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. 2015 Apr;6(2):E16-20.
doi: 10.3978/j.issn.2078-6891.2014.076.

Numb chin syndrome secondary to leptomeningeal carcinomatosis from gastric adenocarcinoma

Vincent J Riesgo  1 , Silvia R Delgado  1 , Julio Poveda  1 , Kottil Rammohan  1
Affiliations

Numb chin syndrome secondary to leptomeningeal carcinomatosis from gastric adenocarcinoma

Vincent J Riesgo et al. J Gastrointest Oncol. 2015 Apr.

Abstract

Numb chin syndrome (NCS) can be a sign of malignancy. Its association with gastric adenocarcinoma is rare. We report a case of a 27-year-old Hispanic female that presented with complaint of left sided headache associated with numbness of the left side of chin and lower gingiva. Initial brain MRI, whole body gallium scan, high resolution CT of chest and elevated protein in the CSF were suggestive of sarcoidosis. She was treated with IV steroids with transient clinical improvement. Two weeks later, her symptoms worsened and further evaluation revealed the diagnosis of a poorly differentiated metastatic gastric adenocarcinoma with leptomeningeal involvement. This case report aims to emphasize the importance of identifying NCS as a possible indication of an underlying malignant condition. Reported cases of NCS associated with metastatic gastric adenocarcinoma are very rare.

Keywords: Numb chin syndrome (NCS); gastric adenocarcinoma; leptomeningeal carcinomatosis (LMC); mental nerve neuropathy; sarcoidosis.

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Figures

Figure 1
Figure 1
MRI of the brain with and without contrast showed dural enhancement adjacent to the left temporal region on February 28, 2014.
Figure 2
Figure 2
SPECT gallium scan displaying increased radiotracer activity (A) in the bilateral lacrimal and salivary glands (Panda Sign) and (B) in both lungs and mid upper abdomen diffusely, highly indicative of sarcoidosis.
Figure 3
Figure 3
(A) Hematoxylin and Eosin (×100) staining of the gastric biopsy showing malignant glandular formation to nests to single cells. The neoplastic cells demonstrate mitoses, increased nuclear-to-cytoplasmic ratio and nuclear hyperchromatism; (B) higher magnification (×200) shows poorly differentiated adenocarcinoma predominately composed of single cell formation; (C) HER-2 immunohistochemistry reveals a strong complete membranous staining (3+) (×200).
Figure 4
Figure 4
Subsequent brain MRI on April 4, 2014 showed worsening with multiple lesions, nodular meningeal enhancement and new focal areas of restricted diffusion in pons, left cerebellum, corpus callosum, and bilateral cerebral hemispheres consistent with leptomeningeal carcinomatosis.
See this image and copyright information in PMC

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