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Clinical Problem Solving: Radiology
December 2006

Radiology Quiz Case 2

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2006;132(12):1385. doi:10.1001/archotol.132.12.1385

A 46-year-old man presented with progressive left-sided hearing loss and a painless swelling anterior to the left ear that had begun a few months earlier. On examination, a firm mass, measuring approximately 5 cm in diameter, was palpated in the left temporal and preauricular region. Otoscopy showed complete obliteration of the external auditory canal, obscuring the tympanic membrane. Audiometry revealed combined conductive and sensory neural hearing loss.

Contrast-enhanced computed tomography of the skull base showed a 10-cm expansile, osteolytic mass primarily involving the squamous part of the temporal bone, with extension to the petrous and mastoid portions (Figure 1 and Figure 2). There was also erosion of the floor of the middle cranial fossa and the greater wing of the sphenoid bone. The lesion was extra-axial, with thick, enhancing septations but no visible calcifications. There was a large intracranial component that was causing significant mass effect, midline shift, and uncal herniation. The patient underwent transtemporal craniectomy with total tumor removal and mastoidectomy. The tumor had not penetrated the dura. Radiotherapy was deferred because it was thought that complete excision had been achieved. The histologic appearance of the tumor is shown in Figure 3 (hematoxylin-eosin, ×400).