Figure - available from: Case Reports in Otolaryngology
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MRI scan of the head, 7/9/2014. (a) Axial T1 image shows a large posterior skull base mass. Note the normal bright fatty marrow (short green arrow) compared to darker signal from the mass (long green arrow). (b) Axial T1 image shows the mass (red oval) involving both the jugular foramen and the hypoglossal canal. Note the normal position of the contralateral jugular foramen (short red arrow) and the hypoglossal canal (long red arrow) for reference. (c) Axial T2 image shows involvement of the petrous temporal bone (blue oval) extending into the posterior inferior mastoid air cells, with bright reactive mastoid fluid (blue arrow).
Source publication
Breast, lung, and prostate cancers are the three most common malignancies to metastasize to the temporal bone. Still, metastatic prostate cancer of the temporal bone is a rare finding, with approximately 21 cases reported in the literature and only 2 cases discovered more than 10 years after initial treatment of the primary. This disease may be asy...
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Introduction
Varicella-zoster virus may cause an infectious disease called Ramsay Hunt syndrome. The related symptoms include facial nerve palsy (FNP), otalgia, the vesicular eruptions of the auricle and external auditory canal, less common ocular movement disorder, facial hypoesthesia, myofascial pain, vestibular symptoms, hearing loss, dysphasia,...
Citations
... Our patient was initially diagnosed as having mastoiditis, and later the clinical impression was revised to metastatic adenocarcinoma upon histopathological specimen analysis. Metastatic carcinoma of the temporal bone needs extensive analysis to search for primary lesion (10)(11)(12). Diagnosis relies on appropriate imaging studies, biopsy and immunohistochemistry (11). Several studies have demonstrated the value of immunohistochemical studies involving the differential expression of CK7 and CK20 as a valuable diagnostic biomarker in differentiating primary and metastatic adenocarcinoma (12). ...
... Metastatic carcinoma of the temporal bone needs extensive analysis to search for primary lesion (10)(11)(12). Diagnosis relies on appropriate imaging studies, biopsy and immunohistochemistry (11). Several studies have demonstrated the value of immunohistochemical studies involving the differential expression of CK7 and CK20 as a valuable diagnostic biomarker in differentiating primary and metastatic adenocarcinoma (12). ...
... The treatment modality consists of a combination of surgery, systemic chemotherapy and radiotherapy. Generally, the prognosis of malignant disease of the temporal bone remains poor (10,11,13). ...
Introduction
Metastatic tumors of the temporal bone are extremely rare. Collet-Sicard syndrome is an uncommon condition characterized by unilateral palsy of the lower four cranial nerves. The clinical features of temporal bone metastasis are nonspecific and mimic infections such as chronic otitis media and mastoiditis.
Case Report
This report describes a rare case of metastatic adenocarcinoma of the temporal bone causing Collet-Sicard syndrome, presenting with hearing loss, headache and ipsilateral cranial nerve palsies. The patient was a 68-year old woman initially diagnosed with extensive mastoiditis and later confirmed as having metastatic adenocarcinoma of the temporal bone, based on histopathologic findings.
Conclusion
Clinical presentation of metastatic carcinoma of the temporal bone can be overshadowed by infective or inflammatory conditions. This case report is to emphasize the point that a high index of clinical suspicion is necessary for the early diagnosis of this aggressive disease which carries relatively poor prognosis. This report highlights that it is crucial to suspect malignant neoplasm in patients with hearing loss, headache and cranial nerve palsies.
... However, metastasis to the brain parenchyma or skull base is relatively uncommon. In the rare cases that this does happen, most of the signs and symptoms are due to the disease involving the orbit and supratentorial space [1][2][3]. Metastasis specifically to the Meckel's cave is even rarer with only two documented cases [4][5]. The Meckel's cave is a dural recess in the posteromedial portion of the middle cranial fossa and is the location of the trigeminal ganglion [6]. ...
... No further information about the outcome of this case was reported [4]. In the second case, it was reported that a patient had a facial palsy with cranial nerve (CN) V and XII involvement by undifferentiated carcinoma, presumably from the prostate gland, but no treatment or details of radiological findings were reported [3]. ...
Prostate cancer commonly spreads to the axial and appendicular skeleton, but metastases to the brain parenchyma or skull base are uncommon. In the cases that this happens, the symptoms are usually associated with disease involving the orbit. Metastasis to the Meckel’s cave causing trigeminal nerve palsy is an exceedingly rare entity. We are presenting a case of this in a man with metastatic castration-resistant prostate cancer. Metastatic prostate cancer to the Meckel's cave is extremely uncommon, and there is no standard of care. Radiation therapy, especially radiosurgery, is increasingly recognized as an excellent alternative to surgery for lesions in the Meckel’s cave and intracranial/skull base prostate cancer metastases. Gamma Knife radiosurgery (Elekta, Stockholm, Sweden), in particular, has been reported to achieve local control close to 90% for calvarial and skull base metastases with few side effects and requires only one treatment. Our patient’s 1.4 x 1.0 x 1.3 cm metastatic prostate cancer lesion in the Meckel's cave was treated with Gamma Knife to 22 Gy with good treatment response including rapid improvement in his symptoms and no side effects. We review the scarce literature documenting cases of prostate cancer metastatic to the brain or skull base and the only two other documented cases of prostate cancer metastasis the Meckel’s cave neither of which was treated with radiotherapy.
Metastasis into temporal bone is uncommon. Involvement of facial nerve is rarer. We report an unusual case of metastatic prostatic carcinoma presenting initially as facial nerve palsy in an 82 year old male. Diagnostic pitfalls have been discussed. Radiological evaluation followed by biopsy was diagnostic.
Background:
Prostate Cancer is the most common cancer among American men, with an incidence of approximately 233,000 cases per year.Intracranial metastases are rare and specifically, metastasis to the pineal gland has only been reported in 2 post mortem cases in the literature.
Case description:
We present the first documented case of confirmed prostate cancer metastasis to the pineal gland in a living patient. The patient underwent an endoscopic third ventriculostomy and pineal lesion biopsy with complete resolution of his hydrocephalus and presenting symptoms. His biopsy results confirmed the prostate origin of the metastasis, and he subsequently underwent stereotactic radiosurgery for treatment of this lesion.
Conclusion:
This is the first report of the clinical management of metastatic prostate cancer to the pineal region and description of the clinical outcome. Although prostate cancer is the most common cancer in American men, metastasis to the pineal has only been reported twice from autopsy examinations. Overall, pineal tumors in the geriatric population are exceedingly rare, and the age and co-morbidities in this patient made management quite unique.
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.
Objective:
The purpose of our study was to assess the efficacy of transcatheter arterial embolization for pancreaticoduodenal artery aneurysms.
Conclusion:
We concluded that transcatheter arterial embolization is the initial and definitive therapeutic choice for pancreaticoduodenal artery aneurysms, with a possible option to perform surgery after embolization.
