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Chu C, Tan SH, Yuen HW, Low D. A clinical conundrum: Temporal bone metastases from lung adenocarcinoma. Am J Otolaryngol 2023; 44:103880. [PMID: 37003029 DOI: 10.1016/j.amjoto.2023.103880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Metastatic disease to the temporal bone is rare. Even more uncommonly, it can be the first manifestation of an underlying malignancy. Patients typically present late in the disease process with non-specific symptoms of hearing loss, facial nerve palsy and otorrhea. CASE A 62-year-old Chinese female presented with right facial weakness, which had near-complete improvement in response to pulse prednisolone. On examination, she had a right temporal swelling and right mild-severe conductive hearing loss. A computed tomography scan showed a destructive lesion centred in the squamous temporal bone, with an associated soft tissue component. Positron emission tomography scan revealed bony and lung metastases, but no distinct hypermetabolic primary site. An incisional biopsy unexpectedly returned as metastatic lung adenocarcinoma. CONCLUSION Although rare, it is important for otolaryngologists to be aware of the insidious nature of temporal bone metastases and possible atypical clinical and radiological features, to facilitate timely workup and initiation of treatment.
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Affiliation(s)
- Clarisse Chu
- Department of Otorhinolaryngology - Head and Neck Surgery, Changi General Hospital, Singapore
| | - Sze Hwa Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Heng Wai Yuen
- Department of Otorhinolaryngology - Head and Neck Surgery, Changi General Hospital, Singapore
| | - David Low
- Department of Otorhinolaryngology - Head and Neck Surgery, Changi General Hospital, Singapore.
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External auditory canal and middle ear tumors: characterization by morphology and diffusion features on CT and MRI. Eur Arch Otorhinolaryngol 2023; 280:605-611. [PMID: 35842859 DOI: 10.1007/s00405-022-07509-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/13/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To explore the value of morphology and diffusion features on CT and MRI in the characterization of external auditory canal and middle ear tumors (EAMETs). METHODS Forty-seven patients with histologically proved EAMETs (23 benign and 24 malignant) who underwent CT and MRI were retrospectively analyzed in this study. CT and MRI characteristics (including size, shape, signal intensity, border, enhancement degree, and bone changes) and apparent diffusion coefficient (ADC) value were analyzed and compared between benign and malignant EAMETs. Logistic regression, receiver operating characteristic (ROC) curve, and Delong test were performed to assess the diagnostic performance. RESULTS Compared with benign tumors, the malignant EAMETs are characterized by irregular shape, ill-defined border, invasive bone destruction, and intense enhancement (all p < 0.05). There were no significant differences on the size and signal intensity between benign and malignant tumors. The ADC value of malignant tumors were (879.96 ± 201.15) × 10-6 mm2/s, which was significantly lower than benign ones (p < 0.05). Logistic regression demonstrates the presence of ill-defined margin, invasive bone destruction, and low ADC value (≤ 920.33 × 10-6 mm2/s) have significant relationship with malignant EAMETs. The combination of characterization by morphology and diffusion features on CT and MRI can further improve the diagnostic efficiency when compared with morphology and diffusion features alone (both p < 0.05). CONCLUSION Some CT and MRI characteristics are helpful in identifying malignant EAMETs from benign ones (especially ill-defined margin, invasive bone destruction, and low ADC value), and the combination of morphology and diffusion features on CT and MRI has best diagnostic efficiency for discriminating these two entities.
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McCracken M, Pai K, Cabrera CI, Johnson BR, Tamaki A, Gidley PW, Manzoor NF. Temporal Bone Resection for Squamous Cell Carcinoma of the Lateral Skull Base: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2023; 168:154-164. [PMID: 35290141 DOI: 10.1177/01945998221084912] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/11/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Temporal bone squamous cell carcinoma (TBSCC) is rare and often confers a poor prognosis. The aim of this study was to synthesize survival and recurrence outcomes data reported in the literature for patients who underwent temporal bone resection (TBR) for curative management of TBSCC. We considered TBSCC listed as originating from multiple subsites, including the external ear, parotid, and external auditory canal (EAC), or nonspecifically from the temporal bone. DATA SOURCES PubMed, Cochrane Library, Embase, and manual search of bibliographies. REVIEW METHOD A systematic literature review conducted in December 2020 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Survival data were collected from 51 retrospective studies, resulting in a pooled cohort of 501 patients with TBSCC. Compared to patients undergoing lateral TBR (LTBR), patients undergoing subtotal (SBTR) or total (TTBR) TBR exhibited significantly higher rates of stage IV disease (P < .001), positive surgical margins (P < .001), facial nerve involvement (P < .001), and recurrent disease (P < .001). A meta-analysis of 15 studies revealed a statistically significant 97% increase in mortality in patients who underwent STBR or TTBR. On multivariate analysis, recurrent disease was independently associated with worse overall survival (P < .001). On univariate analysis, facial nerve involvement was also associated with decreased overall survival (P < .001). CONCLUSION Recurrent disease was associated with risk of death in patients undergoing TBR. Larger prospective multi-institutional studies are needed to ascertain prognostic factors for a wider array of postoperative outcomes, including histology-specific survival and recurrence outcomes.
