Lung cancer presenting with trigeminal neuropathy

Successful osimertinib treatment for Meckel's cave metastasis: a case report

Osimertinib has emerged as the standard first-line treatment for advanced non-small cell lung cancer (NSCLC) with EGFR mutations, offering improved tolerability and demonstrating superior efficacy against brain metastases in comparison with other tyrosine kinase inhibitors. The Meckel's cave is a dural recess in the posteromedial part of the middle cranial fossa that acts as a conduit for the trigeminal nerve between the anterior pontine cisterna and the cavernous sinus, and houses the Gasserian ganglion and proximal radicle of the trigeminal nerve. Trigeminal neuropathy, characterized by numbness and dysesthesia of the skin and mucous membranes of the face, poses diagnostic challenges and often requires differentiation from conditions, such as compression neuropathy, inflammation, and drug-induced reactions. Here, we report the case of Meckel's cave metastasis. She presented headache, anorexia, left facial numbness, and pain indicative of trigeminal neuropathy. Imaging revealed metastasis to Meckel's cave, consistent with her clinical symptoms. EGFR L858R mutation was detected by primary lesion of the lung DNA analysis. Treatment with osimertinib led to regression of the primary tumor and improvement of the trigeminal neuropathy within 3 months. Importantly, our review of the relevant literature identified only two similar cases with metastasis of lung adenocarcinoma to Meckel's cave. Ours was the only case in which symptom resolution was achieved. We underscore the utility of MRI and PET/CT studies in evaluating trigeminal-related symptoms and discuss imaging characteristics that may aid in their differentiation.

Metastatic epithelial ovarian cancer to Meckel's cave with leptomeningeal spread at time of diagnosis

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Rare case of aggressive epithelial ovarian cancer with brain metastasis at time of initial diagnosis.

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First reported case of epithelial ovarian cancer with invasion of Meckel’s cave.

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Increasing numbers of ovarian cancer with brain metastasis in uncommon sites of recurrence.

Background

Brain metastasis occurs in 1–2.5% of epithelial ovarian cancer (EOC) cases and carries a poor prognosis. Typically, brain metastases arise 2–3 years following the primary diagnosis of EOC. Malignant spread to the brain discovered at the time of initial ovarian cancer presentation is exceedingly rare with minimal reported cases in literature.

Case

This is a rare case of highly aggressive EOC in a previously healthy 32-year-old woman with evidence of brain, bone, and vertebral metastasis at the time of initial diagnosis. This is the first reported case of EOC with spread to Meckel’s cave with symptoms consistent with trigeminal nerve disruption. The disease rapidly progressed through radiation and front-line chemotherapy.

Conclusion

This report highlights the first reported case of EOC with invasion of Meckel’s cave—present at time of diagnosis. Consistent with most cases in the literature of brain metastasis in the setting of EOC, our patient had a highly aggressive tumor associated with a poor prognosis. With better primary management of EOC, along with increased overall survival in EOC patients following spread to the brain secondary to multimodal therapies, we can continue to expect increasing numbers of brain metastasis with uncommon sites of recurrence.

Lung Adenocarcinoma with Cheek Dysesthesia as an Initial Symptom: A Case Report and Literature Review

Metastasis from lung carcinoma to the sphenoid bone is rare. Patients with symptoms related to sphenoid bone metastasis as the initial presentation of carcinoma are thus also rare. Herein, we report the case of a patient presenting with only cheek dysesthesia as the first sign of lung adenocarcinoma. The 74-year-old woman presented with a 2-month history of left cheek dysesthesia. CT showed a tumor around 2.5 cm in diameter with heterogeneous enhancement of the central focus at the left foramen rotundum in the sphenoid bone. We endoscopically biopsied the tumor through the left sphenoid sinus. Results of histologic examination were consistent with lung adenocarcinoma. FDG-PET/CT analysis demonstrated lung carcinoma that had already metastasized to mediastinal lymph nodes and multiple bones, such as the ribs and lumbar vertebras, in addition to the sphenoid bone. As EGFR gene mutation (p.L858R) was identified, the patient was treated with oral gefinitib. This treatment proved quite effective, and the patient remains alive without tumor growth as of 18 months.

