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Comparison of
duration of deafness and tumour invasion to the inner ear from
metastatic tumours of the internal auditory canal: human temporal
bone pathology.J
Laryngol Otol. 2002 Apr;116(4):256-60.
Four cases
(seven ears) of metastatic tumour of the internal auditory canal
were studied. The histopathological findings confirmed that the
inner ear invasion of the tumour follows a unique course, as
reported in the literature. Relationship between duration of
deafness and extent of tumour invasion in the inner ear is
discussed. It is suggested that the deafness could occur via neural
invasion or compression near the ductus spiralis foraminosus.
Metastases to
temporal bones from primary nonsystemic malignant neoplasms.Arch
Otolaryngol Head Neck Surg. 2000 Feb;126(2):209-14.
OBJECTIVES: To
compare histopathological and clinical findings of metastasis to the
temporal bone with previous reports and to determine the prevalence
of these metastases in patients with nonsystemic cancer. STUDY
DESIGN: Retrospective. METHODS: Autopsy records of 864 patients were
screened to select those with primary nondisseminated malignant
neoplasms. These were evaluated histopathologically for metastasis
to and site of involvement within the temporal bone, and
histological characteristics of the tumor. Clinical records and
autopsy reports were reviewed for demographic data, clinical course,
otologic and vestibular manifestations, site of primary and its
histological features, extent of metastasis, and mode of spread.
RESULTS: Of 212 patients with primary nondisseminated malignant
neoplasms, 47 had metastases to the temporal bone (76 temporal
bones). Twenty different primary tumors had metastasized, most
commonly breast cancer. Hearing loss was the most common otologic
symptom (seen in 19 patients [40%]), while 17 (36%) had no otologic
or vestibular symptoms. Temporal bone involvement was bilateral in
29 patients (62%). Most metastases to the temporal bone demonstrated
hematogenous spread in 58 temporal bones (76.7%), and petrous apex
was the most common site of metastases in 63 temporal bones (82.9%).
Temporal bone metastases were not observed in cases where the
primary tumor was adequately treated. CONCLUSIONS: In the largest
series to date, we found temporal bone metastases more frequently
than previously reported. Absence of temporal bone involvement in
cases in which the primary tumor was adequately treated stresses the
need for early management of cancer. Metastatic disease must be
considered as a cause of hearing loss in patients with a history of
malignant neoplasm.
Metastatic carcinoma of the temporal bone.Am
J Otol. 1996 Sep;17(5):780-3.
Metastatic
carcinoma of the temporal bone is rare and often not recognized
because it can be either asymptomatic or overshadowed by other
metastases late in the disease course. Metastatic evaluation does
not usually include temporal bone imaging, and the temporal bone is
not routinely sectioned at autopsy, further contributing to
unreported metastases. Two case reports of metastasis to the
internal auditory canal are presented, as well as a review of 139
such patients reported in the world literature. Analysis includes
types of tumor, specific sites of secondary malignancy within the
temporal bone, and manifestations. Although uncommon, metastatic
carcinoma of the temporal bone must be included in the different
diagnosis of any cochleovestibular or facial nerve disorder.
Secondary tumor of the temporal bone with internal auditory meatus
involvement--histopathological study.Nippon
Jibiinkoka Gakkai Kaiho. 1995 Jun;98(6):989-99.
Nineteen cases
of secondary tumor of the temporal bone with involvement of the
internal auditory meatus (IAM) were studied. The cases were
classified into 4 invasion modes; direct extension from head and
neck tumors (12 cases), hematological dissemination (3 cases),
diffuse leptomeningeal carcinomatosis (3 cases), and direct
extension of tumors from the intracranium (1 case). There were some
differences in the manner in which the tumor had spread among these
4 modes. In most cases involving "direct extension from head and
neck tumors", the tumor had invaded the pyramis, and then the
Eustachian tube and the middle ear. When the inner ear or the IAM
was involved, it was directly invaded by massive tumor. In all cases
of "hematological dissemination", metastatic tumor was found
bilaterally, but there were some differences in the manner of
invasion between the two sides. In "leptomeningeal carcinomatosis"
and "intracranial tumor", the tumor had invaded the temporal bone
bilaterally via the IAM. In the IAM, cochlear and inferior
vestibular nerves were more vulnerable to tumor invasion than facial
and superior vestibular nerves. It was suggested that there are some
differences in vulnerability to tumor invasion between the superior
and inferior vestibular nerves. The bottom of the IAM presented a
barrier-like effect against the spread of tumor from the IAM to the
labyrinth. In some cases, however, there was massive tumor invasion
of the internal ear directly from the IAM. Whether denervation of
the ganglionic neurons (spiral or vestibular) causes secondary
degeneration of peripheral sensory endorgans remains controversial.
In some cases in our series, degeneration of the auditory or
vestibular peripheral organs might be attributed to denervation of
neurons in the spiral or vestibular ganglia. In other cases,
however, auditory and vestibular peripheral organs remained intact
despite severe degeneration of ganglionic neurons.
