J Korean Neurosurg Soc.  2015 Mar;57(3):208-210. 10.3340/jkns.2015.57.3.208.

Sixth Cranial Nerve Palsy Caused by Gastric Adenocarcinoma Metastasis to the Clivus

• Lee A
• Chang KH
• Hong H
• Kim H

• KMID: 2191223
• DOI: http://doi.org/10.3340/jkns.2015.57.3.208

Abstract

Tumors of the clivus and metastases to the clivus are very rare. Metastasis involving the clivus has previously been described in only two case reports. In skull metastasis, the breast and prostate are the most common primary foci, while metastasis from gastric carcinoma is extremely rare. A review of the English literature revealed only one published case of clivus metastases from gastric adenocarcinoma. There is no literature thoroughly explaining the differential diagnosis between chordoma and metastasis. Here we report a rare case of metastasis to the clivus from a gastric adenocarcinoma in a 42-year-old female patient with sudden blurry vision, presenting as bilateral cranial nerve VI palsy.

Keyword

Abducens nerve disease; Chordoma; Metastasis; Skull base

MeSH Terms

Abducens Nerve Diseases*
Adenocarcinoma*
Adult
Breast
Chordoma
Cranial Fossa, Posterior*
Diagnosis, Differential
Female
Humans
Neoplasm Metastasis*
Prostate
Skull
Skull Base

Figure

• 

  Fig. 1 A : Pre-contrast axial computed tomography (CT) scan showing a calcified mass in the sellar region. The involvement of the sphenoid and cavernous sinuses and the destruction of the clivus. B : Post-contrast axial CT scan after contrast injection demonstrating heterogeneous enhancement with invasion into both carotid arteries.

• 

  Fig. 2 A : Axial T2-weighted image showing a heterogeneous, hypo-intense, space-occupying lesion at the level of the clivus, invading into the cavernous and sphenoid sinuses and both carotid arteries. B : T1-weighted sagittal images after contrast administration showing heterogeneous enhancement and a cystic portion within the mass. The neoplastic tissue that replaced the normal fatty bone marrow and infiltrated the dura.

• 

  Fig. 3 Histopathologic study of stomach biopsy specimen showing irregular tubular structures, pluristratification, multiple lumens, reduced stroma of intestinal-type adenocarcinoma (hematoxylin-and-eosin stain, ×100 magnification).

• 

  Fig. 4 Histopathologic examination of the mucosa of the sphenoid showing irregular glands or nests with pleomorphic nuclei, consistent with adenocarcinoma (hematoxylin-and-eosin stain, ×100 magnification).

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