Clivus Metastasis of a Duodenal Adenocarcinoma: A Case Report and Literature Review

Background: Clivus metastases of adenocarcinomas are exceptionally rare tumors, especially when they arise from the small intestine. To our knowledge, here we present the first report of a metastasis of a duodenal adenocarcinoma to the clivus. We also present a systematic review detailing metastasis to the clivus.

Methods: Studies were identified using the search terms clivus metastasis, skull base metastasis, and clivus in PubMed. We collected the following information: histopathology of the primary tumor, patient’s sex, age, symptoms at time of diagnosis, history, treatment, and follow up.

Results: A comprehensive review of the literature yielded 56 cases, with a population of 30% female and 70% male patients. Patients developed the first symptoms of clivus metastasis at a mean age of 58 years (range: 3–83). The most common primary neoplasms originated from the prostate (23%), kidney (9%), or liver (9%). Most patients presented with an isolated sixth nerve palsy (46%) or diplopia (29%). The time interval from diagnosis of the primary tumor to symptomatic presentation of clivus metastasis ranged from 2 months to 33 years (mean: 59 months). Sixteen patients initially presented with symptoms of clivus metastasis without a previously diagnosed primary tumor. Patients were mainly treated with non-surgical therapy. Survival data were available for 35 patients, of which 63% died within a range of 2 days to 31 months after initial presentation (mean: 11 months).

Conclusion: Our review found that most primary neoplasms originated from the prostate, kidney, and liver, which differ from previous reports on skull base metastases. Abducens nerve palsy is often the first presentation of clivus metastasis. Clival metastasis from duodenal carcinoma, though very rare, should be considered in the differential diagnosis of bony lesions of the clivus in a patient with a history of duodenal adenocarcinoma.