Anterior Clinoid Metastasis Removed Extradurally: First Case Report

Anterior Clinoid Metastasis as First Presentation of a Signet Ring Cell Carcinoma: An Intriguing Diagnosis

Background  We report an extremely unusual case of anterior clinoid process (ACP) metastasis as the first presentation of a signet ring cell carcinoma.

Case Description  A 54-year-old female patient presented with right-sided visual disturbances due to optic nerve compression from a computed tomography (CT)-identified right anterior clinoid bone lesion. Contrast-enhanced magnetic resonance imaging showed an extra-axial, well-bordered enhancing mass extending from the right ACP toward the inner lumen of the optic canal. Pterional approach was adopted to remove the lesion and decompress the optic canal. Histological examination demonstrated a metastasis from a signet ring cell carcinoma. Postoperative CT showed near-total resection of the tumor and decompression of the optic canal. Visual defect remained unchanged.

Conclusion  Metastasis should be considered in the differential diagnosis of the ACP lesions. The early suspicion and identification of this extremely rare pathological entity can be helpful for the prompt management of patients, especially in the absence of any other signs of oncological diseases.

Imaging of extracranial head and neck lesions in cancer patients: a symptom-based approach

Besides intracranial lesions, neurological symptoms are also caused in cancer patients by extracranial lesions in the head and neck. Common symptoms caused by such lesions include visual loss, visual field defect, diplopia, ptosis, sensory abnormalities of the head and neck region, facial nerve palsy, dysphagia, dysarthria, hoarseness, and syncope. Some cancer patients often have multiple cranial nerve involvement, which is associated with several syndromes such as jugular foramen syndrome. The main causes of cranial nerve dysfunction due to extracranial lesions include bone and nodal metastasis, perineural tumor spread, inflammation, and radiation injury. The location of the lesions causing the neurological symptom may be estimated by the symptoms and physical examination. However, CT/MRI is critical for reaching the final diagnosis and for treatment planning and management of the cancer patients. Moreover, early identification of the extracranial lesions may significantly affect patient care and alter outcomes. Thus, radiologists should be familiar with imaging findings of the common neurological disorders and the complex anatomy of the head and neck region, which should be checked in cancer patients with neurological symptoms.