Anterior Clinoid Metastasis as First Presentation of a Signet Ring Cell Carcinoma: An Intriguing Diagnosis

Abstract

Background We report an extremely unusual case of anterior clinoid process (ACP) metastasis as the first presentation of a signet ring cell carcinoma.

Case Description A 54-year-old female patient presented with right-sided visual disturbances due to optic nerve compression from a computed tomography (CT)-identified right anterior clinoid bone lesion. Contrast-enhanced magnetic resonance imaging showed an extra-axial, well-bordered enhancing mass extending from the right ACP toward the inner lumen of the optic canal. Pterional approach was adopted to remove the lesion and decompress the optic canal. Histological examination demonstrated a metastasis from a signet ring cell carcinoma. Postoperative CT showed near-total resection of the tumor and decompression of the optic canal. Visual defect remained unchanged.

Conclusion Metastasis should be considered in the differential diagnosis of the ACP lesions. The early suspicion and identification of this extremely rare pathological entity can be helpful for the prompt management of patients, especially in the absence of any other signs of oncological diseases.

Keywords

anterior clinoid process - metastasis - signet ring cell carcinoma

• References

• 1 Al-Mefty O. Clinoidal meningiomas. J Neurosurg 1990; 73 (06) 840-849
• 2 O'Donnell TJ, Michael II LM, Laster R, Fleming JC. Isolated pyocele of anterior clinoid process presenting as a cavernous sinus syndrome. Tenn Med 2013; 106 (05) 37-38 , 43
• 3 Gupta RK, Saran RK, Jagetia A, Narang P. Extra-axial dural cavernous hemangioma with dural tail sign, masquerading as meningioma. J Neurosci Rural Pract 2016; 7 (04) 615-616
• 4 Morgenstern P, Pisapia D, Ramakrishna R. Calvarial plasmacytoma mimicking meningioma as the initial presentation of multiple myeloma. Cureus 2017; 9 (03) e1126
• 5 Aoyama Y, Ohtomo K, Sawamura H. Recurrent optic neuropathy caused by a mucocele of the anterior clinoid process after a 5-year remission: a case report and literature review. Neuroophthalmology 2014; 38 (05) 281-285
• 6 Chagla AS, Bhaganagare A, Kansal R, Tyagi D. Complete recovery of visual loss following surgical treatment of mucopyocele of the anterior clinoid process. J Clin Neurosci 2010; 17 (05) 670-672
• 7 Higgins HL, Schimdt III JH. Atypical presentation of a dermoid brain cyst. W V Med J 1996; 92 (06) 312-315
• 8 Hong CS, Lehman NL, Sauvageau E. A pilocytic astrocytoma mimicking a clinoidal meningioma. Case Rep Radiol 2014; 2014: 524574
• 9 Kasliwal MK, Suri A, Gupta DK, Suri V, Rishi A, Sharma BS. Sphenoid wing inflammatory pseudotumor mimicking a clinoidal meningioma: case report and review of the literature. Surg Neurol 2008; 70 (05) 509-513 , discussion 513
• 10 Mansour TR, Medhkour Y, Entezami P, Mrak R, Schroeder J, Medhkour A. The art of mimicry: anterior clinoid dural-based cavernous hemangioma mistaken for a meningioma. World Neurosurg 2017; 100: 708.e19-708.e22
• 11 Azarpira N, Noshadi P, Pakbaz S, Torabineghad S, Rakei M, Safai A. Dural plasmacytoma mimicking meningioma. Turk Neurosurg 2014; 24 (03) 403-405
• 12 Pojskić M, Zbytek B, Arnautović KI. Anterior clinoid metastasis removed extradurally: first case report. J Neurol Surg Rep 2018; 79 (02) e55-e62
