Paraneoplastic neurological syndromes associated with mediastinal tumors

Clinical presentation of mediastinal tumors may be related to the invasion of the adjacent structures leading, in some cases, to life-threatening emergencies. However in some patients, these tumors may be heralded by non-local symptoms due to paraneoplastic neurological diseases (PND) caused by an autoimmune response to antigens co-expressed by the cancer and the nervous system. PND may affect multiple levels of the nervous system from the cerebral cortex to the neuromuscular junction and the muscle. Early diagnosis of PND can be critical for the detection of a new or recurrent occult tumor. Neural-specific autoantibodies serve as diagnostic markers for PND and in some cases may predict the presence of a specific type of cancer. This review focuses on the clinical and immunological characteristics of the PND associated with the most frequent mediastinal cancers, namely thymoma, lymphoma and germ cell tumors.