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.
