We previously suggested to perform a paraneoplastic screening regardless of clinical presentation in AQP4 positive NMOSD despite the lack of specific clinical features in suspected paraneoplastic NMOSD, since several cases of paraneoplastic NMOSD have been reported and AQP4 tumor expression can occur even in patients with atypical oncological accompaniments (as non-adenocarcinomas) (2). The gene discussed is AQP4; the disease is adenocarcinoma.