Tympanomastoid cholesterol granuloma: radiological and intraoperative findings of blood source connection.

The hypothesis that the close contiguity between the cholesterol granulomas and some rich blood sources provided the trigger to the aggressive nature of tympanomastoid cholesterol granulomas has been recently reported. To corroborate this new etiopathogenetic theory we retrospectively reviewed a series of 14 patients with primary middle ear and mastoid cholesterol granulomas and investigated the temporal bone marrow invasion and its hematopoietic potentialities and a possible cholesterol granulomas contiguity with relevant vascular structures such as the carotid artery, sigmoid jugular system, mastoid or dural vein. Eight cases did not show radiological sign of bone marrow invasion or hematopoietic potentialities visible in MRI. Besides no intraoperative vascular connections that could explain an initial bleeding source were found. Cholesterol granulomas bone marrow invasion was present in six patients. A bone marrow hematopoietic potentiality was showed in four of these patients, whereas, an evident anatomical contiguity of the cholesterol granuloma with some important temporal bone vascular structures was visible in five cases. Analysis of cardiovascular risk factors showed that four patients presented one or more of the risk factors analysed.

[A case of middle ear carcinoma with high plasma G-CSF level].

Malignant tumors sometimes yield a variety of paraneoplastic syndrome. We report a case of middle ear cancer demonstrating unusual granulocytosis which was considered to belong to this syndrome. A patient, 67-year-old male, noticed left facial nerve palsy in June 1989, and was operated on under the diagnosis of chronic otitis media. However, middle ear tumor was suspected during the operation, which was confirmed to be squamous cell carcinoma. He was referred to our hospital for radiotherapy. Six months after irradiation, spontaneous liqorrhea due to the dural necrosis occurred. When intracranial repair of dura was performed, tumor invasion into the dura was noticed. Subtotal resection of the temporal bone with iridium implant was done in vain to control the recurrent tumor, which spread quickly to adjacent tissues. A month before the death, progressive granulocytosis without appreciable inflammatory signs started. Numbers of WBC rapidly increased, maximally reaching 88,300/cmm. Plasma G-CSF concentration was assayed at this time, showing about ten times as much as that of normal controls. It was thus postulated that production of this substance by the tumor was responsible for granulocytosis.

[Determination of beta2-microglobulin in breast, lung, colorectal and ENT carcinoma (author's transl)]. / Dosage de la beta2-microglobuline dans les cancers du sein, du poumon, du côlon et de la sphère ORL.

Significant increase of plasma level beta2-microglobulin in cancer patients (breast, bronchus, colorectal and ENT) occurs rarely. More, the highest levels observed are within the range of non malignant diseases. We cannot assume that beta2-microglobulin assay will be useful as tumor marker.