Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 51, Num. 3, 2003, pp. 416

Neurology India, Vol. 51, No. 3, July, 2003, pp. 416

Temporal bone carcinoma with intradural extension

Khan AK, Deb S, Ray DK
Neurosurgery Unit, R. G. Kar Medical College, 1, Kshuiram Bose Rarani, Kolkata - 700004

Correspondence Address:
Block-B, 148, Bangur Avenue, Kolkata - 700055
dibyendukroy@yahoo.com

Code Number: ni03139

ABSTRACT

A case of temporal bone carcinoma having intradural extension is reported. To the best of our knowledge, no such case has been reported so far.

INTRODUCTION

Temporal bone squamous cell carcinoma originates most frequently in the external auditory meatus and then extends into the middle ear and mastoid air cells.[1] We report a case of temporal bone carcinoma having an intradural extension.

CASE REPORT

A 27-year-old male patient had a long-standing purulent left ear discharge. For one year the purulent discharge had become blood-stained. For one month he had headaches and vomiting, intense pain in the left ear, a fungating mass in the retro-auricular region and dribbling of saliva from the left corner of the mouth. On examination, a fleshy pinkish-red, friable polypoidal mass was seen filling the left external auditory canal. The mass measured about 5 cm x 5 cm and bled on touch. The underlying bone at the mar­gin of the growth was eroded. Lower motor neuron type of facial palsy was present on the left side. There was no enlargement of the cervical lymph nodes.

Audiometry revealed both conductive and sensorineural deafness in the left ear. Plain skiagram of the left mastoid showed bony erosion. A computerized tomographic (CT) scan of the head showed an irregularly enhancing lesion eroding the left petrous bone producing a scalp swelling in the left temporal region. The lesion extended intradurally in the posterior temporal region. The tumor enhanced on contrast administration, had extensive perilesional edema and resulted in mass effect [Figure-1]. Histopathological examination (HPE) of the biopsy taken from the tumor mass protruding out of the external ear canal revealed a squamous cell carcinoma. The patient was operated by a retro-mastoid incision and a radical resection of the middle ear, temporal bone and the intradural portion of the tumor, was achieved. The tympanic membrane and the ossicles could not be identified. The dura of the posterior fossa was not involved. The postoperative course was uneventful.

HPE showed epithelial pearls along with inva­sive strands of cells characteristic of well-differentiated squamous cell carcinoma [Figure-2]. Sec­tions from the skin overlying the tumor did not show any such involvement.

DISCUSSION

The dura, like connective tissue elsewhere, constitutes at least a mechanical barrier against infection.[2] There probably also exists a biological resistance of the dura to neoplastic infiltrations.[3] Rare reports of the breach of such resistance exist for glioblastomas[4] and gliosarcomas.[5] Though spread of squamous carcinoma of the ear to the outer layer of dura has been reported,[6] we failed to come across any report of dural penetration of such tumors with subsequent intradural growth.

REFERENCES

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