Author(s)
Cheryl Yu
Srihari Daggumati
Nauman Manzoor
Christopher J. Kandl
Affiliation(s)
Virginia Commonwealth University;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to identify the challenges to diagnosis and management with concurrent neoplasms of overlapping sites.
Objectives: We present a case of a recurrent parotid squamous cell carcinoma (SCC) involving the temporal bone with a concomitant ipsilateral internal auditory canal (IAC) vestibular schwannoma (VS) and discuss the challenges in diagnosis and management.
Study Design: Case report.
Methods: Case report and literature review.
Results: A 63 year old male with history of cutaneous parotid SCC, who previously underwent surgical resection, presented with biopsy proven recurrence with an enlarging preauricular mass. He reported new onset facial paralysis and profound ipsilateral sensorineural hearing loss. CT, MRI, and PET imaging revealed the hypermetabolic parotid neoplasm with extension to the temporal bone as well as focal IAC and facial nerve enhancement concerning for perineural invasion versus separate neoplastic process. Oncologic resection was performed including composite resection and a translabyrinthine approach to the IAC. The tumor was noted to grossly invade the extratemporal facial nerve which was sacrificed. The intratemporal nerve was fully traced and serially evaluated for PNI until frozen specimens returned negative at the labyrinthine segment. The IAC was opened, identifying a separate mass more compatible with VS, which was fully resected. Final pathology confirmed VS at the IAC and no intratemporal PNI of the recurrent SCC.
Conclusions: Concurrent neoplasms within adjacent sites are exceedingly rare and present unique diagnostic and management challenges, particularly in cases involving malignancy as aggressive intervention is necessary for oncologic cure. Cases in the head and neck are further complicated by the anatomical intimacy with vital structures like cranial nerves. Comprehensive cautious evaluation both pre and intraoperatively must be taken to provide optimal care and accurate diagnosis.