RESUMO
Intralabyrinthine schwannomas are a rare subgroup of vestibular schwannomas located within the membranous labyrinth of the inner ear and are known for their variable clinical presentations and symptoms. In the present study, we report on a patient with a persistent history of dizziness and positional vertigo, who was misdiagnosed with posterior canalithiasis. As hearing loss was not developed until late in the disease course, the patient was not properly diagnosed until magnetic resonance imaging revealed an intralabyrinthine schwannoma, which was not discovered on earlier imaging. In addition to the unusual clinical presentation, we describe the audio-vestibular profile of our patient. We suggest that a thorough vestibular evaluation, including caloric testing and a careful examination of the inner ear on imaging, is warranted in cases of treatment of refractory vertigo, even in patients where a diagnosis seems certain.
Assuntos
Imageamento por Ressonância Magnética , Neuroma Acústico , Vertigem , Humanos , Diagnóstico Diferencial , Imageamento por Ressonância Magnética/métodos , Neuroma Acústico/diagnóstico , Neuroma Acústico/diagnóstico por imagem , Vertigem/etiologia , Vertigem/diagnóstico , Orelha Interna/patologia , Orelha Interna/diagnóstico por imagem , Masculino , Tontura/etiologia , Tontura/diagnóstico , Feminino , Pessoa de Meia-Idade , Neoplasias da Orelha/diagnóstico , Neoplasias da Orelha/diagnóstico por imagem , Neoplasias da Orelha/patologia , Doenças do Labirinto/diagnóstico , Erros de Diagnóstico , Neurilemoma/diagnóstico , Neurilemoma/patologia , Neurilemoma/diagnóstico por imagemRESUMO
CLINICAL CASE: The 59-year-old patient complained of hearing loss on the left, ear murmur for a long time, periodic pain and discomfort in the left ear, dizziness for 6 months. She was found to have concurrent vestibular schwannoma in the internal auditory canal and temporal bone paraganglioma. Both tumors were removed in one operation. The schwannoma was removed by translabirinth access due to preoperative deafness, while the glomus tumor was removed during this access. Postoperative biopsy showed the presence of two unrelated diseases: paraganglioma (ICD-0 code 8690/3) and schwannoma (ICD-0 code 9560/0).
Assuntos
Orelha Interna , Orelha Média , Paraganglioma , Humanos , Pessoa de Meia-Idade , Feminino , Orelha Média/cirurgia , Orelha Média/patologia , Orelha Interna/cirurgia , Paraganglioma/cirurgia , Paraganglioma/complicações , Paraganglioma/diagnóstico , Neoplasias da Orelha/cirurgia , Neoplasias da Orelha/complicações , Neoplasias da Orelha/diagnóstico , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/patologia , Neuroma Acústico/cirurgia , Neuroma Acústico/complicações , Neuroma Acústico/diagnóstico , Neoplasias dos Nervos Cranianos/cirurgia , Neoplasias dos Nervos Cranianos/diagnóstico , Neoplasias dos Nervos Cranianos/complicações , Procedimentos Cirúrgicos Otológicos/métodos , Osso Temporal/cirurgia , Osso Temporal/patologiaRESUMO
Middle ear neuroendocrine tumors (MeNETs) are an exceptionally rare occurrence. These benign tumors stem from the tympanic mucosa and can easily be misinterpreted by the clinician and the pathologist. Clinical characteristics, otoscopic findings and medical imaging in these cases are non-specific. We present a case of a 60-year-old male patient with bilateral hearing loss following recent coronavirus disease 2019 disease. Diagnostic work-up revealed a soft tissue neoplasm of the left middle ear. Surgical resection of the tumor mass with implantation of a partial ossicular replacement prosthesis (PORP) was the main modality of treatment. Middle ear neuroendocrine tumors was confirmed through positive immunohistochemistry for neuroendocrine tumor markers. Follow-up magnetic resonance imaging 12 months after the surgery reported no tumor recurrence or significant residual disease with a stable PORP. Our report highlights challenges in diagnosing and treating these rare tumors, while emphasizing surgical resection pitfalls and resulting improvement of quality of life of the patient. We recommend a through followup of patients with unclear soft tissue masses in the middle ear to obtain a definitive diagnosis.