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Affiliation(s)
- Matthew McCracken
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Kavya Pai
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Benjamin R Johnson
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Paul W Gidley
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Nauman F Manzoor
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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The importance of flaps in reconstruction of locoregionally advanced lateral skull-base cancer defects: a tertiary otorhinolaryngology referral centre experience. Radiol Oncol 2021; 55:323-332. [PMID: 33735947 PMCID: PMC8366724 DOI: 10.2478/raon-2021-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/17/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The aim of the study was to identify the value of extensive resection and reconstruction with flaps in the treatment of locoregionally advanced lateral skull-base cancer. PATIENTS AND METHODS The retrospective case review of patients with lateral skull-base cancer treated surgically with curative intent between 2011 and 2019 at a tertiary otorhinolaryngology referral centre was made. RESULTS Twelve patients with locoregionally advanced cancer were analysed. Lateral temporal bone resection was performed in nine (75.0%), partial parotidectomy in six (50.0%), total parotidectomy in one (8.3%), ipsilateral selective neck dissection in eight (66.7%) and ipsilateral modified radical neck dissection in one patient (8.3%). The defect was reconstructed with anterolateral thigh free flap, radial forearm free flap or pectoralis major myocutaneous flap in two patients (17.0%) each. Mean overall survival was 3.1 years (SD = 2.5) and cancer-free survival rate 100%. At the data collection cut-off, 83% of analysed patients and 100% of patients with flap reconstruction were alive. CONCLUSIONS Favourable local control in lateral skull-base cancer, which mainly involves temporal bone is achieved with an extensive locoregional resection followed by free or regional flap reconstruction. Universal cancer registry should be considered in centres treating this rare disease to alleviate analysis and multicentric research.
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Li Y, Zuo JL, Tang JS, Shen XY, Xu SH, Xiao JL. Primary nonkeratinizing squamous cell carcinoma of the scapular bone: A case report. World J Clin Cases 2021; 9:976-982. [PMID: 33585647 PMCID: PMC7852629 DOI: 10.12998/wjcc.v9.i4.976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/09/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Squamous cell carcinoma (SCC) of bone is usually caused by metastasis from the lungs, bladder, or other sites. Primary SCC of bone most frequently involves the skull bones, and primary involvement of other sites in the skeletal system is extremely rare. To date, only three such cases have been reported, which makes the diagnosis, treatment, and prognosis of this disease a challenge.
CASE SUMMARY A 76-year-old Chinese man presented to our hospital with nonspecific pain and limited mobility in the right shoulder for 4 mo. He underwent three-dimensional computed tomography reconstruction and magnetic resonance imaging of the right shoulder, which revealed an osteolytic destructive lesion in the right scapula with invasion into the surrounding muscles and soft tissues. Ultrasound-guided core needle biopsy detected a malignant tumor, and immunohistochemical analysis revealed a poorly differentiated SCC. Wide excision of the right scapular bone was performed, and pathological examination of the surgical specimen confirmed the diagnosis. At the last follow-up examination within 2 years, the patient was doing well with the pain significantly relieved in the right shoulder.
CONCLUSION Primary SCC of bone is extremely rare at sites other than the skull. Clinicians must exhaust all available means for the diagnosis of primary SCC of the bone, so greater attention can be paid to its timely and effective management. Regular and adequate follow-up is essential to help rule out metastasis and judge the prognosis.
