Numb Chin Syndrome as First Symptom of Diffuse Large B-Cell Lymphoma

Abstract

Numb chin syndrome is a rare sensory neuropathy of the mental nerve characterized by numbness, hypoesthesia, paraesthesia, and very rarely pain. Dental causes, especially iatrogenic ones, maxillofacial trauma, or malignant neoplasm are etiologic factors for this rare syndrome. Many malignant and metastatic neoplasms are causing this syndrome, like primary osteosarcoma, squamous cell carcinoma, and mandibular metastasis of primary carcinoma of breast, lung, thyroid, kidney, prostate, and nasopharynx. Haematological malignancies like acute lymphocytic leukaemia, Hodgkin and non-Hodgkin lymphoma, and myeloma can cause this neuropathy. The authors report a case of a 71-year-old woman in which the numb chin syndrome was the first symptom of the diffuse large B-cell lymphoma, which caused infiltration and reabsorption of the alveolar ridge and lower mandibular cortex. A biopsy of the mass was performed on fragments of tissue collected from the mandibular periosteum, medullary and cortical mandibular bone, and inferior alveolar nerve.

Numb Chin Syndrome as the First Symptom of Diffuse Large B-cell Lymphoma

“…3,5) It may be also caused by systemic diseases such as amyloidosis, sickle cell anemia, multiple sclerosis, syphilis, sarcoidosis, vasculitis and diabetes mellitus. 2,3,6) NCS that occurs without trauma or apparent dental cause may indicate the presence of serious underlying condition such as metastatic or intraosseous malignancy. 5) It was reported that NCS was the first specific symptom of malignant disease in 27.7% of cases, and NCS caused by malignancy had an ominous prognosis for the progression of the disease, with a mortality of 78.5% within a mean of 6.9 months.…”

“…7) Metastatic cancer that may cause NCS could be related to breast, lung, thyroid, kidney, prostate, nasopharynx, or colon cancer. 6,8) Hematological malignancies like acute lymphocytic leukemia, Hodgkin and non-Hodgkin lymphoma, and myeloma are also associated with NCS. 6) It was reported that the most frequent malignant disease that cause NCS was metastatic breast cancer in 40.4% of cases, followed by non-Hodgkin lymphoma in 20.5%.…”

“…6,8) Hematological malignancies like acute lymphocytic leukemia, Hodgkin and non-Hodgkin lymphoma, and myeloma are also associated with NCS. 6) It was reported that the most frequent malignant disease that cause NCS was metastatic breast cancer in 40.4% of cases, followed by non-Hodgkin lymphoma in 20.5%. 7) Some cases of NCS as the first symptom of diffuse large B-cell lymphoma was reported.…”

“…7) Some cases of NCS as the first symptom of diffuse large B-cell lymphoma was reported. 6,9) Although this is a rare disease, the fact that it can be the first symptom of malignant tumor makes the role of clinicians on early diagnosis critical. 4,10) This symptom can be triggered without a reason and affects the area of distribution of inferior alveolar nerve with no history of trauma and dental problems.…”

Numb chin: A simple sign of a catastrophic illness

“…The sensory neuropathy of the mental nerve (Numb Chin Syndrome-NCS) is a rare neurological condition, often associated with malignancy, as a sentinel clinical presentation. [1][2][3][4][5][6][7][8][9][10][11][12][13] The most common primary tumours related to it are lymphoma and breast cancer. [7] There are reported cases where there were no history of tumours and it was due to the onset of this symptom that the investigation commenced was conducted.…”