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Clinical Problem Solving: Radiology
July 2002

Radiology Quiz Case

Author Affiliations
 

R. NICKBRYANMDS. JAMESZINREICHMD

Arch Otolaryngol Head Neck Surg. 2002;128(7):855. doi:10.1001/archotol.128.7.855

A 34-YEAR-OLD woman presented in August 1999 with an 8-month history of otalgia and hearing loss in the right ear. On otoscopy, a red mass was found in the hypotympanum, behind an intact tympanic membrane. Hearing tests showed mild conductive hearing loss. The results of neurologic assessment were normal. Subsequent magnetic resonance images (MRIs) and computed tomograms (CTs) demonstrated a lytic tumor of the temporal bone. On CTs (Figure 1 and Figure 2), the tumor seemed to originate from the posteromedial part of the temporal bone. It involved the retrolabyrinthine and infralabyrinthine petrous bone and extended between the internal acoustic meatus and the sigmoid sinus, toward the internal carotid artery forward, the jugular gulf downward, and the hypotympanum laterally. The tumor appeared as a heterogeneous lesion displaying high signal intensity on T2-weighted MRIs (Figure 3). It extended toward the posterior fossa. A small signal was found in the cerebellum (Figure 4). After endovascular embolization of the tumor, a translabyrinthine approach combined with a subtotal petrosectomy was performed in February 2000. The lesion was both extradural and intradural. It appeared as a hypervascular soft tissue mass, filling the mastoid cavity and extending toward the middle ear, hypotympanum, vertical portion of the carotid artery, and lateral sinus, coming into contact with the mastoid portion of the facial nerve. Dura of the posterior fossa was invaded, and a small mass (about 1 cm) was found in the posterior fossa. The tumor was totally removed. Pathologically, it showed a typical papillary architecture. Immunohistochemical stains were positive for cytokeratin, epithelial membrane antigen, vimentin, S100 protein, and neuron-specific enolase.

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