Skull-Base Inflammatory Pseudotumor Involving the Trigeminal and Facial Nerves: A Singular Presentation of a Rare Disease
29 August 2019
14 January 2020
03 March 2020 (online)
Inflammatory pseudotumor (IPT) is a rare disease that is often misinterpreted as a lymphoma or carcinoma. It may involve different body regions but most commonly the lungs and the orbital cavity. We report the case of a patient affected by an IPT of the trigeminal and facial nerves.
A 69-year-old male presented to our hospital with a right facial palsy arisen suddenly 2 days before. A magnetic resonance imaging (MRI) of the head showed an abnormal mass with homogeneous enhancement involving the deep lobe of the parotid gland, the parapharyngeal space, and the infratemporal fossa, extending along the trigeminal nerve and the facial nerve. The patient was planned for multiple transnasal biopsies in the nasopharynx, the region of the foramen ovale, and the deep lobe of the parotid gland, but the results were inconclusive, with no evidence of a malignant process. We considered the possibility that the lesion could be an IPT, and the patient was treated with prednisone and cyclophosphamide. Three months after the conclusion of the treatment, an MRI showed a complete radiological response.
- 1 Ramotar H, Cheung L, Pitkin L. The great mimicker: a rare case of head and neck inflammatory pseudotumour in the presence of human immunodeficiency virus. J Laryngol Otol 2016; 130 (01) 107-110
- 2 Battaglia P, Turri-Zanoni M, Dallan I. , et al. Endoscopic endonasal transpterygoid transmaxillary approach to the infratemporal and upper parapharyngeal tumors. Otolaryngol Head Neck Surg 2014; 150 (04) 696-702
- 3 Scott L, Blair G, Taylor G, Dimmick J, Fraser G. Inflammatory pseudotumors in children. J Pediatr Surg 1988; 23 (08) 755-758
- 4 Patnana M, Sevrukov AB, Elsayes KM, Viswanathan C, Lubner M, Menias CO. Inflammatory pseudotumor: the great mimicker. AJR Am J Roentgenol 2012; 198 (03) W217-27
- 5 Alyono JC, Shi Y, Berry GJ. , et al. Inflammatory pseudotumors of the skull base: meta-analysis. Otol Neurotol 2015; 36 (08) 1432-1438
- 6 Inoue D, Yoshida K, Yoneda N. , et al. IgG4-related disease: dataset of 235 consecutive patients. Medicine (Baltimore) 2015; 94 (15) e680
- 7 Johnston J, Allen JE. IgG4-related disease in the head and neck. Curr Opin Otolaryngol Head Neck Surg 2018; 26 (06) 403-408
- 8 Ferri A, Bergonzani M, Varazzani A, Sesenna E. Inflammatory pseudotumor of the infraorbital nerve: a rare diagnosis to be aware of. J Craniofac Surg 2016; 27 (06) e554-e557
- 9 Ogasawara T, Kasamatsu N, Haga T, Kobayashi T, Shibata M, Hashizume I. A case of Wegener's granulomatosis with orbital inflammatory pseudotumor [in Japanese]. Nihon Kokyuki Gakkai Zasshi 2009; 47 (04) 308-313
- 10 Cheuk W, Yuen HK, Chan JK. Complication of IgG4-related chronic sclerosing dacryoadenitis by lymphoma. Arch Ophthalmol 2008; 126 (08) 1170 , author reply 1170