Facial pain in carcinoma colon

Prashant S Naphade, Abhishek R Keraliya 
 Department of CT/MRI, ESIC Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Prashant S Naphade
Department of CT/MRI, ESIC Hospital, Mumbai, Maharashtra
India

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Sir,

A 26-year-male, operated case of adenocarcinoma transverse colon, presented with left facial pain and numbness. Clinical examination was revealed sensory deficit on the left side of face. Brain magnetic resonance imaging(s) revealed abnormal T2/fluid-attenuated inversion recovery hyperintense oval lesions causing diffuse enlargement of cisternal part of left trigeminal nerve [Figure 1]a and b, thick arrow] and both trigeminal ganglia in Meckel's cave [Figure 1]a and b, thin arrows]. Three dimensional-T2W-driven equilibrium radiofrequency reset pulse axial and sagittal oblique images excellently demonstrated the spread along trigeminal pathways [Figure 1]c-e. These lesions appear heterogeneously hypointense on pre-contrast T1-weighted images [Figure 2]a. Post-contrast scan shows homogenous enhancement of mass lesions as long cisternal part of left trigeminal nerve and both trigeminal ganglia [Figure 2]b-d. No extension was seen along the branches of trigeminal nerves. Brainstem revealed no focal lesion at the expected location of trigeminal nuclei. These findings are suggestive of bilateral trigeminal metastasis. This case illustrates the classic imaging findings in metastatic spread along central trigeminal pathways. Patient is being treated with palliative radiotherapy.{Figure 1}{Figure 2}

Malignant trigeminal neuropathy is commonly due to perineural spread along the branches of trigeminal nerve secondary to squamous cell carcinomas and adenoid cystic carcinomas in head and neck region. Trigeminal nerve metastasis is uncommon reported manifestation in breast cancer, melanoma and colon cancer. [1],[2] To the best of our knowledge; bilateral trigeminal metastasis with trigeminal ganglion involvement due to metastatic colon carcinoma is not reported.

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