Assuntos
Adenoma , Neoplasias da Orelha , Orelha Média , Tumores Neuroendócrinos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Orelha/cirurgia , Neoplasias da Orelha/patologia , Neoplasias da Orelha/diagnóstico , Neoplasias da Orelha/diagnóstico por imagem , Tumores Neuroendócrinos/cirurgia , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/patologia , Orelha Média/patologia , Orelha Média/cirurgia , Orelha Média/diagnóstico por imagem , Adenoma/patologia , Adenoma/cirurgia , Adenoma/diagnóstico , COVID-19/complicações , COVID-19/diagnóstico , Imageamento por Ressonância Magnética/métodos , Substituição Ossicular/métodosRESUMO
Melanoma of the external auditory canal (EAC) is particularly rare and poorly understood, with limited available data on management and survival. This systematic review aims to analyze existing data and provide insights into the management and prognosis the beginning of EAC melanoma. It is conducted using Pubmed and Scopus databases from the beginning to July 2023 and it follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. Searches are performed using the search string "(melanoma) AND (external auditory canal)".The review includes a total of 30 patients diagnosed with EAC melanoma, supplemented by an additional case from the authors' clinical experience. The role of Breslow thickness as a determining factor for the choice of surgery remains inconclusive due to limited available data. Sentinel lymph node biopsy and adjuvant therapy are sparingly employed, indicating the need for standardized guidelines. Patients in the study demonstrate a 50% overall survival rate at 5 years.EAC Melanoma is a rare and aggressive malignancy with limited therapeutic guidelines. Surgical interventions, including wide local excision and lateral temporal bone resection, are the primary treatment options for patients without distant metastases.
Assuntos
Meato Acústico Externo , Neoplasias da Orelha , Melanoma , Humanos , Meato Acústico Externo/patologia , Meato Acústico Externo/cirurgia , Neoplasias da Orelha/patologia , Neoplasias da Orelha/cirurgia , Melanoma/patologia , Melanoma/cirurgia , Melanoma/diagnóstico , Prognóstico , Biópsia de Linfonodo SentinelaRESUMO
Basal cell carcinoma (BCC) of the ear may have aggressive histologic subtypes and a greater propensity for subclinical spread than BCC in other anatomic locations. In this retrospective analysis, we evaluated recurrence rates of BCC of the ear in 102 patients who underwent treatment with Mohs micrographic surgery (MMS) or radiation therapy (RT) at a single institution between January 2017 and December 2019. Data on patient demographics, tumor characteristics, treatment modality, and recurrence rates were collected from medical records. Recurrence rates were assessed over a mean follow-up time of 2.8 years. Although MMS is the gold standard for treatment of BCC of the ear, RT may be a suitable alternative for nonsurgical candidates.
Assuntos
Carcinoma Basocelular , Neoplasias da Orelha , Cirurgia de Mohs , Recidiva Local de Neoplasia , Neoplasias Cutâneas , Humanos , Carcinoma Basocelular/cirurgia , Carcinoma Basocelular/patologia , Carcinoma Basocelular/radioterapia , Masculino , Feminino , Estudos Retrospectivos , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/radioterapia , Idoso , Pessoa de Meia-Idade , Neoplasias da Orelha/radioterapia , Neoplasias da Orelha/cirurgia , Neoplasias da Orelha/patologia , Idoso de 80 Anos ou mais , AdultoRESUMO
OBJECTIVE: To systematically review the literature and understand the behavior, diagnosis, management, and mortality of metastasis to the external auditory canal (EAC). DATABASES REVIEWED: PubMed/Medline, EMBASE, Web of Science. METHODS: Studies from 1948 to June 2023 describing metastasis to the EAC were included. Non-English literature was excluded. Data extraction: Study design, age, sex, pathology, primary site, staging, additional sites of metastasis, time to EAC metastasis from diagnosis, time from diagnosis of EAC metastasis to death, symptoms, exam and imaging findings, and management. RESULTS: Data were synthesized qualitatively with means calculated. Thirty-two studies met the criteria, totaling 37 patients with EAC metastasis. Mean age was 58 years; 73% were male. The most common pathologies were adenocarcinoma (37.8%), acute myelogenous leukemia (8.1%), and renal cell carcinoma (8.1%). Sites of primary malignancy were hematologic (10.8%), breast (8.1%), esophagus (8.1%), renal (8.1%), and prostate (8.1%). Within the temporal bone, 73% had isolated EAC metastasis. Median time to EAC metastasis from the diagnosis of primary malignancy was 18 months. Metastasis to the EAC was the first presentation of malignancy in 21.6% of patients. Median time to death was 4.5 months. Symptoms included hearing loss (59.5%), otalgia (27.0%), otorrhagia (24.3%), facial paralysis (21.6%), otorrhea (16.2%), and aural fullness (13.5%). On imaging, bony erosion was present in 50% of cases. Treatment was primarily palliative with excision and radiation. CONCLUSIONS: EAC metastasis has a distinct presentation from other temporal bone subsites. Early biopsy to establish a diagnosis and intervene is critical.
