Radiology Quiz Case 2

Radiology Quiz Case 2 Hatice T. Sanal, MD; Ozgur Kilickesmez, MD; Cevat Can, MD; Diyarbakir Military Hospital, Diyarbakir, Turkey

A

55-YEAR-OLD WOMAN PRESENTED WITH left-sided acute, painless facial paralysis. The findings of her physical examination were unremarkable. An otoscopic examination was not performed. Because facial nerve edema is one of the the most common causes of facial paralysis, medical therapy was prescribed accordingly. The patient had no response to the therapy, so she was readmitted for the second time 2 months later, at which time otoscopy revealed a skincovered mass obliterating the left external auditory canal.

Computed tomography demonstrated a lytic, partially expansile lesion measuring approximately 4⫻4 cm in the mastoid and styloid portions of the temporal bone, with irregular margins, a wide transition zone, and mild dense calcifications within the internal structure (Figure 1). The bone lesion, which had a soft tissue component (Figure 2), extended to the vicinity of the tympanic membrane, obliterating the external auditory canal inferiorly. An incisional biopsy and then a microscopic examination were performed on the mass in the external auditory canal (Figure 3). What is your diagnosis?

Figure 1.

Figure 2.

Figure 3.

(REPRINTED) ARCH OTOLARYNGOL HEAD NECK SURG/ VOL 131, OCT 2005 922

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