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Raymond MJ, Ottinger A, Rowley MA, Bobian M, Dornhoffer J, Brennan E, Rizk HG. A Scoping Review of Otologic Manifestations of Hematologic Malignancies. Otol Neurotol 2024; 45:362-375. [PMID: 38437804 DOI: 10.1097/mao.0000000000004141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To examine the otologic and neurotologic symptoms, physical examination findings, and imaging features secondary to hematologic malignancies. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases, including PubMed, Scopus, and CINAHL, were searched for articles including patients with otologic manifestations of leukemia, lymphoma and multiple myeloma. Data collected included patient and study demographics, specific hematologic malignancy, timing and classification of otologic symptoms, physical examination findings, imaging features and methods of diagnosis. Pooled descriptive analysis was performed. RESULTS Two hundred seventy-two articles, of which 255 (93.8%) were case reports and 17 (6.2%) were case series, reporting on 553 patients were identified. Otologic manifestations were reported on 307 patients with leukemia, 204 patients with lymphoma and 42 patients with multiple myeloma. Hearing loss and unilateral facial palsy were the most common presenting symptoms for 111 reported subjects with leukemia (n = 46, 41.4%; n = 43, 38.7%) and 90 with lymphoma (n = 38, 42.2%; n = 39, 43.3%). Hearing loss and otalgia were the most common presenting symptoms for 21 subjects with multiple myeloma (n = 10, 47.6%; n = 6, 28.6%). Hearing loss and unilateral facial palsy were the most common otologic symptoms indicative of relapse in subjects with leukemia (n = 14, 43.8%) and lymphoma (n = 5, 50%). CONCLUSION Hearing loss, facial palsy, and otalgia might be the first indication of a new diagnosis or relapse of leukemia, lymphoma, or multiple myeloma. Clinicians should have a heightened level of suspicion of malignant etiologies of otologic symptoms in patients with current or medical histories of these malignancies.
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Affiliation(s)
| | - Allie Ottinger
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - M Andrew Rowley
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Michael Bobian
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Jim Dornhoffer
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | | | - Habib G Rizk
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
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2
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Guan L, Dai K, Han S, Zhang L. Primary lymphoma of the skull base: A case report. Asian J Surg 2023; 46:5652-5654. [PMID: 37633782 DOI: 10.1016/j.asjsur.2023.08.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023] Open
Affiliation(s)
- Lei Guan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Bei-jing, 100093, China.
| | - Kaining Dai
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Bei-jing, 100093, China.
| | - Song Han
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Bei-jing, 100093, China.
| | - Linpeng Zhang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Bei-jing, 100093, China.
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3
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Palsetia DR, Vijan AV, Gala FB, Sahu AC, Patkar DP, A. AS. Clival and Paraclival Lesions: A Pictorial Review. Indian J Radiol Imaging 2023; 33:201-217. [PMID: 37123565 PMCID: PMC10132890 DOI: 10.1055/s-0043-1761183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
AbstractThe clivus is a midline anatomical structure in the central skull base. It is affected by a wide range of non-neoplastic, benign and malignant pathologies, some of which typically affect the clivus because of its strategic location and embryological origins. Clival lesions may often be asymptomatic with occasional complaints like headache or cranial neuropathy in few. Cross-sectional imaging techniques, namely, computed tomographic scan and magnetic resonance imaging, thus, play a key role in approximating to the final diagnosis and estimating the disease extent. In this article, we highlight the important imaging features of various clival and paraclival pathologies to facilitate effective diagnosis, therapeutic planning, and management.
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Affiliation(s)
- Delnaz R. Palsetia
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Antariksh V. Vijan
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Foram B. Gala
- Department of Radiodiagnosis and Imaging, Lifescan Imaging Centre & Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Amit C. Sahu
- Department of Interventional Neuro-Radiology, Wockhardt Hospital, Mumbai, Maharashtra, India
| | - Deepak P. Patkar
- Department of Imaging, Nanavati Superspecialty Hospital, Mumbai, Maharashtra, India
| | - Arpita Sahu A.
