man with gastric adenocarcinoma. J Neurol Sci 2001; 185:135-8.
Rojas I, Graus F, Keime-Guibert F, Reñé R, Delattre JY, Ramón JM, et al. Long-term clinical outcome of paraneoplastic cerebellar degeneration and anti-Yo antibodies. Neurology 2000; 55:713-5.
Hoh ST, The M, Chew SJ. Paraneoplastic optic neuropathy in nasopharyngeal carcinoma--report of a case Singapore Med J 1991; 32:170-3.
Prasad U, Doraisamy S. Optic nerve involvement in nasopharyngeal carcinoma. Eur J Surg Oncol 1991; 17:536–540.
Tsai CC, Ho HC, Kau HC, Kao SC, Hsu WM. Optic neuritis: a rare manifestation of nasopharyngeal carcinoma Eye 2002;16:501–503. https://doi.org/10.1038/sj.eye.6700003
Riancho, J., Rodríguez-Rodríguez, E., Martínez-Camerano, A., Fernández-Enseñat, J., & Morales-Angulo, C. (2025). Paraneoplastic neurologic syndromes associated to nasopharyngeal carcinoma. Systematic review. Revista ORL, 16(3), e33191. https://doi.org/10.14201/orl.33191
Most read articles by the same author(s)
- Minerva Rodríguez-Martín, Eugenia López-Simón, Ramón Cobo-Díaz, Belén Salvatierra-Vicario, Yaiza García-Ibáñez, Laura Baldizán-Velasco, Carmelo Morales-Angulo, Evaluation of Patients Diagnosed with Sudden Profound Unilateral Hearing Loss: 12-year Retrospective Study , Revista ORL: Vol. 13 No. S2 (2022): XXVIII Congreso de la Sociedad Otorrinolaringológica de Castilla y León, Cantabria y La Rioja Valladolid 2, 3 y 4 de junio de 2022
- Andrea Martínez-Camerano, Carmelo Morales-Angulo, Aida Veiga-Alonso, Julia Fernandez-Enseñat, Vasovagal syncope and head and neck tumors. Retrospective study , Revista ORL: Vol. 16 No. 2 (2025)
- Leticia Acle-Cervera, Patricia Corriols-Noval, María Teresa Gil-Aguilar, Ana Foltalva-Romero, Carmelo Morales-Angulo, Osteogenesis imperfecta: Hearing and genetic study of a family with a mutation in the COL1A1 gene , Revista ORL: Vol. 10 No. 2 (2019)
- Minerva Rodríguez-Martín, Laura Baldizán-Velasco, Eugenia López-Simón, Ramón Cobo-Díaz, Belén Salvatierra-Vicario, Yaiza García-Ibáñez, Carmelo Morales-Angulo, Otologic Symptoms as the First manifestation of IgG4-Related Disease , Revista ORL: Vol. 13 No. S2 (2022): XXVIII Congreso de la Sociedad Otorrinolaringológica de Castilla y León, Cantabria y La Rioja Valladolid 2, 3 y 4 de junio de 2022
- Natalia Castañeda-Curto, MARIA Martino-González, Carmelo Morales-Angulo, Bazex syndrome related to oropharyngeal carcinoma. Case report , Revista ORL: Vol. 10 No. 3 (2019)
- Gloria Río-González, Patricia Corriols-Noval, Aiara Viana-Cora, Nathalia Castillo-Ledesma, Eugenia López-Simón, Carmelo Morales-Angulo, Incidence and clinical and epidemiological characteristic of nasopharynx carcinoma in Cantabria in 2014 , Revista ORL: Vol. 10 No. 3 (2019)
- Minerva Rodriguez-Martin, Elena Marin-Diez, Aida Veiga-Alonso, Carmelo Morales-Angulo, Squamous cell carcinoma of the nasal septum secondary to cocaine use. A case report , Revista ORL: Vol. 16 No. 1 (2025)
