Histopathological temporal bone study of the metastatic rhabdomyosarcoma

Metastatic Disease of the Temporal Bone: A Contemporary Review

OBJECTIVES

To identify the frequency and primary site of metastatic pathologies to the temporal bone and characterize the associated symptomatology.

METHODS

The MEDLINE, Embase, and Web of Science databases were systematically reviewed according to the PRISMA guidelines to identify all cases of pathologically confirmed distant temporal bone metastases published with English translation until October 2019. Descriptive statistics were performed.

RESULTS

Out of 576 full-length articles included for review, 109 met final criteria for data extraction providing 255 individual cases of distant temporal bone metastases. There was a male predominance (54.9%) with median age of 59.0 years (range 2-90). The most common locations of primary malignancy included the breasts (19.6%), lungs (16.1%), and prostate (8.6%). Most tumors were carcinomas of epithelial origin (75.3%) and predominantly adenocarcinoma (49.4%). The commonest metastatic sites encountered within the temporal bone were the petrous (72.0%) and mastoid (49.0%) portions. Bilateral temporal bone metastases occurred in 39.8% of patients. Patients were asymptomatic in 32.0% of cases. Symptomatic patients primarily reported hearing loss (44.3%), facial palsy (31.2%), and otalgia (16.6%) for a median duration of 1 month. Petrous lesions were associated with asymptomatic cases (P = .001) while mastoid lesions more often exhibited facial palsy (P = .026), otalgia (P < .001), and otorrhea (P < .001). Non-carcinomatous tumors were associated with petrosal metastasis (P = .025) and asymptomatic cases (P = .109). Carcinomatous metastases more often presented with otalgia (P = .003).

CONCLUSIONS

Temporal bone metastasis is uncommon but should be considered in patients with subacute otologic symptoms or facial palsy and history of distant malignancy. Laryngoscope, 131:1101-1109, 2021.

A rare location for sarcoma metastasis: The temporal bone

Skeletal sarcoma metastasis is relatively rare; moreover, for this type of metastasis, the temporal bone is also a rare location. The temporal bone appears to be affected by metastatic tumors in discrete histopathologic patterns, with characteristic clinical presentations. In this study, we analyzed the records of 6 patients with skeletal sarcoma metastasis to the temporal bone, with an emphasis on histopathologic sections of human temporal bones. The most common site of sarcoma metastasis in the temporal bone was petrous apex in our series. Physicians should keep in mind that a sarcoma patient may manifest with ear findings due to temporal bone metastasis.

Orbito-ethmoidal rhabdomyosarcoma in an adult patient: a case report and review of the literature

We report a patient who presented to the ENT service complaining of nasal obstruction, exophthalmos, edema and ipsilateral facial congestion. Imaging studies revealed an aggressive noncalcified solid mass centered in the left nasoethmoidal region and heterogeneous avid enhancement following contrast media injection. Subsequently, a biopsy confirmed the presence of solid alveolar rhabdomyosarcoma. The patient was treated with chemoradiation therapy for 7 weeks. Due to the advanced stage of the disease, the patient was enrolled in a palliative care and pain control program.

Peripheral facial palsy caused by neoplastic meningitis

OBJECTIVES/HYPOTHESIS

To describe the clinical presentation of peripheral facial palsy caused by neoplastic meningitis.

STUDY DESIGN

Retrospective case series.

METHODS

Retrospective review, including accompanying symptoms and magnetic resonance imaging (MRI) findings.

RESULTS

Between January and December 2011, six patients were diagnosed with peripheral facial palsy caused by neoplastic meningitis. The patient age at presentation ranged from 56 to 77 years. The tumor origins were as follows: malignant lymphoma (n = 3), lung cancer (n = 2), and kidney cancer (n = 1). In three patients, sudden sensorineural hearing loss accompanied the facial palsy. Three patients were judged to be tumor-free at the onset of the facial palsy. In two patients, the malignancy was not diagnosed at the onset of facial palsy and hearing loss. Only one patient was diagnosed as having a tumor at the onset of the facial palsy. On the MRI, a mass lesion was detected in the internal auditory canals (IAC) of four patients; one had a solitary IAC tumor. In this patient, the diagnosis required a histopathological study using a translabyrinthine approach. In the other two patients, the facial nerve was enhanced with gadolinium, but it was difficult to differentiate the observed condition from Bell's palsy. In these patients, repeated cytological studies led to the correct diagnoses.

CONCLUSIONS

The clinical symptoms and MRI findings of peripheral facial palsy caused by neoplastic meningitis sometimes mimic those of benign facial palsy.

Small cell tumors of bone

Bone tumors are fortunately rare, but small cell tumors of bone are a relatively common subset of these lesions. They comprise of a diverse group of primary and metastatic neoplasms in both children and adults. The most common small cell tumors of bone include Ewing sarcoma/primitive neuroectodermal tumor, small cell osteosarcoma, multiple myeloma, lymphoma, leukemia, neuroblastoma, rhabdomyosarcoma, and Langerhans cell histiocytosis. Although each entity has its distinctive features, the differential diagnosis of this group of tumors is still challenging because they are all "small, blue, and round cell tumors", histologically. The correct diagnosis of small cell tumors of bone depends on an evaluation of clinical, radiologic, pathologic, and genetic features. Patients' age and sex are very important, as are the signs and symptoms at presentation. Radiologically, which bone is involved, the specific portion of the bone (epiphysis, metaphysis, or diaphysis; cortex vs. medulla) involved, and the radiographic manifestations (lytic, blastic, or mixed lytic and blastic) are also often critical parameters for the diagnosis. In recent years, with a better understanding of the molecular and cytogenetic background of several small cell tumors, more accurate diagnoses have been supported by the clinicopathologic criteria and by a panel of immunohistochemical studies. In this review we will provide an overview of the clinical, radiologic, pathologic, and genetic characteristics of these tumors.