I had a muscle biopsy to rule out metabolic disease which showed a CD-3, CD-8 T-cell perivascular infiltrate in the small caliber vessels of the muscle, with death of associated nerves and neurogenic atrophy of muscle fibers with some necrosis. My biopsy was read by a neuromuscular pathologist here and sent to Mayo as a consult. All agreed that I have either an autoimmune disease (either mixed connective tissue or polymyositis) or a paraneoplastic neurological syndrome. My rheumy spoke with neurologists at Mayo and Johns Hopkins who favor paraneoplastic based on the lack of clear cut criteria on the biopsy and my symptoms.

The next step was to do imaging studies for occult tumors by mammography, chest x-ray, and colonoscopy. My HMO approved all that, since they are age-appropriate screenings anyway. I had bloodwork done for lymphoma, monoclonal gammopathies, breast and ovarian cancer, and also for ANNA's (antineuronal nuclear antibodies). There are many other antibodies associated with tumors that most frequently cause paraneoplastic syndromes, but I guess the trick is figuring out which one to order based on clinical presentation. A CT scan of chest, abdomen, and pelvis is kind of routine when paraneoplastic syndrome is suspected, but my healthplan does not believe there is enough evidence to justify it. Maybe they want a positive antibody first? Problem is an identifiable antibody is present in only about 30% of cases. Hmmmm. I'll refrain from ranting on HMO's and "patient care" and "preventive medicine".

Athena