Tan Zhibin, Tan Si Ying
Department of Neurology, National Neuroscience Institute, Singapore, Singapore.
Neuroscience Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore.
Front Oncol. 2024 Mar 11;14:1349073. doi: 10.3389/fonc.2024.1349073. eCollection 2024.
Numb cheek syndrome, a rare corollary of numb chin syndrome, is due to infra-orbital neuropathy. It can occur in association with an underlying malignancy, which can cause neuropathy by direct malignant nerve infiltration or via a paraneoplastic mechanism. Although numb cheek syndrome has been reported in association with a variety of cancers, it has previously not been reported in association with breast cancer. We report a case of left breast cancer presenting with left numb cheek syndrome.
A 65-year-old woman presented to the Neurology clinic with a 7-month history of left cheek numbness and occasional cheek tenderness. Examination revealed slightly diminished pin-prick sensation in the left cheek and a vaguely palpable left breast lump. A magnetic resonance imaging scan of the brain showed abnormal enhancement of the left maxillary nerve at the foramen rotundum, but cerebrospinal fluid analysis was normal. Mammography, ultrasound scans, and core biopsy of the left breast confirmed the diagnosis of invasive left breast carcinoma (estrogen and progesterone receptor negative, c-erb-B2 equivocal, fluorescence hybridization negative). There was no evidence of distant metastases on computed tomography and bone scintigraphy scans. The patient underwent neoadjuvant chemotherapy (4 cycles of doxorubicin and cyclophosphamide, followed by 4 cycles of paclitaxel and carboplatin), and left breast wide excision and sentinel lymph node biopsy, and a repeat magnetic resonance imaging scan performed 2 months after surgical resection showed resolution of the left maxillary nerve enhancement. The patient's left numb cheek symptoms improved over a course of 5 months after cancer resection but did not completely resolve.
Our case represents the first reported left numb cheek syndrome in association with breast cancer, due to maxillary neuropathy without any discrete mass or compressive cause. To avoid delays in diagnosing malignancy, physicians and surgeons should be aware that numb cheek syndrome can occur in association with an underlying malignancy, and that breast cancer should be counted amongst the possibilities.
面颊麻木综合征是颏部麻木综合征的一种罕见并发症，由眶下神经病变引起。它可能与潜在的恶性肿瘤相关，恶性肿瘤可通过直接侵犯神经或副肿瘤机制导致神经病变。尽管面颊麻木综合征已被报道与多种癌症相关，但此前尚未有与乳腺癌相关的报道。我们报告一例表现为左侧面颊麻木综合征的左乳腺癌病例。
一名65岁女性因左侧面颊麻木7个月并伴有偶尔的面颊压痛就诊于神经科门诊。检查发现左侧面颊针刺觉略有减退，左侧乳房可隐约触及肿块。脑部磁共振成像扫描显示左侧上颌神经在圆孔处异常强化，但脑脊液分析正常。乳腺钼靶、超声扫描及左侧乳房粗针活检确诊为左侧浸润性乳腺癌（雌激素和孕激素受体阴性，c-erb-B2结果不明确，荧光原位杂交阴性）。计算机断层扫描和骨闪烁扫描未发现远处转移迹象。患者接受了新辅助化疗（4个周期的阿霉素和环磷酰胺，随后是4个周期的紫杉醇和卡铂），并行左侧乳房广泛切除及前哨淋巴结活检，手术切除2个月后复查磁共振成像扫描显示左侧上颌神经强化消失。患者左侧面颊麻木症状在癌症切除后5个月内有所改善，但未完全缓解。
我们的病例是首例报道的与乳腺癌相关的左侧面颊麻木综合征，病因是上颌神经病变，无任何明确的肿块或压迫性病因。为避免恶性肿瘤诊断延误，医生和外科医生应意识到面颊麻木综合征可能与潜在的恶性肿瘤相关，乳腺癌也应被列入可能的病因之中。
