Hearing loss due to metastasis of gastric cancer to temporal bone: A case report

Bilateral Hearing Loss Due to Metastatic Gastric Signet Cell Adenocarcinoma Involving the Internal Auditory Canal and Cerebellopontine Angle

Intracranial metastases of stomach cancers are very rare and are associated with a poor prognosis. Of those, metastases of gastric cancers in the internal auditory canal and cerebellopontine angle represent an extremely rare subgroup. Such metastatic lesions may be indistinguishable from vestibular schwannomas in imaging studies and clinical presentation. In this report, we describe a case of gastric signet cell adenocarcinoma metastasizing to the internal auditory canal and cerebellopontine angle bilaterally and causing bilateral hearing loss, including a unilateral sudden deafness. Due to the co-detection of multiple other intracranial masses in the magnetic resonance imaging scan, the suspected diagnosis of leptomeningeal metastatic disease was clear, and the patient was referred to palliative whole brain radiotherapy. The case further highlights the importance of prompt diagnosis and treatment of metastatic cerebellopontine angle lesions to prevent permanent neurological sequelae. Metastatic tumors should therefore be considered in the differential diagnosis of cerebellopontine angle lesions, especially in patients with a known history of malignant disease.

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.

Gastric cancer initially presenting as bone metastasis: Two case reports and a literature review

Gastric cancer frequently spreads to the regional lymph nodes, liver and lungs following surgery or late in the clinical course. However, an initial clinical presentation of bone metastasis in gastric cancer patients is relatively rare. The current study presents two cases of gastric cancer diffusely metastasized to the spinal vertebrae and with a single metastasis to the trapezium, respectively. The initial presentations were an increased alkaline phosphatase level without any symptoms associated with bone metastasis in the first case and a swelling in the right carpometacarpal joint of the thumb in the second case. These clinical manifestations are also extremely rare in gastric cancer with bone metastasis. The study emphasizes that a diagnosis of gastric cancer should be considered in patients with increased alkaline phosphatase without clinical symptoms or with a single bone metastasis.