Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis: have you checked the ovaries?

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Kirsty Cleverly 1, Pietro Gambadauro 2 and Ramesan Navaratnarajah 1
1. Bart’s Health NHS Trust, London, UK; 2. Karolinska Institutet, Stockholm, Sweden
Acta Obstet Gynecol Scand. 2014;93(7):712-5. DOI: 10.1111/aogs.12386

Abstract

Anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis is an autoimmune disorder which can occur as a paraneoplastic phenomenon related to ovarian teratomas. It is a serious but reversible condition with improved outcomes following prompt tumor removal.

We report two cases from our recent experience. In the first case a small poorly described lesion, confirmed as a teratoma only at histology, was managed by laparoscopic oopohorectomy. In the second case a large teratoma was managed by laparoscopic cystectomy. Post-operatively both women made a good recovery.

Gynecologists may be called upon to perform ovarian surgery outside of normal surgical indications, in young women who will often lack capacity to consent. Fertility sparing ovarian cystectomy is possible in some cases, but will be challenging for small deeply buried tumors. Blind bilateral oophorectomy has been performed successfully in extreme cases. Information of the benefit of ovarian surgery will be essential to the surgeon during pre-operative counseling.

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Acta Obstetricia et Gynecologica Scandinavica: Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis: have you checked the ovaries?