Metastatic Lesions of the Clivus: A Systematic Review

Jozsa, Felix; Das, Joe M

doi:10.1016/j.wneu.2021.11.105

Cited by 7 publications

(21 citation statements)

References 46 publications

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“…Finally, our cohort included only 3 children younger than 10 years. However, the distribution of cancer types is comparable to that of reported series (1). The radiologists had access to the full range of standard pulse sequences.…”

Section: Discussionsupporting

confidence: 84%

“…C ancer of the clivus is caused by primary osseous or chondral lesions, such as chordomas or chondrosarcomas, local spread of oropharyngeal masses, and metastasis of solid or hematopoietic tumors (1)(2)(3)(4). Because the sixth nerve traverses the tight space of the Dorello canal adjacent to the clivus, it is readily compromised by a tumor, such that sixth nerve palsy may be a presenting sign (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

mentioning

confidence: 99%

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MRI Diagnosis of Clival Cancer and Sixth Nerve Palsy

Halawa¹,

Kim²,

Liao³

et al. 2022

Journal of Neuro-Ophthalmology

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Background:Imaging diagnosis of clival cancer may be difficult, in part because of normal variation in marrow signal with aging. Identifying whether clival cancer has damaged the sixth cranial nerve is a further challenge because minimal clival abnormalities could impinge on the nerve, which travels very close to the clivus.Methods:Two neuroradiologists, who were unaware of previous imaging and clinical diagnoses, reviewed MRI studies of 25 patients with cancer but no clival involvement and no sixth nerve palsy, 24 patients with clival cancer but without sixth nerve palsy, and 31 patients with clival cancer and sixth nerve palsy. The radiologists were tasked with determining whether there was clival cancer, whether there was a sixth nerve palsy and its laterality, and with indicating the pulse sequences used to make those determinations.Results:Both neuroradiologists correctly identified all 25 cases with a normal clivus. In about half of those cases, they depended on finding a homogeneously bright marrow signal; in the remaining cases, they excluded cancer by determining that the clivus was not expanded and that there were no focal signal abnormalities. Both neuroradiologists correctly identified clival cancer in 54 (98%) of the 55 cases with and without sixth nerve palsy. In doing so, they relied mostly on clival expansion but also on focal signal abnormalities. Both neuroradiologists were at least 80% correct in identifying a sixth nerve palsy, but they often incorrectly identified a palsy in patients who did not have one. When there was a one-sided signal abnormality or the clivus was expanded in one direction, both neuroradiologists were accurate in identifying the side of the sixth nerve palsy.Conclusion:Current MRI pulse sequences allow accurate differentiation of a normal from a cancerous clivus. When the marrow signal is not homogeneously bright in adults, cancer can be diagnosed on the basis of clival expansion or focal signal abnormalities. MRI is less accurate in predicting the presence of a sixth nerve palsy. However, the side of a unilateral palsy can be predicted when the clivus is clearly expanded in one direction or there is a focal signal abnormality on one side.

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Section: Discussionsupporting

confidence: 84%

mentioning

confidence: 99%

MRI Diagnosis of Clival Cancer and Sixth Nerve Palsy

Halawa¹,

Kim²,

Liao³

et al. 2022

Journal of Neuro-Ophthalmology

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“…4 Metastatic tumors involving the clivus are estimated to account for less than 0.02% of all intracranial tumors. 5 Although chordomas comprise the majority of clival tumors, clival masses in patients with a known cancer diagnosis are nevertheless more likely to be of metastatic origin. 6,7 A recent meta-analysis by Jozsa and Das showed that, by incidence, metastatic tumors to the clivus most frequently arose from the prostate, kidney, and lung primaries.…”

Section: Discussionmentioning

confidence: 99%

Decision-Making in Clival Mass Lesions: Risk Factors for Malignant Disease and an Illustrative Case Example