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Affiliation(s)
- Yang Li
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Jian-Lin Zuo
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Jin-Shuo Tang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Xian-Yue Shen
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Sheng-Hao Xu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Jian-Lin Xiao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
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Alam U, Shafqat I, Ahsan S, Alonso J, Han AY, Mukdad L, Wang M, Ahsan SF. Survival in Middle Ear Malignancy: A Population-Based Analysis Based on the SEER Database. Otolaryngol Head Neck Surg 2021; 165:122-128. [PMID: 33400624 DOI: 10.1177/0194599820980708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the clinical features and survival outcomes of patients with middle ear malignancies at a population level. STUDY DESIGN Retrospective cohort study with data from a national database. SETTING National database of middle ear malignancy. METHODS Records of patients diagnosed with a middle ear malignancy from 1973 to 2016 were extracted from the SEER database (Surveillance, Epidemiology, and End Results). SPSS (version 27; IBM) was used to conduct 5-year survival analysis. RESULTS The average survival for all 431 patients was 61.4 months. Five-year disease-specific survival for squamous cell carcinoma (SCCA), adenocarcinoma, other carcinoma, and noncarcinoma subtypes varied significantly at 54.6%, 82.1%, 71.8%, and 82.6%, respectively (P < .0001). There was an improved 5-year survival for patients with adenocarcinoma who received surgery versus those who did not (91.7% vs 65.1%; P = .023, log-rank). Five-year disease-specific survival was significantly better in patients aged <55 years (mean ± SD, 77.8% ± 0.39%) as compared with those >70 years (55.1% ± 5.1%) and those aged 55 to 69 years (60.2% ± 4.9%; P < .01 and P < .001, respectively, log-rank). Patients with SCCA were significantly older than those with adenocarcinoma (P < .0001). Noncarcinoma subtypes were more likely to present with local disease, as opposed to regional or distant disease, when compared with SCCA (P = .0027). CONCLUSION Prognosis and treatment outcomes for primary middle ear malignancies depend on histologic subtype and age at diagnosis. The noncarcinoma and adenocarcinoma subtypes carry the best prognoses. Patients with adenocarcinoma were most likely to benefit from surgery.
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Affiliation(s)
- Usman Alam
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Iram Shafqat
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Sara Ahsan
- University of California, Berkeley, California, USA
| | - Jose Alonso
- Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Albert Y Han
- Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Laith Mukdad
- Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Marilene Wang
- Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Syed F Ahsan
- Department of Head and Neck Surgery, Kaiser Permanente, Anaheim, California, USA.,Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, USA
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Jones AJ, Tucker BJ, Novinger LJ, Galer CE, Nelson RF. Metastatic Disease of the Temporal Bone: A Contemporary Review. Laryngoscope 2020; 131:1101-1109. [PMID: 32940937 DOI: 10.1002/lary.29096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/20/2020] [Accepted: 08/22/2020] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- Alexander J Jones
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Brady J Tucker
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Leah J Novinger
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Chad E Galer
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Rick F Nelson
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.,Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
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Acharya PP, Sarma D, McKinnon B. Trends of temporal bone cancer: SEER database. Am J Otolaryngol 2020; 41:102297. [PMID: 31727339 DOI: 10.1016/j.amjoto.2019.102297] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This retrospective review aims to analyze epidemiological trends related to temporal bone cancer, and primarily of the squamous cell subtype. Potential trends analyzed included age, gender, and geographical location. DATA SOURCES This retrospective review analyzed data found in the National Cancer Institute's SEER Database for cases of carcinomas of the middle ear. Cases were selected between 1975 and 2016 and using the primary site of Middle Ear (Site code C30.1), and then narrowed using additional variables, which included age, sex, and state-county. Languages covered included English. DATA EXTRACTION The extracted data was entered into an Excel spreadsheet for further analysis in SPSS Version 25. DATA SYNTHESIS An Analysis of Covariance (ANCOVA) and a Bonferroni correction were applied to the data for further analysis of significant trends. The data was then placed into tables outlining the distribution of cases among select patient characteristics of age and sex, and significant age group pairwise comparisons. CONCLUSIONS Age at diagnosis of temporal bone cancer is strongly associated with the prevalence of temporal bone cancer. We urge providers to consider subtypes of temporal bone cancer, including squamous cell carcinoma, when evaluating older adults with risk factors for temporal bone cancer and an abnormal physical exam.
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Affiliation(s)
- Pankti P Acharya
- Rowan University School of Osteopathic Medicine, United States of America.
| | - Deeksha Sarma
- Drexel University College of Medicine, United States of America
| | - Brian McKinnon
- Drexel University College of Medicine, United States of America.
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