Solitary Metastasis to the Facial/Vestibulocochlear Nerve Complex Case Report and Review of the Literature

Abstract

Background and Importance: Distant metastasis of mucinous adenocarcinoma from the gastrointestinal tract, ovaries, pancreas, lungs, breast or urogenital system is a well described entity. Mucinous adenocarcinomas from different primary sites are histologically identical with gland cells producing a copious amount of mucin. This report describes a very rare solitary metastasis of a mucinous adenocarcinoma of unknown origin to the facial/ vestibulocochlear nerve complex in the cerebellopontine angle. Clinical Presentation: A 71-year-old woman presented with several month history of progressive neurologic decline and a negative extensive workup performed elsewhere. She presented to our institution with complete left facial weakness, left-sided deafness, gait unsteadiness, headache and anorexia. A repeat MRI scan of the head revealed a cystic, enhancing abnormality involving the left cerebellopontine angle and internal auditory canal. A left retrosigmoid craniotomy was performed and the lesion was completely resected. The final pathology was a mucinous adenocarcinoma of indeterminate origin. Postoperatively, the patient continued with her preoperative deficits and subsequently died of her systemic disease six weeks after discharge. Conclusion: The facial/vestibulocochlear nerve complex is an unusual location for metastatic disease in the central nervous system. Clinicians should consider metastatic tumor as the possible etiology of an unusual appearing mass in this location causing profound neurologic deficits. The prognosis following metastatic mucinous adenocarcinoma to the cranial nerves in the cerebellopontine angle may be poo