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Isolated trigeminal neuralgia: An early weird presentation of carcinoma breast

1 Department of Medical and Pediatric Oncology and Hematology, Kerudi Cancer Hospital, Bagalkot, Karnataka, India
2 Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
3 Department of Radiation Oncology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
4 Department of Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India

Correspondence Address:
Irappa Madabhavi,
Department of Medical and Pediatric Oncology and Hematology, Kerudi Cancer Hospital, Bagalkot - 587 101, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcrt.JCRT_712_20

We report an interesting case of a 52-year-old postmenopausal female who presented with a 2-month history of headache, tingling sensation, and sharp shooting pain over the left face, followed by left facial paresthesia with pain over the maxillary region. Magnetic resonance imaging scan revealed presence of enplaque altered signal intensity soft-tissue lesion along the left 5th nerve from its origin at pons, and positron emission tomography with concurrent computed tomography showed a 2.9 cm × 2.6 cm intensely 18F-fluorodeoxyglucose-avid breast mass, in the upper outer quadrant of the right breast. Core-needle biopsy revealed infiltrating ductal carcinoma. Her estrogen receptor, progesterone receptor, and Her2-neu analysis suggested triple-negative breast cancer. She was managed with cranial radiotherapy and palliative chemotherapy. The patient responded very well to radiotherapy and chemotherapy with complete improvement in her neurological symptoms and now she is under regular follow-up for chemotherapy for 8 months without any subjective or objective progression of the disease. Isolated cranial neuropathy may be an early harbinger of metastatic breast cancer, so we should search for the primary malignancy. TNBC is associated with early central nervous system metastasis because of heterogeneity in the biology of the disease. Whole-brain radiotherapy and palliative chemotherapy are the best available treatment modalities.

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