- , , , , Complications of nasopharyngeal swab in the diagnosis of suspected COVID-19 , Revista ORL: Vol. 16 No. 2 (2025)
- Natalia Castañeda-Curto, M.ª Teresa Gil-Aguilar, Aiara Viana-Cora, Carmelo Morales-Angulo, Retrospective study of acute epiglottitis in Cantabria in the period 1992-2015 , Revista ORL: Vol. 9 No. 1 (2018)
Similar Articles
- , , , , Complications of nasopharyngeal swab in the diagnosis of suspected COVID-19 , Revista ORL: Vol. 16 No. 2 (2025)
- Jose Manuel SERRADILLA-LÓPEZ, Luis CABRERA-PÉREZ, Ángel BATUECAS-CALETRIO, Victoria DÍAZ-SÁNCHEZ, Marta NÚÑEZ-GUTIERREZ, Pedro BLANCO-PÉREZ, Felipe GÓMEZ CAMINERO-LÓPEZ, Susana MARCOS-ALONSO, PET/CT in head and neck cancer: staging, treatment, and detection of synchronous tumors , Revista ORL: Vol. 17 No. 3 (2026)
- Belén Salvatierra-Vicario, Patricia Corriols-Noval, Minerva Rodríguez-Martín, Ramón Cobo-Díaz, Aida Veiga-Alonso, Carmelo Morales-Angulo, Sergio Obeso-Agüera, Robot assisted lingual tonsillectomy for the diagnosis of unknown primary squamous cell carcinoma , Revista ORL: Vol. 15 No. 4 (2024)
- José Granell, Kyu Eun Lee, Remote access thyroid surgery , Revista ORL: Vol. 11 No. 2 (2020)
- Javier Riancho, Eloy Rodríguez-Rodríguez, Andrea Martínez-Camerano, Carmelo Morales-Angulo, Myelitis and anti-Yo antibodies: a paraneoplastic syndrome associated with nasopharyngeal carcinoma detected by positron emission tomography. A case report , Revista ORL: Vol. 16 No. 1 (2025)
- Juan Manuel Granados Sitges, Jose Granell Navarro, Isabel Fernández Rastrilla, Hernán López Tello, Raimundo Gutierrrez Fonseca, Epidemiological Trends and Diagnostic Evolution of HPV-Related Oropharyngeal Cancer in a Spanish Tertiary Center: A 12-Year Retrospective Study , Revista ORL: Vol. 17 No. 1 (2026)
- Ana Herrero Ruiz, Ana Isabel Sánchez Marcos, María Angeles Martín Almendra, María García Duque, Louisa Myriam Beaulieu Oriol, María Teresa Mories Álvarez, Diagnosis of medullary thyroid carcinoma , Revista ORL: Vol. 13 No. 2 (2022)
- Gloria Río-González, Patricia Corriols-Noval, Aiara Viana-Cora, Nathalia Castillo-Ledesma, Eugenia López-Simón, Carmelo Morales-Angulo, Incidence and clinical and epidemiological characteristic of nasopharynx carcinoma in Cantabria in 2014 , Revista ORL: Vol. 10 No. 3 (2019)
- María San Millán-González, Luis Miguel Torres-Morientes, Marta Alonso-Mesonero, Jaime Santos-Pérez, Dermoplatysmal flap reconstruction following buccal squamous cell carcinoma resection , Revista ORL: Vol. 16 No. 2 (2025)
- Chiara MONOPOLI-ROCA, Guillermo CORONEL-TOUMA, Luis CABRERA-PÉREZ, José SERRADILLA-LÓPEZ, Pedro BLANCO-PÉREZ, Marta NÚÑEZ-GUTIÉRREZ, Utility of Sentinel Lymph Node Biopsy in Head and Neck Melanoma. A Retrospective Longitudinal Cohort Study , Revista ORL: Vol. 17 No. 3 (2026)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 > >>
You may also start an advanced similarity search for this article.
Downloads
Download data is not yet available.
+
−