Secondary
malignant tumors of the temporal bone. A histopathologic study and
review of the world literature.Nippon
Jibiinkoka Gakkai Kaiho. 1991 Jul;94(7):924-37.
Metastatic
involvement of the temporal bone by malignant tumors is considered
to be rare. The actual incidence of metastatic temporal bone tumors,
however, is probably much higher than suggested by reports in the
literature. The reason for this is that histologic studies are
rarely performed on temporal bones in routine postmortem
examinations of patients with possible metastatic disease. Also, in
patients with multiple metastatic lesions, otologic complaints and
signs may often be overshadowed by other more disabling symptoms.
Twelve temporal bones were histopathologically examined from 6
patients who had metastatic temporal bone disease from various
primaries and the results obtained in our present series of 6 cases
were: 3 cases of hematogenous dissemination from a distant primary
(a hepatic cell carcinoma, a bronchogenic squamous cell carcinoma,
and an adenocarcinoma of unknown primary); 2 cases of direct
invasion from adjacent head and neck tumors (squamous cell
carcinomas of the eyelid and hypopharynx); and one case of diffuse
metastatic leptomeningeal carcinomatosis (a transitional cell
carcinoma of the renal pelvis). Among these, to our knowledge either
hepatic cell carcinoma or renal pelvis carcinoma metastatic to the
temporal bone has not been reported previously in the world
literature. We reviewed the previously published reports of
metastatic temporal bone tumors and found that there were 212
reported cases cited in the literature and that the most common
sites of origin in order of frequency were breast, lung, pharynx,
kidney, and prostate. Our temporal bone study and literature survey
reveal that there are three distinct routes of tumor spread from the
primaries to the temporal bone: 1) hematogenous dissemination from a
distant primary, 2) direct neoplastic extension from adjacent areas,
and 3) diffuse metastatic leptomeningeal carcinomatosis (DMLC). Our
study also indicates that in most cases temporal bone symptoms
appeared late in the course of disease, but in some cases the
otologic symptoms were an initial sign of tumor, which was
particularly conspicuous in the cases of DMLC. In the cases of
hematogenous dissemination, the metastatic lesion tends to be
overlooked or undiagnosed because occult metastases are relatively
common or, when symptomatic, the otologic symptoms often resemble
the features characterized by a severe form of mastoiditis. In the
cases of direct neoplastic invasion, on the other hand, recognition
of temporal bone involvement is usually simple since the primary
disease is quite evident. Although metastatic temporal bone
malignancies are rare, otologist should always be aware of existence
of this disease entity in clinical practice.
Histopathology of
metastatic temporal bone tumors.Arch
Otolaryngol Head Neck Surg. 1991 Feb;117(2):189-93.
Temporal
bone metastasis is now being reported with increasing frequency. To
understand the process of temporal bone metastasis, complete
histologic evaluation of the temporal bones is essential. In this
study, 60 temporal bones from 33 patients were evaluated. Different
patterns of temporal bone involvement were noted depending on the
mode of spread to the temporal bone. Involvement of the temporal
bone usually occurs late in the disease process and is often
asymptomatic.
Metastatic tumours
of the temporal bone. A histopathological report.J
Laryngol Otol. 1985 Sep;99(9):839-46.
Metastatic
tumours of the temporal bone seem to be more common than is
recognized. Most of these tumours are microscopic and asymptomatic
in nature. Microscopic examination of 22 temporal bones belonging to
13 cases of metastatic tumours is reported. The commonest site of
involvement in the temporal bone was the petrous apex followed by
the tegmen tympani, mastoid bone and internal auditory canal.
Primary tumours were most commonly located in the breast. Other
sites of primary tumours included the thyroid gland, brain, lungs,
prostate and blood (leukaemia). Two cases had undetermined sites of
origin. Full neurotologic evaluation is indicated in every case
suspected of having a temporal bone metastasis. All three modalities
(of surgery, radiotherapy and chemotherapy) are used in combination
for the treatment of these tumours.
Metastatic tumors in the temporal bone--a pathophysiologic study.J
Otolaryngol. 1979 Feb;8(1):85-95.
Nineteen
temporal bones were examined from 11 patients who had metastatic
temporal bone disease from a distant primary. The salient clinical
features were: the high incidence of occult temporal bone
involvement (7 of the 10 clinically documented cases), the
considerable incidence of melanoma (3 of 10) and the variable
correlation between clinical findings and pathologic localization of
tumor in the temporal bone. Pathologic examination revealed two
distinct modes of tumor spread within the temporal bone: 1)
vascularosseous (petrous apex, mastoid, middle ear, external canal);
and 2) perineural (nerves in IAC branches, labyrinthine endorgans).
Every case was involved by one or both or these routes and no case
of CSF-borne metastasis to the perilymphatic space was seen. The
external canal was involved extensively in spite of an intact
tympanic membrane. Since the presence of symptomatic or occult
metastases in the temporal bone affects treatment and prognosis,
they must be actively sought by the clinician.
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