Abstract
Background: Glomus jugulare tumor is a rare, slow-growing, hyper-vascular paraganglioma that originates from the neural crest derivatives in the wall of the jugular bulb. The most common clinical manifestations of glomus jugulare are pulsatile tinnitus, conductive hearing loss, and hoarseness due to its vascularity and invasion of surrounding structures. Isolated hypoglossal nerve palsy as a presenting feature of the glomus jugulare is very rare. Case Report: We report a 61-year-old woman with a past medical history of breast cancer and diabetic mellitus presenting with progressive difficulty handling food in her mouth and tongue atrophy. Investigations showed skull base lesion and solitary pulmonary nodule. Further work-up led to glomus jugulare and benign solitary pulmonary fibrous tumor diagnosis, although the first impression was metastatic involvement of the jugular foramen. Endovascular embolization of the glomus jugulare was performed, but the patient refused any open surgery due to co-morbidities and the risk of operation. She had no new symptoms at the one-year follow-up, and the size of the lesion became more minor on the follow-up imaging relative to the baseline. Conclusion: Glomus jugulare tumors should be considered and surveyed in the diagnostic work-up of patients with hypoglossal nerve palsy. [GMJ.2021;10:e2222]
Highlights
Jugular foramen (JF) tumor is a rare, deeply seated, cranial base lesion that divides into primary and secondary according to its locations and extension from JF into the surrounding structures or vice versa [1]
Twelfth cranial nerve palsy as an initial presentation of glomus jugulare is very rare, and far, only a few cases have been reported [3,5,6,7]. In this unique case report, we describe a patient with a past medical history (PMH) of breast cancer who developed glossal atrophy, which was proved to be caused by a glomus jugulare tumor
In the present case, considering the patient’s PMH and magnetic resonance imaging (MRI) findings, the most probable differential diagnosis is metastasis followed by primary JF tumors and less likely vasculitis and inflammatory disorders such as sarcoidosis
Summary
Jugular foramen (JF) tumor is a rare, deeply seated, cranial base lesion that divides into primary and secondary according to its locations and extension from JF into the surrounding structures or vice versa [1]. Twelfth cranial nerve palsy as an initial presentation of glomus jugulare is very rare, and far, only a few cases have been reported [3,5,6,7] In this unique case report, we describe a patient with a past medical history (PMH) of breast cancer who developed glossal atrophy, which was proved to be caused by a glomus jugulare tumor. A 61-year-old woman was admitted to the emergency department of Shariati hospital, affiliated with Tehran University of Medical Sciences, Tehran, Iran She complained of progressive difficulty in eating performance two months before the admission. Angiography was performed that affirmed the diagnosis of glomus jugulare (Figure-1D), and embolization of the tumor was made during the procedure Because of her co-morbidities and high risk of surgery, the patient preferred to be followed by clinical examination and MR imaging. Informed consent was obtained from the patient to publish her anonymous data in this case report
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