A 74-year-old woman was admitted to our centre complaining of nausea and vomiting, gait instability, horizontal binocular diplopia and speech disorders for one week.
She had a history of allergy to contrast-enhanced iodine and ductal breast carcinoma with positive and negative estrogen and progesterone receptors three years earlier.
Surgical treatment and residual breast radiotherapy were performed.
He was currently in remission and was treated with anastrozole.
The physical examination revealed a speech in silence, gait disturbance, rapid rotational component in all four limbs and visual impairment, right cranial nerve palsy, disabling truncal ataxia with inability to walk.
The superior cortical functions were preserved.
The general analysis showed normal biochemical blood count and hemostasis.
Usual tumor markers (CA 125, CA 15-3, CA19-9, glycoprotein and alpha-blocker antigen) were normal.
A neuroimaging study was performed with a normal brain computed tomography (CT) and magnetic resonance imaging (MRI).
DCP was isolated and anti-Yo antibodies that were positive to high titers in serum and CSF were determined.
While the study of occult neoplasia was performed, treatment with immunoglobulins, cyclophosphamide and methylprednisolone was started without evident clinical improvement.
Abdominal CT, mammography, MRI of the breast and bone scintigraphy showed no evidence of tumor pathology.
Positron emission tomography (PET) showed two 15 mm nodular lesions located behind the pancreatic head compatible with malignant etiology mesenchymal adenopathies.
No other sites of malignancy were observed.
Laparotomy and biopsy were performed.
The pathological study showed the presence of metastasis of poorly differentiated adenocarcinoma.
The diagnosis of metastasis from breast carcinoma was considered, and the On Medical Service initiated treatment with epirubicin and cyclophosphamide.
The clinical evolution of the patient was stabilization without improvement of signs and symptoms, the patient was not able to perform activities of daily living alone and needs wheels for displacements.
