Facial nerve palsy as the first sign of late breast cancer metastasis to the temporal bone

Zoran Dudvarski; Nenad Arsović; Milovan Dimitrijević; Saša Jakovljević; Novica  Boričić; Ivan Boričić

doi:10.2298/VSP210212040D

Zoran Dudvarski University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Nenad Arsović University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Milovan Dimitrijević University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Saša Jakovljević University Clinical Center of Serbia, Clinic of Otorhinolaryngology and Maxillofacial Surgery, Belgrade, Serbia
Novica Boričić University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Ivan Boričić University of Belgrade, Faculty of Medicine, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP210212040D

Keywords: breast neoplasms, facial nerve diseases, immunohistochemistry, neoplasm metastasis, temporal bone, tomography, x-ray computed, treatment outcome

Abstract

Introduction. Late metastases of malignant tumors in the temporal bone are very rare lesions. They can be asymptomatic for a long time and usually manifest themselves in the form of hearing loss, dizziness, tinnitus, and paralysis of the facial nerve. Modern radiological diagnostics and explorative surgery with biopsy are essential for diagnosis. Case report. We present a rare and unusual case of a 66-year-old female patient with facial nerve paralysis that appeared as the first sign of metastatic breast cancer in the temporal bone 10 years after treatment. A sudden hearing loss and dizziness occurred six months later, and the value of CA 15-3 was elevated. Scintigraphy pointed to susceptible metastatic deposits of the axial skeleton without lesions in the temporal bone. Finally, repeated computed tomography revealed osteolytic changes in the temporal bone six months after that. Immunohistochemical analysis of mastoid tissue samples confirmed that it was a breast cancer metastasis. One year after palliative radiotherapy and oral hormone therapy, a patient had a good general condition with a better function of the facial nerve. Conclusion. A high degree of clinical suspicion sometimes requires repeated radiological diagnostics in order to detect osteolytic metastatic changes in the temporal bone but also in other bone structures within the hematogenous dissemination of the malignant disease.

References

Castillo MN, Serdà RF, Molins BA, Martí PJ, Claramunt CF, Scherdel PE. Facial paralysis of metastatic origin. Review of metastatic lesions of the temporal bone. An Otorrinolaringol Ibero Am 2000; 27(3): 255‒63. (Spanish)

Streitmann MJ, Sismanis A. Metastatic carcinoma of the tem-poral bone. Am J Otol 1996; 17(5): 780‒3.

Gabrovski N, Poptodorov G, Velinov N, Gabrovski S. Late metas-tases from breast cancer-report of two cases. Khirurgiia (Sofi-ia) 2010; (1): 62‒6. (Bulgarian)

Gloria-Cruz TI, Schachern PA, Paparella MM, Adams GL, Fulton SE. Metastases to temporal bones from primary nonsystemic malignant neoplasms. Arch Otolaryngol Head Neck Surg 2000; 126(2): 209‒14.

Lan MY, Shiao AS, Li WY. Facial paralysis caused by metasta-sis of breast carcinoma to the temporal bone. J Chin Med As-soc 2004; 67(11): 587‒90.

Berlinger NT, Koutroupas S, Adams G, Maisel R. Patterns of in-volvement of the temporal bone in metastatic and systemic malignancy. Laryngoscope 1980; 90(4): 619‒27.

Jalava-Karvinen P, Kemppainen J, Saario R, Kotilainen P. Metasta-sis in the temporal bone mimicking temporal arteritis. J Clin Rheumatol 2010; 16(1): 19‒21.

Tsunoda A, Tanaka Y, Sato T, Kirimura S, Kitamura K. Vertigo by Breast Cancer Metastasis 33 Years after Treatment. Intern Med 2016; 55(3): 311‒3.

Sari S, Battal BV, Akgun V, Salih Deveci MS. Metastasis of Breast Carcinoma to the External Auditory Canal: Report of an Unusual Case and Literature Review. J Belg Soc Radiol 2015; 99(1): 53‒7.

Ferri GG, Castellucci A, Vecchio VD, Brandolini C. Skull Base Metastasis of a Breast Carcinoma. Clin Surg 2016; 1: 1105.

Maddox HE 3rd. Metastatic tumors of the temporal bone. Ann Oto Rhinol Larygol 1967; 76(1): 149‒65.

Schuknecht HF, Allam AF, Murakami Y. Pathology of second-ary malignant tumors of the temporal bone. Ann Otol Rhinol Laryngol 1968; 77(1): 5‒22.

Jung TT, Jun BH, Shea D, Paparella MM. Primary and secondary tumors of the facial nerve. A temporal bone study. Arch Oto-laryngol Head Neck Surg 1986; 112(12): 1269‒73.

Saito H, Chinzei K, Furuta M. Pathological features of periph-eral facial paralysis caused by malignant tumour. Acta Oto-laryngol Suppl 1988; 446: 165‒71.

Breadon GE, Cody DT, Weiland LH. Facial palsy: unusual eti-ology. Laryngoscope 1977; 87(1): 26‒34.

Svendsen ML, Gammelager H, Sværke C, Yong M, Chia VM, Christiansen CF, et al. Hospital visits among women with skel-etal-related events secondary to breast cancer and bone metas-tases: a nationwide population-based cohort study in Den-mark. Clin Epidemiol 2013; 5: 97‒103.

Zhang H, Zhu W, Biskup E, Yang W, Yang Z, Wang H, et al. In-cidence, risk factors and prognostic characteristics of bone metastases and skeletal-related events (SREs) in breast cancer patients: a systematic review of the real world data. J Bone Oncol 2018; 11: 38‒50.

Harries M, Taylor A, Holmberg L, Agbaje O, Garmo H, Kabilan S, et al. Incidence of bone metastases and survival after a di-agnosis of bone metastases in breast cancer patients. Cancer Epidemiol 2014; 38(4): 427‒34.