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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 838-839

Lung cancer with occipital condyle syndrome in a non-smoker female patient: A case report


1 Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
3 Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission06-Aug-2020
Date of Decision26-Oct-2020
Date of Acceptance27-Oct-2020
Date of Web Publication25-Dec-2020

Correspondence Address:
Navneet Singh
Department of Pulmonary Medicine, Room No. 4, F Block, Level IV, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_271_20

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How to cite this article:
Baldi M, Mehta S, Gupta N, Singh N. Lung cancer with occipital condyle syndrome in a non-smoker female patient: A case report. Cancer Res Stat Treat 2020;3:838-9

How to cite this URL:
Baldi M, Mehta S, Gupta N, Singh N. Lung cancer with occipital condyle syndrome in a non-smoker female patient: A case report. Cancer Res Stat Treat [serial online] 2020 [cited 2021 Jan 20];3:838-9. Available from: https://www.crstonline.com/text.asp?2020/3/4/838/304959



Occipital condyle syndrome (OCS) involves unilateral pain in the occipital region and ipsilateral hypoglossal nerve palsy and was first described almost 35 years ago during an analysis of 43 patients with skull base metastasis.[1] In this report, we describe the clinical, radiological, and cytological characteristics of a non-smoker female patient with lung adenocarcinoma and OCS.

A previously healthy 60-year-old woman presented to us with right pleuritic chest pain and left occipital headache. She also complained of difficulty maneuvering food boluses in her mouth. A clinical examination revealed left hypoglossal nerve palsy [Figure 1]a; Supplementary Video 1]. Contrast-enhanced computed tomography scan of the thorax showed a 4 cm × 4 cm lobulated mass in of the right upper lobe [Figure 1]b with ipsilateral hilar and mediastinal adenopathy and pleural effusion. Magnetic resonance imaging (MRI) of the brain revealed altered signal intensity (T1 hypointense; T2 hyperintense) in a well-defined expansile intraosseous lesion involving the left occipital condyle [Figure 1]c. Pleural fluid cytology showed adenocarcinoma [Figure 1]d. A diagnosis of Stage IV non-small cell lung cancer (adenocarcinoma; T2aN2M1b) was made. No mutations in the epidermal growth factor receptor or rearrangement of the anaplastic lymphoma kinase gene were detected. The patient was started on pemetrexed–cisplatin chemotherapy and zoledronate, with simultaneous radiation to the skull base. After four cycles of chemotherapy, her tongue movements improved, MRI of the brain showed resolution of the lytic lesion, and there was a partial response as per the Response Evaluation Criteria in Solid Tumors (48.8% reduction in the size of the primary lesion was observed). The patient subsequently received another cycle of platinum doublet followed by maintenance pemetrexed. The timeline of events in the case is provided in [Table 1].
Figure 1: Clinical examination of the tongue (a), contrast-enhanced computed tomography scan of the thorax (b), magnetic resonance imaging brain (c), pleural fluid cytology (d)

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Table 1: Important timelines

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The hypoglossal nerve which innervates the tongue muscles exits the posterior cranial fossa just anterior to the occipital condyles. In disorders affecting the lower motor neurons of the hypoglossal nerve, the unopposed action of the contralateral genioglossus muscle causes the tongue to deviate to the affected side. Due to close proximity, lesions affecting the occipital condyle may also affect the hypoglossal nerve. OCS is a rare but stereotypic syndrome which is usually caused by metastatic disorders;[2] however, chronic inflammatory states such as tuberculosis[3] and granulomatosis with polyangitis[4] have also been described as etiologies. Lung cancer is an unusual cause for OCS with four previously reported cases (including two cases of adenocarcinoma histology).[5],[6],[7],[8]

This case report highlights the importance of scrupulous history taking and astute clinical examination and the incessant scuffle between Occam's razor and Hickam's dictum. In this particular case, we see the former taking an edge over the latter. Though we were not able to derive a tissue for cytological diagnosis from the expansile intraosseous lesion, the improvement in the weakness of tongue muscles, and resolution of the same on MRI following chemotherapy, indicates the metastatic nature of the lesion.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images, video, and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published, and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Greenberg HS, Deck MD, Vikram B, Chu FC, Posner JB. Metastasis to the base of the skull: Clinical findings in 43 patients. Neurology 1981;31:530-7.  Back to cited text no. 1
    
2.
Capobianco DJ, Brazis PW, Rubino FA, Dalton JN. Occipital condyle syndrome. Headache 2002;42:142-6.  Back to cited text no. 2
    
3.
Neera C, Yogesh P, Vinod P, A KG. Occipital condyle syndrome in a young male: A rare presentation of cranio-vertebral tuberculosis. J Clin Diagn Res 2014;8:MD01-3.  Back to cited text no. 3
    
4.
Hornik A, Rodriguez-Porcel F, Ersahin CH, Kadanoff R, Biller J. Wegener's disease presenting with occipital condyle syndrome. Front Neurol 2012;3:53.  Back to cited text no. 4
    
5.
Moeller JJ, Shivakumar S, Davis M, Maxner CE. Occipital condyle syndrome as the first sign of metastatic cancer. Can J Neurol Sci 2007;34:456-9.  Back to cited text no. 5
    
6.
Bahl A, Suresh P, Talwar V, Doval DC. Occipital condyle syndrome as a rare metastatic presentation of small cell lung carcinoma. Neurol India 2010;58:666-8.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Liu MT, Lin GY, Lin CC, Cheng CA, Chen MH, Lee JT. Occipital condyle syndrome as an initial presentation of lung cancer: A case report. Acta Neurol Taiwan 2015;24:11-4.  Back to cited text no. 7
    
8.
Takeuchi S, Osada H, Nagatani K, Shima K. Occipital condyle syndrome as the first sign of skull metastasis from lung cancer. Asian J Neurosurg 2017;12:145-6.  Back to cited text no. 8
[PUBMED]  [Full text]  


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