Facial nerve palsy caused by T cell lymphoma

Introduction:

Facial palsy due to infiltration of Non-Hodgkin lymphoma (NHL) in the parotid gland is rare. In the following case we report on peripheral facial nerve palsy, observed as a symptom of parotid gland infiltration by the T cell lymphoma.

Methods:

A 66-year-old patient was admitted to our department with an acute incomplete peripheral facial nerve palsy and pain of the left face. She also presented two skin lesions of the left ear and cheek. Previous biopsy of the skin had revealed the diagnosis of benign lymphomatoid papulosis. Therefore, the patient had been treated with local radiotherapy (8 Gy) and low dose methotrexate. During ENT-examination, a parotid lesion was evident in ultrasonogram and could be confirmed by a CT scan with contrast.

Results:

We excluded the presence of squamous cell carcinoma via excisional biopsy of the skin lesions. Hereafter, an explorative parotidectomy was performed. Infiltration of parotid tissue by a malignant lymphoma was suspected from intraoperative frozen sections. The final result revealed the presence of the peripheral T cell lymphoma (PTCL NOS). In the MRI scan of the head, perineural spread of the lymphoma along the trigeminal and facial nerve and consecutive carcinomatous meningeosis were present. The patient was immediately treated with high dose MTX, Ara-C and Thiotepa followed by high dose chemotherapy and autologous stem cell transplantation.

Conclusion:

Facial nerve palsy due to the infiltration of a lymphoma is rare. However, in unusual cases, perineural spread should be considered and excluded by MRI and biopsy. As demonstrated in the present case, a polyneuritis due to infiltration of T cell lymphoma needs immediate and aggressive therapy in an interdisciplinary setup.

Publication History

Publication Date:
23 April 2019 (online)