Squamous Cell Carcinoma of the External Auditory Canal Presenting as a Persistent Ear Infection: A Case Report and Imaging Features.

Squamous cell carcinoma (SCC) is the most common malignant tumor involving the temporal bone but generally very rare. The temporomandibular joint (TMJ), middle cranial fossa, and facial nerve canal are uncommon areas for the tumor to spread. We present the case of primary SCC of the temporal bone in a 63-year-old male presenting for otorrhea, otalgia, facial weakness, and facial pain after failing outpatient antibiotic therapy for an ear infection. Initial inpatient workup was significant for a hypertensive emergency, leukocytosis, and acute kidney injury. Opacification of cavities (i.e., left middle ear, external auditory canal (EAC)), destructive bony changes (i.e., mastoiditis, erosion of facial nerve canal, and TMJ), and invasion of the middle cranial fossa due to a soft tissue mass were noted on CT and MRI. Operative biopsy showed moderately differentiated SCC. The patient received treatment at the hospital consisting of antibiotics and supportive treatment. Plans for an outpatient PET scan and chemoradiotherapy per consultants' recommendations were arranged. The patient was discharged with appropriate medications and outpatient referrals and underwent infuse-a-port placement. Overall, this case describes some key points given the limited studies thus far. It demonstrates certain imaging characteristics of SCC of the temporal bone in the setting of a chronic ear infection. The malignancy spreads to the posterior TMJ wall and the temporal lobe, which very few cases have shown. The tumor also invades specifically the mastoid and tympanic segments of the facial nerve canal. This may be one of the first cases to showcase these features given the rarity of their simultaneous occurrence.

A rare case of progressive multifocal leukoencephalopathy.

Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease of the central nervous system (CNS) due to John Cunningham (JC) virus reactivation most often in immunocompromised patients. The brainstem and the anterior corpus callosum are uncommon locations for white matter lesions. We present a case of PML in a 40-year-old female presenting to the emergency department for a tonic seizure with transient postictal confusion. The inpatient workup revealed low cluster of differentiation cell counts (CD3 and CD4), transaminitis, positive drug screen, and abnormal electroencephalogram (EEG). The computed tomogram (CT) of the head and magnetic resonance image (MRI or MR) of the brain showed evidence of subcortical and periventricular white matter lesions in the right hemisphere extending into the brainstem and the left frontal lobe. The hospital course consisted of supportive measures, seizure treatment along with prophylaxis, and human immunodeficiency virus (HIV) management along with prophylactic antibiotics. The patient was discharged with appropriate medications and outpatient referrals. Overall, this case describes some key points. It highlights particular imaging characteristics of PML in the setting of inadequately treated HIV. For example, white matter lesions cross the anterior corpus callosum rather than the splenium, as in the "barbell" sign. In addition, the lesions extend inferiorly along the ipsilateral corticospinal tract into the midbrain and pons. This could be one of the first cases to capture both of these features given the rarity of their concomitant occurrence.

Creeping through the cranium: A rare and interesting presentation of a meningioma.

A meningioma is a rare primary CNS tumor that tends to present more so in females in a slowly progressive fashion. The cavernous sinus and cerebellopontine angle are uncommon locations for meningiomas. We present a case of a meningioma in a 60-year-old female presenting to the emergency department for a sudden onset headache, vertigo, facial paresthesias, and chest pain. Inpatient workup revealed orthostatic hypotension, a meningioma spanning from the left cavernous sinus to the left cerebellopontine angle encasing the left cavernous internal carotid artery on MRI and CTA, and an incidental 12 mm calcified fibroadenoma on CT. Hospital course consisted of supportive treatment, physical rehabilitation, and review of previous imaging to determine need for intervention per consultants' recommendations. The patient was discharged with an antiplatelet, an antihistamine, appropriate additional medications, a vestibular therapy script, and outpatient referrals for a decision regarding surveillance and intervention. Overall, this case describes some key points. It demonstrates that cavernous sinus and cerebellopontine angle meningiomas can occur simultaneously, especially as a continuous mass, which very few cases have done so far. It also highlights an acute clinical presentation of a meningioma, contrary to the gradually progressive one observed in most instances. Last, but not least, it shows how nonspecific symptoms can lead to unique findings at times.

Immunotherapies and Combination Strategies for Immuno-Oncology.

The advent of novel immunotherapies in the treatment of cancers has dramatically changed the landscape of the oncology field. Recent developments in checkpoint inhibition therapies, tumor-infiltrating lymphocyte therapies, chimeric antigen receptor T cell therapies, and cancer vaccines have shown immense promise for significant advancements in cancer treatments. Immunotherapies act on distinct steps of immune response to augment the body's natural ability to recognize, target, and destroy cancerous cells. Combination treatments with immunotherapies and other modalities intend to activate immune response, decrease immunosuppression, and target signaling and resistance pathways to offer a more durable, long-lasting treatment compared to traditional therapies and immunotherapies as monotherapies for cancers. This review aims to briefly describe the rationale, mechanisms of action, and clinical efficacy of common immunotherapies and highlight promising combination strategies currently approved or under clinical development. Additionally, we will discuss the benefits and limitations of these immunotherapy approaches as monotherapies as well as in combination with other treatments.