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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4
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Jia G, Zhou P, Shao N. Primary non-Hodgkin's lymphoma of the skull base with abductor nerve palsy. Asian J Surg 2023; 46:1172-1173. [PMID: 36030162 DOI: 10.1016/j.asjsur.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/06/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Geng Jia
- Department of Neurosurgery, Third Affiliated Hospital of Soochow University, Changzhou, 213000, China
| | - Peng Zhou
- Department of Neurosurgery, Third Affiliated Hospital of Soochow University, Changzhou, 213000, China
| | - Naiyuan Shao
- Department of Neurosurgery, Third Affiliated Hospital of Soochow University, Changzhou, 213000, China.
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5
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Kobayashi Y, Hanai S, Nakagomi D. Diffuse large B-cell lymphoma mimicking granulomatosis with polyangiitis and otitis media with antineutrophil cytoplasmic antibodies-associated vasculitis. Arch Rheumatol 2022; 37:635-637. [PMID: 36879578 PMCID: PMC9985380 DOI: 10.46497/archrheumatol.2022.9293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/21/2021] [Indexed: 03/08/2023] Open
Affiliation(s)
- Yoshiaki Kobayashi
- Department of Rheumatology, University of Yamanashi Hospital, Chuo-Shi, Yamanashi, Japan
| | - Shunichiro Hanai
- Department of Rheumatology, University of Yamanashi Hospital, Chuo-Shi, Yamanashi, Japan
| | - Daiki Nakagomi
- Department of Rheumatology, University of Yamanashi Hospital, Chuo-Shi, Yamanashi, Japan
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6
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Paglia F, di Norcia V, D'Angelo L, Berra LV, Santoro A. A rare case of Meckel's cave primary lymphoma: a case report and elaboration of the diagnostic algorithm. Acta Neurol Belg 2021; 121:907-914. [PMID: 31983037 DOI: 10.1007/s13760-020-01281-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/11/2020] [Indexed: 11/26/2022]
Abstract
Management of lesions involving Meckel's cave can represent a challenge for neurosurgeons, because of the deep-seated location and the surrounding complex neurovascular structures. Very small lesions arising from MC are generally asymptomatic and radiological follow-up with head MRI and PET-CT is sufficient to control these lesions. In rare cases, the rapid increase in the size of lesions and the alteration of the neurologic status make early histological characterization mandatory in the plethora of lesions arising from Meckel's cave; a very small percentage is represented by central nervous system lymphomas. Primary diffuse large B-cell lymphoma is the most commonly found. Aggressive surgery, in case of suspicious Meckel's cave lesions, is strongly discouraged, because this procedure may increase the risk of postoperative deficit and provides no survival benefit compared with biopsy alone. The aim of the present paper is to report a very rare case of primary Meckel's cave diffuse large B-cell lymphoma (only seven cases were described in literature) and standardize an operative algorithm to avoid the risks of an incorrect surgical conduct.
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Affiliation(s)
- Francesco Paglia
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy.
| | - Valerio di Norcia
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Luca D'Angelo
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Luigi Valentino Berra
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
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7
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Reznitsky M, Petersen MMBS, West N, Stangerup SE, Cayé-Thomasen P. The natural history of vestibular schwannoma growth-prospective 40-year data from an unselected national cohort. Neuro Oncol 2021; 23:827-836. [PMID: 33068429 DOI: 10.1093/neuonc/noaa230] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Optimal management of vestibular schwannoma (VS) is still debated and thus international consensus has not been achieved. Treatment options are observation, radiotherapy, and surgery. Knowledge on the natural history of tumor growth is essential for choice of treatment modality. The aim is to present intra-/extrameatal tumor growth and management data from a prospective, unselected national cohort of patients diagnosed with VS during the period 1976-2015. METHODS Since 1976, all data from patients diagnosed with sporadic VS in Denmark have been referred to our national treatment center, where they have been entered prospectively into the national database. Data on tumor localization, growth, and treatment were retrieved. Growth definition: >2 mm by linear measurement, in accordance with the Tokyo 2001 consensus-meeting recommendations. RESULTS 3637 cases of VS were diagnosed, in which 1304 patients had surgery and 21 received radiotherapy post diagnosis. 2312 patients were observed with mean follow-up of 7.33 years. Of these, 434(19%; 102 intra-and 332 extrameatal tumors) changed to active treatment during the observation period due to tumor growth. 5 years after diagnosis, 21% of the intrameatal tumors exhibited growth during observation, whereas 37% of extrameatal tumors had grown, increasing to 25% intrameatal and 42% extrameatal after 10 years. Following growth, the intrameatal tumors were mostly observed further and the extrameatal mostly underwent surgery. Tumor growth occurred mainly within the first 5 years post diagnosis. CONCLUSION This natural history study documents the growth occurrence of both intra-and extrameatal VS during the first 12 years after diagnosis and should be used in patient counseling, management, and treatment decision making.