Assuntos
Meato Acústico Externo , Neoplasias da Orelha , Humanos , Meato Acústico Externo/patologia , Neoplasias da Orelha/patologia , Masculino , Feminino , Pessoa de Meia-IdadeRESUMO
The relevance of the problems of diagnosis and treatment of skin cancer is currently determined not only by the high incidence rate, but by the existing difficulties in differential diagnosis and treatment with traditional methods. For localizations of basal cell skin cancer (BCSC) that are "inconvenient" for treatment, such as the external auditory canal, auricle, and wing of the nose, treatment is associated with certain difficulties and the possible appearance of a cosmetic defect, therefore, when choosing a treatment method, the anatomical features of these organs are taken into account. It has been determined that the effectiveness of treatment for primary BCSC of the nose and auricles is higher than recurrent one, and among the various treatment methods, the most effective and radical is the surgical method. The immediate results of treatment of BCSC in the form of PR by surgical method were 86.7%, which is statistically significant compared with other types of treatment (p < 0.05). Long-term treatment results with the surgical method are also higher (77%) compared to other methods, which is also statistically significant (p < 0.05).
Assuntos
Carcinoma Basocelular , Neoplasias Nasais , Neoplasias Cutâneas , Humanos , Carcinoma Basocelular/cirurgia , Carcinoma Basocelular/terapia , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/patologia , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , Neoplasias Nasais/cirurgia , Neoplasias Nasais/diagnóstico , Neoplasias Nasais/terapia , Pessoa de Meia-Idade , Resultado do Tratamento , Idoso , Masculino , Feminino , Neoplasias da Orelha/cirurgia , Neoplasias da Orelha/terapia , Neoplasias da Orelha/diagnóstico , Adulto , Idoso de 80 Anos ou maisRESUMO
The resection of middle ear paragangliomas can be challenging given their vascular nature and the small volume of the tympanic cavity, particularly when the tumor in the hypotympanum is close or attached to the internal carotid artery (ICA). We performed combined underwater endoscopic and microscopic surgery for a Class B1 middle ear paraganglioma according to the modified Fisch classification. The suspicious bone in the hypotympanum and around the petrous ICA was drilled with underwater endoscopy. The feeding arteries, the caroticotympanic and inferior tympanic arteries, were suctioned and cauterized under microscopy. To the best of our knowledge, no case of middle ear paraganglioma treated with underwater endoscopy has been reported. Underwater endoscopy, providing a clear operative field with blood and bone dust irrigation, is a good indication for middle ear paragangliomas. In contrast, microscopic preparation for unexpected bleeding is important, particularly when the tumor closely extends to vital structures, such as the ICA or the jugular bulb.
Assuntos
Neoplasias da Orelha , Orelha Média , Endoscopia , Paraganglioma , Humanos , Endoscopia/métodos , Orelha Média/cirurgia , Orelha Média/patologia , Paraganglioma/cirurgia , Paraganglioma/patologia , Paraganglioma/diagnóstico por imagem , Neoplasias da Orelha/cirurgia , Neoplasias da Orelha/patologia , Microcirurgia/métodos , Feminino , Pessoa de Meia-Idade , MasculinoRESUMO
Cutaneous malignancies affecting the ear, exacerbated by extensive ultraviolet (UV) exposure, pose intricate challenges owing to the organ's complex anatomy. This article investigates how the anatomy contributes to late-stage diagnoses and ensuing complexities in surgical interventions. Mohs Micrographic Surgery (MMS), acknowledged as the gold standard for treating most cutaneous malignancies of the ear, ensures superior margin control and cure rates. However, the ear's intricacy necessitates careful consideration of tissue availability and aesthetic outcomes. The manuscript explores new technologies like Reflectance Confocal Microscopy (RCM), Optical Coherence Tomography (OCT), High-Frequency, High-Resolution Ultrasound (HFHRUS), and Raman spectroscopy (RS). These technologies hold the promise of enhancing diagnostic accuracy and providing real-time visualization of excised tissue, thereby improving tumor margin assessments. Dermoscopy continues to be a valuable non-invasive tool for identifying malignant lesions. Staining methods in Mohs surgery are discussed, emphasizing hematoxylin and eosin (H&E) as the gold standard for evaluating tumor margins. Toluidine blue is explored for potential applications in assessing basal cell carcinomas (BCC), and immunohistochemical staining is considered for detecting proteins associated with specific malignancies. As MMS and imaging technologies advance, a thorough evaluation of their practicality, cost-effectiveness, and benefits becomes essential for enhancing surgical outcomes and patient care. The potential synergy of artificial intelligence with these innovations holds promise in revolutionizing tumor detection and improving the efficacy of cutaneous malignancy treatments.