Baier,

Cheong,

Shi

et al. 2023

J Neurol Surg Rep

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Introduction Clival tumors are rare and heterogeneous. Although some benign prototypical sellar lesions may present as clival tumors, the likelihood of malignant disease is higher. Here we define a novel algorithm for the workup and management of clival masses through an illustrative case of colorectal adenocarcinoma metastasis to the clivus. Methods In this case report, the best practice guidelines for managing clival masses are described through a literature review and refined by senior author consensus. We conducted a focused systematic review to characterize the present case in the context of clival metastasis from gastrointestinal malignancy. Results An 83-year-old woman presented with 4 weeks of headaches and blurry vision. Examination revealed partial right abducens and left oculomotor palsies. Magnetic resonance imaging (MRI) identified a large, weakly enhancing sellar and clival mass with sphenoid sinus extension. An aggressive subtotal endoscopic endonasal resection was performed with removal of all sphenoid, clival, and sellar disease without cavernous sinus wall resection. Pathology confirmed colorectal adenocarcinoma; computed tomography (CT) imaging identified an ascending colon mass with metastases to the liver and mesenteric nodes. Palliative oncologic therapies were recommended, but she elected hospice, and died 3 months after initial presentation. Gastrointestinal clival metastases are exceedingly rare among sellar and clival pathologies, with eight prior cases reported, most of which presented with diplopia from abducens nerve involvement. Conclusion Clival masses are uncommon skull base lesions that are associated with more aggressive diseases. We present a consolidated framework for decision-making in these challenging patients, alongside an unusual case example that illustrates the importance of increased suspicion for malignant clinical entities in this setting.

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“…On T1weighted imaging, FD is characterized by low to intermediate signal intensity and variable signal intensity on T2-weighted imaging [39]. The low T1-weighted signal intensity requires the differential diagnoses of chordomas, myelomas, chondrosarcomas, cholesteatomas, mucoceles and pituitary macroadenomas [40]. FD may also produce intermediate signal intensity on T1-weighted imaging and thus, can mimic soft tissue tumors.…”

Section: The Radiological Differential Diagnosis To Exclude Other Cli...mentioning

confidence: 99%

“…Metastases on the clivus have been reported from prostate cancer in most cases, while those from thyroid cancer and hepatocarcinoma have been reported less frequently. Metastases from Ewing's sarcomas, melanomas and gastric and renal carcinomas have been described in single reports [25,27,32,40]. The probability of finding metastases on the clivus of patients with known primary malignancies is relatively high in contrast to those with unknown primary tumors.…”

Section: The Radiological Differential Diagnosis To Exclude Other Cli...mentioning

confidence: 99%

A Rare Case of a Primary Leiomyoma of the Clivus in an Immunocompetent Patient and a Review of the Literature Regarding Clival Lesions

Kunicki

Rzewuska

Kunicki³

et al. 2022

Diagnostics

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Leiomyomas are common lesions that are usually located in the genitourinary and gastrointestinal tracts. Primary leiomyomas at the skull base are uncommon. They are composed of well-differentiated smooth muscle cells without cellular atypia. The diagnosis of a leiomyoma has to be confirmed by immunohistochemistry. The tumor tissue is immunoreactive for SMA, S100 and cytokeratin. Leiomyomas mainly occur in immunocompromised patients. Most tumor tissues are positive for EBV. The presented case is that of a 56-year-old immunocompetent woman with a tumor on the clivus. The radiological images suggested chordoma or fibrous dysplasia. Transnasal transsphenoidal surgery was performed. The tumor tissue consisted of well-differentiated smooth muscle cells with elongated nuclei. Immunohistochemistry revealed a positive reaction for desmin, SMA and h-Caldesmon and a negative reaction for S100, beta-catenin, PGR and Ki67. The leiomyoma diagnosis was subsequently established. To the best of our knowledge, the case of a primary leiomyoma on the clivus of an immunocompetent patient is the first to be described. We also extensively reviewed the literature on the immunohistopathological and radiological differential diagnosis of clival lesions.

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Metastatic Lesions of the Clivus: A Systematic Review

Cited by 7 publications

References 46 publications

MRI Diagnosis of Clival Cancer and Sixth Nerve Palsy

MRI Diagnosis of Clival Cancer and Sixth Nerve Palsy

Decision-Making in Clival Mass Lesions: Risk Factors for Malignant Disease and an Illustrative Case Example

A Rare Case of a Primary Leiomyoma of the Clivus in an Immunocompetent Patient and a Review of the Literature Regarding Clival Lesions

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