Trigeminal neuralgia as the first clinical manifestation of anti-hu paraneoplastic syndrome induced by a borderline ovarian mucinous tumor

Paraneoplastic neurologic syndrome (PNS) is an uncommon manifestation of cancer that is not caused by the tumor or metastasis. Trigeminal neuralgia (TN) is an initial symptom of this disease, but it has rarely been reported in the literature. Here, we report the case of a 76-year-old woman who presented with classic TN, followed by limbic encephalitis due to an underlying ovarian intestinal-type mucinous borderline tumor, with the presence of anti-Hu antibodies. She recovered quickly after removal of the tumor and was essentially free of symptoms 2 weeks after surgery. Because PNS precedes the tumor in approximately 60% of cases, its rapid detection and treatment are crucial. Therefore, we propose that PNS be considered during the management of TN when brain imaging is normal, as it is followed by other central and/or peripheral neurological manifestations as well as the presence of systemic symptoms such as anemia, fatigability, loss of appetite, or weight loss.

Pulmonary adenocarcinoma metastasis to a dorsal root ganglion: a case report and review of the literature

INTRODUCTION

The dorsal root ganglion is a rare manifestation of metastatic spread. We report what we believe to be the first case of metastasis of a pulmonary adenocarcinoma to the lumbar dorsal root ganglion. Only four descriptions for different primary tumors spreading to the dorsal root ganglion have been described in the literature so far.

CASE PRESENTATION

A 70-year-old Caucasian woman with a four-month history of left-sided lumbar radiculopathy was admitted to our department under the assumption of a herniated lumbar disc. Her past medical history included a pulmonary adenocarcinoma and invasive ductal breast cancer.Lumbar magnetic resonance imaging revealed a space-occupying mass in her left neuroforamen L3-L4 with compression of her L3 nerve root. Neurinoma was taken into account as a differential diagnosis, although not considered typical. Surgery revealed a metastasis of pulmonary adenocarcinoma to her dorsal root ganglion.

CONCLUSIONS

Dorsal root ganglion metastases seem to be extremely rare and can mimic primary local nerve sheath tumors. Therefore, they usually present as incidental findings. Resection should be performed strictly under intraoperative monitoring as tumor spread between the nerve fibers is commonly observed. Metastases should be taken into account in spinal nerve tumors involving the dorsal root ganglion, especially in patients harboring known malignant diseases. The low incidence means that no clear treatment advice can be given. Resection is possible under intraoperative monitoring and relieves neurological symptoms.

Subclinical peripheral neuropathy is a common finding in colorectal cancer patients prior to chemotherapy

PURPOSE

Of the numerous complications associated with cancer and cancer treatment, peripheral neuropathy is a deleterious and persistent patient complaint commonly attributed to chemotherapy. The present study investigated the occurrence of subclinical peripheral neuropathy in patients with colorectal cancer before the initiation of chemotherapy.

EXPERIMENTAL DESIGN

Fifty-two patients underwent extensive quantitative sensory testing (QST) before receiving chemotherapy. Changes in multiple functions of primary afferent fibers were assessed and compared with a group of healthy control subjects. Skin temperature, sensorimotor function, sharpness detection, and thermal detection were measured, as was touch detection, using both conventional (von Frey monofilaments) and novel (Bumps detection test) methodology.

RESULTS

Patients had subclinical deficits, especially in sensorimotor function, detection of thermal stimuli, and touch detection that were present before the initiation of chemotherapy. The measured impairment in touch sensation was especially pronounced when using the Bumps detection test.

CONCLUSIONS

The patients with colorectal cancer in this study exhibited deficits in sensory function before undergoing chemotherapy treatment, implicating the disease itself as a contributing factor in chemotherapy-induced peripheral neuropathy. The widespread nature of the observed deficits further indicated that cancer is affecting multiple primary afferent subtypes. Specific to the finding of impaired touch sensation, results from this study highlight the use of newly used methodology, the Bumps detection test, as a sensitive and useful tool in the early detection of peripheral neuropathy.