Assuntos
Carcinoma Basocelular , Neoplasias da Orelha , Cirurgia de Mohs , Neoplasias Cutâneas , Humanos , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Neoplasias da Orelha/cirurgia , Neoplasias da Orelha/patologia , Neoplasias da Orelha/diagnóstico por imagem , Neoplasias da Orelha/diagnóstico , Carcinoma Basocelular/cirurgia , Carcinoma Basocelular/patologia , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Microscopia Confocal/métodos , Análise Espectral Raman/métodos , Dermoscopia/métodos , Margens de ExcisãoRESUMO
BACKGROUND: The posterior auricular flap has long been favored for repairing skin defects on the ear's surface. However, achieving optimal esthetic outcomes in ear reconstruction requires a flexible approach to flap transfer methods. While bipedicle advancement flaps are commonly used for body wound coverage, they are rarely used in auricular defect repair. OBJECTIVE: To propose a modified flap transfer approach based on the orientation of the auricular defect's long axis and assess the postoperative esthetic outcomes. METHODS: The authors reported 12 patients treated using 2 distinct flap transfer techniques. Mild to moderate helix soft tissue defects remained after excision of the masses. A direct island flap was created for patients with longitudinal defects to cover the defect. For patients with transverse defects, a combination of bipedicle and island flaps was used for repair. Scar quality and esthetic outcomes were assessed at least 6 months postsurgery using the Scar Cosmesis Assessment and Rating scale. RESULTS: All patients experienced no serious complications and achieved excellent cosmetic results. Patients undergoing combined flap transfer exhibited relatively more favorable esthetic outcomes. CONCLUSION: The authors propose a novel concept for repairing helix soft tissue defects by designing local flaps based on the direction of the defect's long axis. For repairing helix soft tissue defects with a long axis parallel to the auricular edge, the combined utilization of bipedicle advancement flap and island rotation flap transfer should be consideration more.
Assuntos
Estética , Procedimentos de Cirurgia Plástica , Retalhos Cirúrgicos , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/métodos , Adulto , Resultado do Tratamento , Idoso , Neoplasias da Orelha/cirurgia , Orelha Externa/cirurgia , Pavilhão Auricular/cirurgia , Cicatriz/cirurgiaAssuntos
Carcinoma Basocelular , Neoplasias da Orelha , Neoplasias Cutâneas , Transplante de Pele , Humanos , Carcinoma Basocelular/cirurgia , Carcinoma Basocelular/patologia , Neoplasias da Orelha/cirurgia , Neoplasias da Orelha/patologia , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Transplante de Pele/métodos , Procedimentos de Cirurgia Plástica/métodos , Masculino , Estética , Feminino , Resultado do Tratamento , Cartilagem/transplante , Cartilagem/patologia , Idoso , Orelha Externa/cirurgia , Orelha Externa/patologiaAssuntos
Adenoma , Neoplasias da Orelha , Orelha Média , Tumores Neuroendócrinos , Humanos , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/diagnóstico , Neoplasias da Orelha/patologia , Orelha Média/patologia , Adenoma/patologia , Adenoma/diagnóstico , Feminino , Masculino , Pessoa de Meia-IdadeAssuntos
Adenoma , Neoplasias da Orelha , Orelha Média , Humanos , Neoplasias da Orelha/cirurgia , Neoplasias da Orelha/patologia , Neoplasias da Orelha/diagnóstico por imagem , Orelha Média/diagnóstico por imagem , Orelha Média/cirurgia , Orelha Média/patologia , Adenoma/cirurgia , Adenoma/diagnóstico por imagem , Adenoma/patologia , Endoscopia , Tumores Neuroendócrinos/cirurgia , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/patologia , Feminino , Tomografia Computadorizada por Raios X , Masculino , Pessoa de Meia-IdadeRESUMO
Objective:To explore strategies for preserving facial nerve function during surgeries for rare tumors of the internal auditory canal. Methods:A total of 235 cases of internal auditory canal tumors treated between 2010 and 2023 were included, encompassing vestibular schwannomas, cavernous hemangiomas, meningiomas, and other rare tumors. Various data, including clinical presentations, imaging classifications, and treatment processes, were meticulously analyzed to delineate the characteristics of rare tumors and assess pre-and postoperative facial nerve function. Results:Among all internal auditory canal tumors, vestibular schwannomas accounted for 91.9%. In rare tumors, facial nerve schwannomas constituted 5.3%, cavernous hemangiomas 26.3%, meningiomas 15.8%, and arterial aneurysms 10.5%. Significantly, patients with cavernous hemangiomas displayed pronounced invasion of the facial nerve by the tumor, in contrast to other tumor types where clear boundaries with the facial nerve were maintained. During surgery, individualized approaches and strategies for facial nerve protection were implemented for different tumor types, involving intraoperative dissection, tumor excision, and facial nerve reconstruction. Conclusion:Preservation of the facial nerve is crucial in the surgical management of rare tumors of the internal auditory canal. Accurate preoperative diagnosis, appropriate timing of surgery, selective surgical approaches, and meticulous intraoperative techniques can maximize the protection of facial nerve function. Personalized treatment plans and strategies for facial nerve functional reconstruction are anticipated to enhance surgical success rates, reduce the risk of postoperative facial nerve dysfunction, and ultimately improve the quality of life for patients.
