Case Report: Neuromyelitis optica spectrum disorder associated with gastric cardia and pancreatic cancers: clinical features and oncological implications.

This article reports two elderly patients with Neuromyelitis Optica Spectrum Disorder (NMOSD) associated with gastric cardia cancer and pancreatic cancer, respectively each presenting distinctive clinical manifestations and diagnostic challenges. Case 1 involved a 69-year-old male who developed stroke-like symptoms after surgery for gastric cardia cancer, which later progressed to optic neuritis, confirmed by positive aquaporin-4 (AQP4) antibodies in both serum and cerebrospinal fluid. Case 2 was a 64-year-old female whose initial presentation included optic neuritis and myelitis. Early cervical spinal MRI revealed a focal space-occupying lesion, and AQP4 antibodies were negative, complicating the diagnosis. However, the diagnosis was ultimately established based on characteristic clinical symptoms, a marked response to corticosteroid therapy, and the appearance of longitudinally extensive transverse myelitis (LETM) on imaging during relapse. This report describes the dynamic imaging evolution of spinal cord inflammatory demyelinating pseudotumor in NMOSD. It also expands the spectrum of tumors associated with NMOSD to include gastric cardia cancer and pancreatic cancer. It emphasizes that in elderly patients or those with atypical NMOSD presentations, potential oncological etiologies should be considered and targeted malignancy evaluation should be performed. Furthermore, a multidisciplinary collaborative approach is essential to develop individualized treatment strategies that simultaneously address both the neoplasm and the immune-mediated demyelinating disorder.