Klin Onkol 2025; 38(2): 128-131. DOI: 10.48095/ccko2025128.
Background: A metastasis to the basilar bones, including the occipital bone, is extremely rare. Such metastases can result in hypoglossal nerve dysfunction, which poses diagnostic challenges. We report a case of lung cancer presenting with hypoglossal nerve dysfunction caused by metastasis to the posterior condyle of the occipital bone. Case: A 52-year-old man was referred to our hospital due to hypoglossal nerve dysfunction and occipital pain. Imaging studies revealed a metastatic lesion in the posterior condyle of the occipital bone and a 12- mm nodule in the apex of the left lung. Histopathological analysis confirmed stage IVB lung adenocarcinoma without actionable driver mutations or significant PD-L1 expression. The patient underwent radiation therapy targeting the occipital lesion, followed by systemic therapy with carboplatin, paclitaxel, bevacizumab, and atezolizumab. Maintenance therapy with bevacizumab and atezolizumab was continued. After 20 months of follow-up, the patient remained disease-free, with resolution of hypoglossal nerve dysfunction. Imaging confirmed ossification at the site of the bone metastasis, indicating a favorable response to treatment. Conclusion: Although such cases are extremely rare, this report provides valuable insight into the management of patients with similar metastases. Early diagnosis and a multidisciplinary approach, including chemotherapy, immunotherapy, and radiation therapy, are essential for improving outcomes in patients with rare metastases involving the posterior condyle of the occipital bone.