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Immunohistochemical analysis of the immune reaction in the nervous system in paraneoplastic encephalomyelitis

Departments of Neurology (Dr. Graus), Pathology (Drs. Ribalta and Campo), Internal Medicine (Drs. Monforte and Urbano), and Hematology (Dr. Rozman), Hospital Clinic i Provincial, Barcelona, Spain.

We examined frozen sections of frontal cortex, medulla, and dorsal root ganglia from a patient with small-cell lung cancer and paraneoplastic encephalomyelitis, involving the medulla and dorsal root ganglia, with a panel of antibodies reactive for IgG, IgM, C3, B cells, T cells, T cell subsets, macrophages, and class I and II (HLA-DR) major histocompatibility complex (MHC) antigens. We detected an antineuronal antibody (anti-Hu) in the serum and CSF of the patient and found deposits of IgG in the periphery of some neurons in dorsal root ganglia. The infiltrates were almost exclusively T cells with a predominance of CD8-positive cells. Neurons did not express class I or II MHC antigens. Satellite cells in the dorsal root ganglia from the patient and controls were HLA-DR-positive. These data indicate that CD8-positive T cells predominate in the inflammatory infiltrates of paraneoplastic encephalomyelitis. IgG deposits may be relevant in the damage of the sensory neurons.

Address correspondence and reprint requests to Dr. Francesc Graus, Department of Neurology, Hospital Clinic i Provincial, Villarroel 170, 08036 Barcelona, Spain.

Supported in part by a grant from the Fondo de Investigaciones Sanitarias, Madrid, Spain.

Presented in part at the 41st annual meeting of the American Academy of Neurology, Chicago, IL, April 1989.

Received May 24, 1989. Accepted for publication in final form July 10, 1989.

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