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(A) Temporal bone CT scan: thickened mucosa within the mastoid air cells. (B) Presence of an expansive osteolytic temporal bone lesion; note the destruction of mastoid apex.
Context in source publication
Context 1
... to medical record, patient was treated for chronic obstructive bronchitis and osteoporosis, with regular controls and follow-up. Temporal bone computed tomography (CT) revealed mucosal thickening within the mastoid air cells, osteolytic lesion in the left mastoid and occipital bone and the het- erogeneous mass in the middle ear structures (Fig. 1). Treatment with intravenous antibiotics ensued (Ceftria- xone 2 g/per day), without any improvement of symptoms. Patient had no signs or symptoms of the malignant disease; chest radiography showed no signs of lung ...Citations
... Meanwhile, omission of congenital abnormalities, systemic inflammation or infection, or trauma as a prime cause of facial palsy should raise a suspicion of metastatic tumors to the temporal bone, as well as primary malignancies. Temporal bone metastasis is a rare clinical event and imposes a diagnostic challenge due to its asymptomatic feature in most cases [4]. The mounting clinical report displays the involvement of temporal bone metastasis as the cause of facial nerve palsy [5][6][7]. ...
Isolated facial nerve palsy resulting from temporal bone metastasis is rare and has been sparsely reported in the literature to be the initial presentation of cancer. The most commonly reported sites of origin of such metastases include the breast, lung, kidney, gastrointestinal tract, larynx, prostate, and thyroid, to name a few. Here, we discuss a patient initially presenting with isolated lower motor neuron facial nerve palsy. The diagnosis was revised to that of breast cancer with metastasis to the temporal bone resulting in facial nerve paralysis following the subsequent clinical presentation.
... In the current case, however, the tumor showed diffuse invasive growth, and the patient had "mass effect" and neurological dysfunction. If the tumor involves the skull base, most cranial nerves can be involved, resulting in paralysis [4][5][6][7][8][9][10] . Tumors of the middle and posterior fossa involve more nerves, and patients can show different syndromes, such as acute cavernous sinus syndrome, Garxin syndrome, and occipital condylar syndrome. ...
... Most patients with skull metastasis of lung cancer have a very poor prognosis, especially when the tumor invades the skull base and cannot be removed by surgery. Even different radiotherapy and chemotherapy schemes may not result in an ideal response, and patients often die within months of their diagnosis, or are at risk of sudden death [5] . The current patient initially refused surgical treatment because of the surgical risk. ...
Background: The skull is an uncommon site for bone metastasis of lung cancer. The most common type of skull metastasis is calvarial circumscribed intraosseous lesions. However, the use of targeted therapy or surgery remains controversial and the prognosis is poor.
Case presentation: Skull metastasis was detected in a woman 4 years after resection of non-small cell lung cancer. Despite targeted drug therapy, the tumor continued to grow. However, the patient refused surgical treatment until she developed neurological deficit. An epidural effusion occurred after the operation. The patient was followed up for 16 months and her condition remained stable.
Conclusion: Skull metastases of lung cancer can grow invasively. The current and previously reported cases highlight the importance of prompt removal of tumors located in the calvaria.
... The exclusion of congenital disorder, inflammatory disease, infection or trauma as cause of facial palsy should raise a suspicion of metastatic tumors to the temporal bone, as well as primary malignancies. However, temporal bone metastases are quite rare and early diagnosis is a challenge due to asymptomatic course of the disease [1]. ...
Introduction. Facial nerve paralysis originates from various factors, although in most cases etiology is idiopathic. Temporal bone metastases are quite rare, but should still be suspected in cases when congenital disorders, inflammatory disease, infection or trauma are excluded as cause of facial palsy. We present an unusual case of facial nerve paralysis as the initial sign of temporal bone metastasis of breast carcinoma and discuss diagnostic pitfalls. Case outline. A 70-year-old patient presented with facial nerve palsy, severe otalgia, hearing loss and vertigo. Patient underwent steroid treatment 6 months earlier due to peripheral facial palsy with complete neurological resolution. CT scan revealed osteolytic lesion of the right temporal bone with extension into the parietal bone and soft-tissue. Additional examination confirmed ductal breast carcinoma and osteolysis of the ribs and vertebrae. After four months, the patient with metastatic breast carcinoma to the temporal bone died despite chemotherapy. Conclusion. Temporal bone metastasis of breast cancer is very rare condition with poor prognosis. Late diagnosis and inadequate management of breast cancer are factors that contribute to the temporal bone metastasis formation. Temporal bone metastasis should be excluded in elderly patients, both with and without any history of malignancy, especially in cases of peripheral facial palsy refractory to treatment.
Objectives:
To identify the frequency and primary site of metastatic pathologies to the temporal bone and characterize the associated symptomatology.
Methods:
The MEDLINE, Embase, and Web of Science databases were systematically reviewed according to the PRISMA guidelines to identify all cases of pathologically confirmed distant temporal bone metastases published with English translation until October 2019. Descriptive statistics were performed.
Results:
Out of 576 full-length articles included for review, 109 met final criteria for data extraction providing 255 individual cases of distant temporal bone metastases. There was a male predominance (54.9%) with median age of 59.0 years (range 2-90). The most common locations of primary malignancy included the breasts (19.6%), lungs (16.1%), and prostate (8.6%). Most tumors were carcinomas of epithelial origin (75.3%) and predominantly adenocarcinoma (49.4%). The commonest metastatic sites encountered within the temporal bone were the petrous (72.0%) and mastoid (49.0%) portions. Bilateral temporal bone metastases occurred in 39.8% of patients. Patients were asymptomatic in 32.0% of cases. Symptomatic patients primarily reported hearing loss (44.3%), facial palsy (31.2%), and otalgia (16.6%) for a median duration of 1 month. Petrous lesions were associated with asymptomatic cases (P = .001) while mastoid lesions more often exhibited facial palsy (P = .026), otalgia (P < .001), and otorrhea (P < .001). Non-carcinomatous tumors were associated with petrosal metastasis (P = .025) and asymptomatic cases (P = .109). Carcinomatous metastases more often presented with otalgia (P = .003).
Conclusions:
Temporal bone metastasis is uncommon but should be considered in patients with subacute otologic symptoms or facial palsy and history of distant malignancy. Laryngoscope, 2020.
Metastatic lesions to the temporal bone are relatively rare in clinical practice, but the temporal bone is often involved by metastatic disease in autopsy studies. The most common site for metastatic involvement is the petrous portion of the temporal bone. Breast, lung, prostate, melanoma, kidney, and stomach cancers are the most likely primary tumors to produce temporal bone metastases. Hearing loss, otorrhea, vertigo, and facial paralysis are the most common symptoms of temporal bone metastasis; however, a large proportion of metastatic lesions to the temporal bone are asymptomatic. In the patient with a history of malignant disease, the differential diagnosis should include metastasis when patients present with otologic complaints. Diagnostic imaging with CT and MRI, especially when combined with PET/CT or whole-body bone scan, usually leads to the diagnosis. Surgical resection of metastatic disease in the temporal bone is typically not warranted because temporal bone metastases are usually a sign of widespread metastatic disease.
