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Clinical Problem Solving: Pathology
December 2001

Pathology Quiz Case 1

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2001;127(12):1502. doi:10.1001/archotol.127.12.1502

A 45-YEAR-OLD man initially presented at the age of 35 years complaining of right-sided hearing loss. On physical examination, sensorineural hearing loss and peripheral facial palsy on his right side were noted. Radiological studies revealed a right cerebellopontine angle (CPA) tumor destroying temporal bone and expanding the internal auditory canal. The patient underwent biopsy of the CPA tumor. He required 2 more operations at the ages of 39 and 43 years because of tumor regrowth. Radiological studies before the third operation revealed a right extra-axial tumor destroying petrous bone, with extension to the jugular foramen. Gadopentetate-enhanced T1-weighted magnetic resonance images of the tumor showed heterogeneous enhancement (Figure 1). T2-weighted images revealed an extra-axial tumor destroying the internal auditory canal, with obliteration of the right CPA and indentation of the middle cerebellar peduncle (Figure 2). On the third operation, the polipoid tumor was noted to be extremely vascular, with erosion into the mastoid and middle ear, invading the eustachian canal and compressing the facial nerve.