Hypoglossal Nerve Palsy As an Initial Presentation of Glomus Jugulare Tumor in Patient with Breast Cancer: A Case Report and Literature Review
DOI:
https://doi.org/10.31661/gmj.v10i.2222Keywords:
Glomus Jugulare Tumor; Paraganglioma; Jugular Foramen; Hypoglossal Nerve PalsyAbstract
Background: Glomus jugulare tumor is a rare, slow-growing, hyper-vascular paraganglioma that originates from the neural crest derivatives in the wall of the jugular bulb. The most common clinical manifestations of glomus jugulare are pulsatile tinnitus, conductive hearing loss, and hoarseness due to its vascularity and invasion of surrounding structures. Isolated hypoglossal nerve palsy as a presenting feature of the glomus jugulare is very rare. Case Report: We report a 61-year-old woman with a past medical history of breast cancer and diabetic mellitus presenting with progressive difficulty handling food in her mouth and tongue atrophy. Investigations showed skull base lesion and solitary pulmonary nodule. Further work-up led to glomus jugulare and benign solitary pulmonary fibrous tumor diagnosis, although the first impression was metastatic involvement of the jugular foramen. Endovascular embolization of the glomus jugulare was performed, but the patient refused any open surgery due to co-morbidities and the risk of operation. She had no new symptoms at the one-year follow-up, and the size of the lesion became more minor on the follow-up imaging relative to the baseline. Conclusion: Glomus jugulare tumors should be considered and surveyed in the diagnostic work-up of patients with hypoglossal nerve palsy. [GMJ.2021;10:e2222]
References
Lowenheim H, Koerbel A, Ebner FH, Kumagami H, Ernemann U, Tatagiba M. Differentiating imaging findings in primary and secondary tumors of the jugular foramen. Neurosurg Rev. 2006;29(1):1-11 https://doi.org/10.1007/s10143-005-0420-7PMid:16283211 Prasad SC, Pallavi NT, Prasad KC. Paragangliomas of the head and neck: the KMC experience. Indian J Otolaryngol Head Neck Surg. 2011;63(1):62-73. https://doi.org/10.1007/s12070-010-0107-4PMid:22319720 PMCid:PMC3109956 Chung SM, Kim HS, Jung J, Lee HK, Lee WS. Clinical Presentation and Management of Jugular foramen Paraganglioma. Clin Exp Otorhinolaryngol. 2009;2(1):28-32. https://doi.org/10.3342/ceo.2009.2.1.28PMid:19434288 PMCid:PMC2671826 Fayad JN, Keles B, Brackmann DE. Jugular foramen tumors: clinical characteristics and treatment outcomes. Otol Neurotol. 2010;31(2):299-305. https://doi.org/10.1097/MAO.0b013e3181be6495PMid:19779386 Spector GJ, Druck NS, Gado M. Neurologic Manifestations of Glomus Tumors in the Head and Neck. Arch Neurol. 1976;33(4):270-4. https://doi.org/10.1001/archneur.1976.00500040054008PMid:176982 Kumar K, Ahmed R, Bajantri B, Singh A, Abbas H, Dejesus E, et al. Tumors Presenting as Multiple Cranial Nerve Palsies. Case Rep Neurol. 2017;9(1):54-61. https://doi.org/10.1159/000456538PMid:28553221 PMCid:PMC5425756 Tocaciu S, Irons SM, McMillan B. Jugular foramen tumour resulting in hypoglossal denervation pseudohypertrophy: a rare and significant cause for tongue asymmetry. Int J Oral Maxillofac Surg. 2019;48(1):23-27. https://doi.org/10.1016/j.ijom.2018.05.005PMid:29843952 Mitsuya K, Nakasu Y, Horiguchi S, Harada H, Nishimura T, Yuen S, et al. Metastatic skull tumors: MRI features and a new conventional classification. J Neurooncol 2011; 104(1): 239-45. https://doi.org/10.1007/s11060-010-0465-5PMid:21110218 PMCid:PMC3151370 Lee KY, Oh YW, Noh HJ, Lee YJ, Yong HS, Kang EY, et al. Extraadrenalparagangliomas of the body: imaging features. AJR Am J Roentgenol. 2006;187(2):492-504. https://doi.org/10.2214/AJR.05.0370PMid:16861555 Michael LM, Robertson JH. Glomus jugulare tumors: historical overview of the management of this disease. Neurosurg Focus. 2004;17(2):E1. https://doi.org/10.3171/foc.2004.17.2.1PMid:15329016 Gupta AK, Purkayastha S, Bodhey NK, Kapilamoorthy TR, Kesavadas C. Preoperative embolization of hypervascular head and neck tumors. AstralasRadiol. 2007;51(5):446-52. https://doi.org/10.1111/j.1440-1673.2007.01869.xPMid:17803797 Trombetta M, Silverman J, Colonias A, Lee V, Mohanty A, Parda D. Paraganglioma: a potentially challenging tumor. Oncology (Williston Park). 2008;22(3):341-3, 347, 350; discussion 350-2. Kida Y, Kobayashi T, Tanaka T, Oyama H, Niwa M. A new strategy for the treatment of jugular foramen tumors using radiosurgery. No Shinkei Geka 1995;23(8):671-5.
