Abstract Details

Title Metastatic Hepatocellular Carcinoma Presenting with Multiple Lower Cranial Nerve Palsies (Collet-Sicard Syndrome)

Topic Neuro-oncology

Presentation(s) P06 - (-)

Poster/Presentation
Number 143

Objective

Background BACKGROUND: 62 year-old male with a history of alcoholic cirrhosis presented with three-months history of headache, dysphagia, dysarthria and dysphonia.

Design/Methods DESIGN/METHODS: Initial neurological evaluation for headache was unremarkable. Speech evaluation was suggestive of mild weakness and atrophy of the left tongue with leftward deviation upon protrusion. Re-evaluation in 2 months: - marked left tongue weakness, atrophy and fasciculations; - uvula deviated to right; - weakness of the left trapezius and sternocleidomastoid.

Results RESULTS: Alpha fetoprotein (AFP): moderately elevated. Initial evaluation with unenhanced brain MRI: non-diagnostic; Repeat MRI brain with contrast: expansile mass in the clivus with extension into the left occipital condyle. Workup for primary malignancy: - CT abdomen/pelvis: mild splenomegaly and a 'subtle hypodense' 3.3 cm mass in the right hepatic lobe. - Abdominal MRI: non-diagnostic; - USG abdomen: 3.3 cm echodense and fairly well marginated mass in right lobe of the liver most likely hemangioma. - Whole body FDG-PET: mild uptake in the skull base without other abnormal activity. Biopsy of clivus mass: moderately well-differentiated hepatocellular carcinoma.

Conclusions CONCLUSIONS: The patient initially manifested the 'Occipital condyle syndrome' - unilateral headache and ipsilateral tongue weakness. By the time of diagnosis tumor involved multiple lower cranial nerves: 'Collet-Sicard syndrome'- a lesion of cranial nerves IX, X, XI, XII. A recent review identified only 25 reports of HCC metastatic to skull base. Our patient did not have a well-defined primary lesion accessible for biopsy based on extensive imaging studies therefore clivus mass was biopsied and was consistent with HCC. The prognosis is poor, with usual survival less than 9 months.

Authors/Disclosures
Gowri Lakshminarayan, MD PRESENTER	No disclosure on file
John C. Adair, MD (University of New Mexico)	No disclosure on file
	No disclosure on file

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