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LETTER TO EDITOR
Year : 2010  |  Volume : 58  |  Issue : 4  |  Page : 666-668

Occipital condyle syndrome as a rare metastatic presentation of small cell lung carcinoma


Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi- 110085, India

Date of Acceptance02-Jul-2009
Date of Web Publication24-Aug-2010

Correspondence Address:
Ankur Bahl
Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi- 110085
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.68686

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How to cite this article:
Bahl A, Suresh P, Talwar V, Doval D C. Occipital condyle syndrome as a rare metastatic presentation of small cell lung carcinoma. Neurol India 2010;58:666-8

How to cite this URL:
Bahl A, Suresh P, Talwar V, Doval D C. Occipital condyle syndrome as a rare metastatic presentation of small cell lung carcinoma. Neurol India [serial online] 2010 [cited 2019 Aug 23];58:666-8. Available from: http://www.neurologyindia.com/text.asp?2010/58/4/666/68686


Sir,

Occipital condyle syndrome (OCS) is a rare clinical syndrome and consists of unilateral occipital region pain associated with same side hypoglossal nerve palsy and most commonly occurs due to the skull base metastasis. [1] Metastatic diseases to the occipital condyle have been reported rarely. Till now only two cases of lung carcinoma (one small cell lung carcinoma and other squamous cell carcinoma) causing OCS have been. [2]

This 63-year-old man, a known diabetic and hypertensive, presented with complaints of severe constant pain in left occipital area, radiating over the head since one month. There was history of heaviness of the tongue with difficulty in eating and radiating pain down the spine on coughing. Clinically there was wasting of the left half of the tongue with deviation to the same side with no evidence of any other cranial nerve palsy. There was evidence of diabetic neuropathy.

Biochemical and hematological investigations were normal. Serum ionized calcium and alkaline phosphatase were raised (1.7 mmol/l and 700 U/L, respectively). Contrast enhanced computed tomography (CECT) head was suggestive of metastatic lesion involving the skull and the scalp tissue. Magnetic Resonance imaging (MRI) head revealed enhancing soft tissue lesions in skull vault (calvarium) in left parietal region posteriorly with destruction of linear table, focal thickening of underlying dura, enhancing soft tissue mass in left jugular fossa infiltrating CP angle cistern, and lacunar infarct in right basal ganglia. MRI spine showed enhancing soft tissue mass lesion at C1 level, left occipital condyle, adjoining part of occipital bone and collapse of D8 vertebra [Figure 1]. Left parietal craniotomy was done and per operative finding revealed involvement of extra calvarial soft tissue, bone in the form of osteolysis and invasion of dura by the tumor. Histopathology report of the excised tissue was suggestive of small to medium sized malignant cuboidal cells with ovoid hyperchromatic nuclei suggestive of small cell carcinoma [Figure 2]. Immunohistocytochemistry (IHC) revealed CK, CD 56 and synaptophysin as positive while TTF-1 and chromogranin were negative. Technetium methylidene diphosphonate (Tc-99 MDP) bone scan showed increased uptake in collapsed D8 vertebra and in right sacro-iliac joint. CECT chest was done to find out the primary lesion which revealed soft tissue mass in right upper lobe with bilateral enlarged mediastinal lymph nodes in pre, para tracheal, pre carinal, AP window, and pre vascular regions. CT-guided fine needle aspiration cytology (FNAC) of the lung was suggestive of small cell carcinoma. Liver showed multiple hypodense lesions in both lobes on CECT abdomen.
Figure 1 :MRI head showing enhancing soft tissue mass lesion seen involving left lateral mass at C1 level, left occipital condyle left jugular fossa and infiltrating CP angle cistern

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Figure 2 :H and E section showing small to medium sized malignant cuboidal cells with ovoid hyperchromatic neuclei

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He was managed as SCLC extensive stage with osseous, hepatic metastasis. He was given iv bisphosphonates and palliative radiation to the occiput and cervical spine. On completion of involved field radiotherapy (IFRT), he was started on carboplatin and etoposide-based palliative chemotherapy.

Like all bones, skull is a common site of metastasis from systemic cancers. Skull base metastasis from distant tumors occurs in 4% of all the cancer patients. [3] The two most causes of skull metastasis are breast and prostate cancer accounting for 40% and 12% of the cases. [3] In one case series prostate cancer was the most common cause of skull metastasis in men while breast cancer was leading cause in women. [4] However, dissemination to the skull base may occur in many other cancers. [1],[5],[6] OCS is rare and is usually associated with skull base metastasis and often underdiagnosed. Till date only two case reports of lung malignancy (one squamous cell carcinoma and other small cell carcinoma) with skull metastasis causing OCS have been reported. [2] In almost all the patients, headache preceded the tongue paresis often by days to weeks as in our patient. [7] As with our patient, diagnosing the underlying cause of OCS can be challenging as our patient was only symptomatic for OCS and there were no sign and symptoms suggestive of underlying lung malignancy.

 
 » References Top

1.Capobianco DJ, Brazis PW, Rubino FA, Dalton JN. Occipital condyle syndrome. Headache 2002;42:142-6.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Jeremy JM, Sudeep S, Mary D. Occipital condyle syndrome as the first sign of metastatic cancer.Can J Neurol Sci 2007;34:456-9.  Back to cited text no. 2      
3.Greenberg HS, Deck MD, Vikram B, Chu FC, Posner JB. Metastasis to the base of the skull:clinical finding in 43 patients. Neurology 1981;31:530-7  Back to cited text no. 3      
4.Florence LD, Sophie T, Nadine MD, Jerzy H. Skull base metastases. J Neurooncol 2005;75:63-9.  Back to cited text no. 4      
5.Jansen BP, Sillevis Smitt PA. Skull and dural metastases. In: Schiff D, Wen PY, editor. Cancer Neurology in Clinical Practice. Totowa, New Jersey: Humana Press; 2002. p. 87-92.  Back to cited text no. 5      
6.Mubaidin SI, Sunna JB, Beiruti MA, Shennak MM, Ayoub MS. Renal cell carcinoma presenting as Garcin's syndrome. J Neurol Neurosurg Psychiatry 1990;53:613-4.   Back to cited text no. 6  [PUBMED]  [FULLTEXT]  
7.Salamanca JI, Murrita C, Jara J. Occipital condyle syndrome guiding diagnosis to metastatic prostate cancer. Int J Urol 2006;13:1022-4.  Back to cited text no. 7      


    Figures

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Headache: The Journal of Head and Face Pain. 2017; 57(5): 699
[Pubmed] | [DOI]



 

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