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Affiliation(s)
- Martin Reznitsky
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Niels West
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sven-Eric Stangerup
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Per Cayé-Thomasen
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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8
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Álvarez Jáñez F, Barriga LQ, Iñigo TR, Roldán Lora F. Diagnosis of Skull Base Osteomyelitis. Radiographics 2021; 41:156-174. [PMID: 33411616 DOI: 10.1148/rg.2021200046] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Skull base osteomyelitis (SBO) is an infection of the temporal, sphenoid, or occipital bone that can be a challenge to diagnose because of its nonspecific symptoms, long clinical course, and radiologic findings that mimic those of other entities. The authors review this unusual infection on the basis of six proven cases. The diagnosis of SBO should be made according to four points: a high index of clinical suspicion, radiologic evidence of infection, repeated biopsies that are negative for malignancy, and positive results of microbiologic tests. SBO typically manifests clinically in patients with diabetes and recurrent otitis externa; the infection usually extends inferiorly to the compact bone of the infratemporal fossa, affecting the lower cranial nerve foramina. Several image-based techniques should be used to diagnose SBO. CT is the best option for evaluating bone erosion and demineralization, MRI can help delineate the anatomic location and extent of disease, and nuclear imaging is useful for confirming bone infection with high sensitivity. However, the standard diagnostic procedure for SBO is for patients to undergo repeated biopsies to rule out malignancy, with histopathologic signs of infection and detection of microorganisms in the biopsied bone or soft tissue indicating SBO. The ability to diagnose SBO can be increased by identifying patients at risk, recognizing the most important causes and routes of infection, describing the main radiologic findings, and always considering the differential diagnosis. ©RSNA, 2021.
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Affiliation(s)
- Fátima Álvarez Jáñez
- From the Department of Radiology, Hospital Universitario Virgen del Rocío, Avenue Manuel Siurot, S/n, 41013, Seville, Spain
| | - Luis Quintana Barriga
- From the Department of Radiology, Hospital Universitario Virgen del Rocío, Avenue Manuel Siurot, S/n, 41013, Seville, Spain
| | - Tania Rocha Iñigo
- From the Department of Radiology, Hospital Universitario Virgen del Rocío, Avenue Manuel Siurot, S/n, 41013, Seville, Spain
| | - Florinda Roldán Lora
- From the Department of Radiology, Hospital Universitario Virgen del Rocío, Avenue Manuel Siurot, S/n, 41013, Seville, Spain
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9
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Abstract
We report a case of primary temporal bone diffuse B-cell non-Hodgkin lymphoma, which is a rare entity. A 71-year-old male with a history of dementia and hemicraniectomy presented due to 1 month of a pronounced left ulcerative mastoid lesion. Strikingly, there were no cranial nerve deficits which was unexpected due to the degree of the lesion. Initially, infectious mastoiditis was suspected based on physical examination alone. Due to the patient being a poor historian, it was difficult to determine whether this was an acute or chronic issue. Temporal bone squamous cell carcinoma, infectious mastoiditis, and actinomycosis were on the differential, but biopsies revealed non-Hodgkin lymphoma.
