A case of mediastinal lymph node cancer of unknown primary origin discovered in paraneoplastic neurological syndrome and positive for anti-Hu antibodies

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A 71-year-old female was seen by a previous physician for gait disturbance that had worsened a month prior. Neurological examination led to a diagnosis of sensory ataxia due to peripheral neuropathy. The patient tested positive for anti-Hu antibodies, so nervous system paraneoplastic syndrome was suspected, and the patient was referred to this hospital. An FDG-PET scan revealed masses with clearly defined margins concentrated on the left side of the aortic arch and in the left supraclavicular fossa, so the patient was diagnosed with an anterior mediastinal tumor and nervous system paraneoplastic syndrome. The patient then underwent surgery. The surgical approach was a median sternotomy. Intraoperative frozen section diagnosis revealed a malignant epithelial tumor. Given the potential for thymic carcinoma, an extended thymectomy was performed and masses in the left supraclavicular fossa were removed. Small cell carcinoma was detected in permanent specimens, and the patient was diagnosed with cancer of unknown primary origin in mediastinal lymph nodes. The patients postoperative course was satisfactory, and the patient began 4 courses of chemotherapy (CBDCA+VP16) a month later. Neurologic symptoms have disappeared, and the patient is now able to walk unassisted. Gait disturbance testing revealed cancer in the mediastinal lymph nodes that tested positive for anti-Hu antibodies, as reported here.