Peripheral facial nerve paralysis in the setting of metastatic SCLC

Case report A 60-year-old female patient presented with a painless left preauricular mass for 2 months and a new onset of unilateral peripheral facial nerve paralysis. The patient noticed loss of appetite and unintentional weight loss of 5kg in 9 months. She reported 38py and regular alcohol consumption. Clinical and sonographic findings revealed an extensive mass with blurred margins in the left parotid gland with concomitant ipsilateral cervical lymphadenopathy. Computed tomography of the neck, thorax and abdomen showed disseminated tumor disease with suspicious findings in the lung, left parotid, kidneys and suspicious cervical and thoracic lymph nodes. MRI revealed brain metastases. Histopathology of the parotid mass showed portions of a small-cell neuroendocrine carcinoma. Results revealed the presence of a small-cell neuroendocrine tumor of the lung with nodal, glandular, renal, and cerebral filiae. The patient underwent palliative radiochemotherapy with whole brain radiation therapy.

Conclusion  In patients with peripheral facial paralysis, malignancy should be considered as a differential diagnosis. Therefore imaging of the parotid gland is crucial in the diagnostic work-up. Haematogenous dissemination of small-cell lung carcinomas can lead to parotideal metastases and should be considered in parotid tumors. Parotid metastasis with concomitant facial nerve paralysis due to SCLC is rare.

Publication History

Article published online:
12 May 2023