Assuntos
Nervo Facial , Humanos , Feminino , Masculino , Nervo Facial/cirurgia , Pessoa de Meia-Idade , Adulto , Idoso , Neuroma Acústico/cirurgia , Meningioma/cirurgia , Orelha Interna/cirurgia , Hemangioma Cavernoso/cirurgia , Neoplasias da Orelha/cirurgia , Adulto Jovem , Adolescente , Neoplasias Meníngeas/cirurgiaAssuntos
Progressão da Doença , Tumor do Glomo Jugular , Humanos , Tumor do Glomo Jugular/radioterapia , Tumor do Glomo Jugular/cirurgia , Tumor do Glomo Jugular/patologia , Neoplasias da Orelha/radioterapia , Neoplasias da Orelha/patologia , Conduta Expectante , Paraganglioma/radioterapia , Paraganglioma/patologia , Paraganglioma/diagnóstico por imagemRESUMO
Trichoblastomaï¼TBï¼ is a rare germ cell skin adnexal tumor of the hair, and it is a rare follicular tumor of the skin that differentiates from the hair germ epithelium and is often regarded as a benign skin tumorHowever, it is poorly confined and has a local infiltrative growth pattern. tb occurs in the head and neck region, especially in the face, and presents clinically as a slow growing, well-defined and elevated nodule. TB is routinely treated surgically. Due to the lack of universally accepted treatment guidelines or protocols, the recurrence rate after surgery is high, which makes clinical cure more difficult. In this study, a 65-year-old female patient was found to have a swelling with recurrent rupture and pus flow from the right external auditory canal opening and the auricular cavity. After initial misdiagnosis as otitis externa, she was treated with conventional anti-infective therapy, but her symptoms did not resolve and gradually worsened before coming to our hospital. The condition presented in this case is relativelyrare,therepre,timely and accurate diagnosis and treatment are crucial for prognosis improvement of such diseases.
Assuntos
Neoplasias Cutâneas , Humanos , Feminino , Idoso , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias da Orelha/patologia , Neoplasias de Anexos e de Apêndices Cutâneos/patologia , Neoplasias de Anexos e de Apêndices Cutâneos/diagnóstico , Meato Acústico Externo/patologiaAssuntos
Neoplasias da Orelha , Orelha Média , Tumores Neuroendócrinos , Humanos , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Neoplasias da Orelha/diagnóstico por imagem , Neoplasias da Orelha/patologia , Neoplasias da Orelha/diagnóstico , Orelha Média/patologia , Orelha Média/diagnóstico por imagem , Feminino , Masculino , Pessoa de Meia-IdadeRESUMO
Endolymphatic sac tumor (ELST) is a rare disease that originates from the endolymphatic sac system of the inner ear. Being a low-grade malignant tumor, ELST has a mild morphology and is characterized by a slow but aggressive growth. Most clinicians and pathologists are unfamiliar with this disease. ELST can be misdiagnosed as metastatic renal cancer because of the similarity in morphology and expression of nephrogenic markers such as PAX8. The presented case of a 27-year-old man revealed that observing the characteristic location and confirming the absence of renal neoplasm to rule out the possibility of metastasis are critical for obtaining an accurate final diagnosis.