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Affiliation(s)
- Eytan Keidar
- Department of Otolaryngology, 21138McLaren Oakland Health System, Michigan State University, Pontiac, MI, USA
| | - Ian Bowers
- Department of Otolaryngology, 21138McLaren Oakland Health System, Michigan State University, Pontiac, MI, USA
| | - Eric Sargent
- Michigan Ear Institute, Farmington Hills, MI, USA
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10
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Marinelli JP, Marvisi C, Vaglio A, Peters PA, Dowling EM, Palumbo AA, Lane JI, Appelbaum EN, Sweeney AD, Carlson ML. Manifestations of Skull Base IgG4‐Related Disease: A Multi‐Institutional Study. Laryngoscope 2019; 130:2574-2580. [DOI: 10.1002/lary.28478] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/01/2019] [Accepted: 11/26/2019] [Indexed: 01/28/2023]
Affiliation(s)
- John P. Marinelli
- Department of Otolaryngology–Head and Neck Surgery Mayo Clinic Rochester Minnesota U.S.A
| | - Chiara Marvisi
- Department of Rheumatology University of Modena and Reggio Emilia Modena Italy
| | - Augusto Vaglio
- Department of Biomedical Experimental and Clinical Sciences “Mario Serio” University of Firenze Firenze Italy
- Nephrology and Dialysis Unit, Meyer Children's University Hospital Firenze Italy
| | - Pierce A. Peters
- Department of Neurologic Surgery Mayo Clinic Rochester Minnesota U.S.A
| | - Eric M. Dowling
- Department of Otolaryngology–Head and Neck Surgery Mayo Clinic Rochester Minnesota U.S.A
| | | | - John I. Lane
- Department of Radiology Mayo Clinic Rochester Minnesota U.S.A
| | - Eric N. Appelbaum
- Department of Otolaryngology–Head and Neck Surgery Baylor College of Medicine Houston Texas U.S.A
| | - Alex D. Sweeney
- Department of Otolaryngology–Head and Neck Surgery Baylor College of Medicine Houston Texas U.S.A
| | - Matthew L. Carlson
- Department of Otolaryngology–Head and Neck Surgery Mayo Clinic Rochester Minnesota U.S.A
- Department of Neurologic Surgery Mayo Clinic Rochester Minnesota U.S.A
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11
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Guarnizo A, Glikstein R, Torres C. Imaging Features of isolated hypoglossal nerve palsy. J Neuroradiol 2019; 47:136-150. [PMID: 31034896 DOI: 10.1016/j.neurad.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022]
Abstract
The hypoglossal nerve gives motor innervation to the intrinsic and extrinsic muscles of the tongue. Pathology of this nerve affects the balanced action of the genioglossus muscle causing tongue deviation toward the weak side. Clinically, hypoglossal nerve palsy manifests with difficulty chewing, swallowing and with dysarthric speech herein, we review the anatomy of the hypoglossal nerve as well as common and infrequent lesions that can affect this nerve along its course.
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Affiliation(s)
- Angela Guarnizo
- Neuroradiology Fellow, University of Ottawa - The Ottawa Hospital, Ottawa, Canada
| | - Rafael Glikstein
- Neuroradiologist, University of Ottawa - The Ottawa Hospital, Ottawa, Canada.
| | - Carlos Torres
- Neuroradiologist, University of Ottawa - The Ottawa Hospital, Ottawa, Canada
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12
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Marinelli JP, Peters PA, Vaglio A, Van Gompel JJ, Lane JI, Carlson ML. Skull Base Manifestations of Erdheim-Chester Disease: A Case Series and Systematic Review. Neurosurgery 2019; 85:E693-E701. [DOI: 10.1093/neuros/nyz027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 01/28/2019] [Indexed: 11/12/2022] Open
Abstract
AbstractBACKGROUNDErdheim-Chester disease (ECD) is a rare, non-Langerhans cell histiocytosis. Up to 50% of patients develop central nervous system involvement, and a subset of these patients can present with isolated tumor-like masses.OBJECTIVETo describe the skull base manifestations of ECD with an emphasis on aspects most pertinent to surgeons who may be referred such patients for primary evaluation.METHODSScopus, Web of Science, and PubMed were searched from database inception to May 1, 2018 for articles reporting skull base ECD. An institutional retrospective analysis of all patients treated at the authors’ institution since January 1, 1996 was also performed to supplement these data.RESULTSOf 465 retrieved articles, 18 studies totaling 20 patients met inclusion criteria. Institutional review identified an additional 7 patients. Collectively, the median age at diagnosis was 49 yr (interquartile range, 42-58) with a 4:1 male-to-female ratio. Patients frequently presented with diplopia (48%), headache (30%), dysarthria (22%), and vertigo or imbalance (22%), though trigeminal hypesthesia (11%), facial nerve paresis (7%), hearing loss (7%), and trigeminal neuralgia (7%) were also observed. ECD commonly mimicked meningioma (33%), trigeminal schwannoma (8%), neurosarcoidosis (8%), and skull base lymphoma (8%).CONCLUSIONDiscrete skull base lesions frequently mimic more common pathology such as meningioma or cranial nerve schwannomas. Medical therapy comprises the initial treatment for symptomatic skull base disease. Surgical resection is not curative and the utility of surgical intervention is largely limited to biopsy to establish diagnosis and/or surgical debulking to relieve mass effect.