• 13 Copeland WR, Van Gompel JJ, Giannini C, Eckel LJ, Koeller KK, Link MJ. Can preoperative imaging predict tumor involvement of the anterior clinoid in clinoid region meningiomas?. Neurosurgery 2015; 77 (04) 525-529 , discussion 530
• 14 Watts J, Box G, Galvin A, Brotchie P, Trost N, Sutherland T. Magnetic resonance imaging of meningiomas: a pictorial review. Insights Imaging 2014; 5 (01) 113-122
• 15 Gelinne A, Akture E, Tranmer B. Tenosynovial giant cell tumor of the clinoid: rare condition. World Neurosurg 2018; 118: 168-171
• 16 Go PH, Klaassen Z, Meadows MC, Chamberlain RS. Gastrointestinal cancer and brain metastasis: a rare and ominous sign. Cancer 2011; 117 (16) 3630-3640
• 17 Lee A, Chang KH, Hong H, Kim H. Sixth cranial nerve palsy caused by gastric adenocarcinoma metastasis to the clivus. J Korean Neurosurg Soc 2015; 57 (03) 208-210
• 18 Hirai O, Kikuchi H, Hashimoto N. Skull base metastasis from gastric cancer--case report. Neurol Med Chir (Tokyo) 1992; 32 (12) 908-910
• 19 Fukushima M, Katayama Y, Shigemori Y, Miyake H, Hirayama T, Kotani A. Clivus metastasis from gastric signet ring cell carcinoma after a 10-year disease-free interval--case report. Neurol Med Chir (Tokyo) 2012; 52 (10) 751-753
• 20 Sano T, Aiko T. New Japanese classifications and treatment guidelines for gastric cancer: revision concepts and major revised points. Gastric Cancer 2011; 14 (02) 97-100
• 21 Nie RC, Yuan SQ, Li YF. , et al. Clinicopathological characteristics and prognostic value of signet ring cells in gastric carcinoma: a meta-analysis. J Cancer 2017; 8 (17) 3396-3404
• 22 Mohandas KM, Swaroop VS, Krishnamurthy S. , et al. Unusual bone metastasis as the initial symptom of gastric cancer--a report of four cases. Indian J Cancer 1993; 30 (03) 146-150
• 23 Dittus C, Mathew H, Malek A, Negroiu A. Bone marrow infiltration as the initial presentation of gastric signet ring cell adenocarcinoma. J Gastrointest Oncol 2014; 5 (06) E113-E116
• 24 Drake CG, Vanderlinden RG, Amacher AL. Carotid-ophthalmic aneurysms. J Neurosurg 1968; 29 (01) 24-31
• 25 Noguchi A, Balasingam V, Shiokawa Y, McMenomey SO, Delashaw Jr JB. Extradural anterior clinoidectomy. Technical note. J Neurosurg 2005; 102 (05) 945-950
• 26 Mariniello G, de Divitiis O, Seneca V, Maiuri F. Classical pterional compared to the extended skull base approach for the removal of clinoidal meningiomas. J Clin Neurosci 2012; 19 (12) 1646-1650
• 27 Dolenc V. Direct microsurgical repair of intracavernous vascular lesions. J Neurosurg 1983; 58 (06) 824-831
• 28 Day JD, Giannotta SL, Fukushima T. Extradural temporopolar approach to lesions of the upper basilar artery and infrachiasmatic region. J Neurosurg 1994; 81 (02) 230-235
• 29 Krisht AF, Kadri PA. Surgical clipping of complex basilar apex aneurysms: a strategy for successful outcome using the pretemporal transzygomatic transcavernous approach. Neurosurgery 2005; 56 (2, Suppl): 261-273 , discussion 261–273
• 30 Andrade-Barazarte H, Jägersberg M, Belkhair S. , et al. The extended lateral supraorbital approach and extradural anterior clinoidectomy through a frontopterio-orbital window: technical note and pilot surgical series. World Neurosurg 2017; 100: 159-166
• 31 Dolenc VV. A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg 1985; 62 (05) 667-672
• 32 Risi P, Uske A, de Tribolet N. Meningiomas involving the anterior clinoid process. Br J Neurosurg 1994; 8 (03) 295-305