Author(s)
Stephanie Yizhu Wang, BS
Neel Sangal, MD
Alexandra Quimby, MD
Jane Lee, MD
Jason Brant, MD
Affiliation(s)
Perelman School of Medicine at University of Pennsylvania ;
Abstract:
Educational Objective:
At the conclusion of this presentation, the participants should be aware of a unique possible presentation of neuroendocrine tumor.
Objective:
Metastasis to the temporal bone is an extremely rare entity. Previous literature has described small cell carcinoma of the urinary bladder (SCCB) metastasizing to the liver, brain, and adrenal glands. No cases have been reported of it metastasizing to the temporal bone. We present this clinical case, its management, and outcomes.
Study Design:
Case report.
Methods:
The authors participated in care for the patient and retrospectively reviewed provider impressions, radiologic imaging, and pathology slides.
Results:
A 79-year-old male recently diagnosed with SCCB presented to the emergency department with left ear discomfort and left-sided facial paralysis of two week duration and outside hospital CT and MRI with concern for otomastoiditis. Exam was significant for obstructive edema of the left ear canal and tenderness to palpation over the mastoid region. Repeat CT temporal bone was consistent otomastoiditis and skull base osteomyelitis. He was started with broad spectrum antibiotics pending further imaging. STAT MRI was significant for a destructive mass centered in the left mastoid skull base, hyperintense on T1 and hypointense on T2. The patient was taken to the operating room for mastoidectomy, facial nerve decompression, and lateral skull base biopsy. Biopsy was significant for metastatic small cell carcinoma. The patient underwent testing and planning for systemic chemotherapy with medical oncology and was discharged home.
Conclusions:
Although otomastoiditis is an extremely common clinical entity, we must have a degree of suspicion for atypical parallel presentations. We report the only case of metastatic SCCB to the temporal bone.