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Affiliation(s)
- John P Marinelli
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Pierce A Peters
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Augusto Vaglio
- Nephrology Unit, Parma University Hospital, Parma, Italy
- Department of Biomedical Experimental and Clinical Sciences “Mario Serio”, University of Firenze, Firenze, Italy
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Firenze, Italy
| | - Jamie J Van Gompel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - John I Lane
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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13
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Briani C, Visentin A, Campagnolo M, Salvalaggio A, Ferrari S, Cavallaro T, Manara R, Gasparotti R, Piazza F. Peripheral nervous system involvement in lymphomas. J Peripher Nerv Syst 2019; 24:5-18. [PMID: 30556258 DOI: 10.1111/jns.12295] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/01/2018] [Accepted: 12/08/2018] [Indexed: 12/11/2022]
Abstract
The peripheral nervous system may be involved at any stage in the course of lymphoproliferative diseases. The different underlying mechanisms include neurotoxicity secondary to chemotherapy, direct nerve infiltration (neurolymphomatosis), infections, immune-mediated, paraneoplastic or metabolic processes and nutritional deficiencies. Accordingly, the clinical features are heterogeneous and depend on the localization of the damage (ganglia, roots, plexi, and peripheral nerves) and on the involved structures (myelin, axon, and cell body). Some clinical findings, such a focal or diffuse involvement, symmetric or asymmetric pattern, presence of pain may point to the correct diagnosis. Besides a thorough medical history and neurological examination, neurophysiological studies, cerebrospinal fluid analysis, nerve biopsy (in selected patients with suspected lymphomatous infiltration) and neuroimaging techniques (magnetic resonance neurography and nerve ultrasound) may be crucial for a proper diagnostic workup.
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Affiliation(s)
- Chiara Briani
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | | | | | - Sergio Ferrari
- Department of Neurology, Azienda Ospedaliera Universitaria Integrata, University Hospital G.B. Rossi, Verona, Italy
| | - Tiziana Cavallaro
- Department of Neurology, Azienda Ospedaliera Universitaria Integrata, University Hospital G.B. Rossi, Verona, Italy
| | - Renzo Manara
- Neuroradiology, Department of Medicine and Surgery, University of Salerno, Fisciano, Italy
| | - Roberto Gasparotti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Piazza
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
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14
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Primary Lymphoma of the Skull Base in the Chinese: Clinical, Radiological, Pathological, and Therapeutic Experience in a Series of 8 Patients. World Neurosurg 2018; 123:e171-e179. [PMID: 30476664 DOI: 10.1016/j.wneu.2018.11.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Primary lymphoma of the skull base (PLSB) is an extremely rare neoplasm and not much is known regarding the clinical features of, treatment strategies for, and prognoses of these lesions. We investigated the manifestations and clinical outcomes of Chinese patients with PLSB. METHODS We retrospectively reviewed the data from 8 consecutive patients with PLSB who had been treated at our center from October 2008 to December 2016 and analyzed their clinical features, treatment strategies, and prognoses. RESULTS Of the 8 patients, 3 were men and 5 were women, with a male/female ratio of 0.6. The median age was 53.5 years. In most instances, the onset was characterized by headache, followed by dysfunction of the cranial nerves. The most frequently affected region was the cavernous sinus. On magnetic resonance imaging, the main characteristic was that the internal carotid artery was encased by the tumor without an obvious tendency to be deformed, dislocated, or narrowed. All patients underwent surgical biopsy via a transsphenoidal or sublabial-transmaxillary approach. The pathological diagnosis was non-Hodgkin lymphoma for all 8 patients, with diffuse large B-cell lymphoma in 7 patients. The patients underwent chemotherapy and involved-field radiotherapy. The median overall survival was 52 months, and the 1-year progression-free survival rate was 87.5%. CONCLUSIONS PLSB is a rare disease and a diagnostic challenge, with most cases in the Chinese due to diffuse large B-cell lymphoma. We found that the incidence peaked in middle and old age, and the cavernous sinus was usually affected. Multidisciplinary treatment involving surgical biopsy, chemotherapy, and radiotherapy was an effective therapeutic strategy.
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