Upon final review, the intraoperative diagnoses were corroborated. The remainder of the specimen was examined following standard histological processing and staining with hematoxylin and eosin. All specimens were interpreted as consistent with benign mixed tumor (pleomorphic adenoma). Throughout the procedure, multiple specimens were collected for intraoperative frozen sections. Finally, the remaining tumor was removed from the jugular foramen, lateral infratemporal fossa skull base, and the superior parapharyngeal region. Once proximal and distal venous control was achieved, the sigmoid and transverse sinuses (both involved by tumor) were resected inferior to the vein of Labbé. After tumor had been removed from these areas, the overlying dura was resected.
Alexandros powers m.d free#
The mass infiltrated the posterior semicircular canal and the aditus ad antrum however, the middle ear space and facial recess were free of tumor. The tumor had also eroded into the fallopian canal, requiring debridement and transection of the grossly involved facial nerve. It eroded through the dura of the posterior fossa medial to the sigmoid sinus and into the cerebellum. Upon entering the mastoid, tumor was noted completely infiltrating the mastoid cavity. The patient was taken to the operating room for transtemporal resection. (A) Axial T1, (B) axial T2, (C) coronal T1, and (D) sagittal T1-weighted images reveal a variably enhancing mass in the right mastoid air cells extending medially along the floor of the posterior fossa, extending inferiorly into the parotid bed and medially into the cerebellum. The differential diagnosis at this point included carcinoma ex pleomorphic adenoma, postradiation sarcoma, another parotid gland carcinoma, and recurrent pleomorphic adenoma. In addition, a 1 × 1 cm enhancing nodule in the right cerebellum medial to the cystic lesion was observed. The mass extended inferiorly into the parapharyngeal space and extrinsically compressed the right sigmoid sinus displacing it medially. The superior portions of the mastoid were opacified with enhancement, suggesting tumor infiltration.
The mass eroded through the mastoid laterally and inferiorly into the upper cervical soft tissues. Magnetic resonance imaging of the head confirmed a large, irregular, heterogeneous, and variably enhancing mass in the right mastoid with extension medially along the floor of the posterior fossa measuring ~5 × 5 × 5 cm ( Fig. After this he remained asymptomatic for nearly 30 years. Postoperatively the tumor bed was treated with external beam radiotherapy. Pathology confirmed recurrent pleomorphic adenoma. During surgery the facial nerve was sacrificed due to tumor encasement. He presented with several subcutaneous nodules 7 years after the initial treatment, which were treated by total parotidectomy. The patient had a right parotid pleomorphic adenoma 35 years ago, which was treated by enucleation. Audiogram demonstrated a right moderate conductive hearing loss with flat (Type B) tympanogram. The remainder of his cranial nerve examination was normal, with the exception of the long-standing House-Brackmann Grade VI/VI right facial nerve paralysis. Physical examination demonstrated a mass behind an intact right eardrum, and tuning fork evidence of a conductive hearing loss.
He denied vertigo, dizziness, otorrhea, or tinnitus. He had recently been treated with antibiotics for sinusitis at an outside hospital but his symptoms failed to resolve. Here we discuss the features of recurrent pleomorphic adenoma and review the current literature.Ī 53-year-old man presented to the emergency department with a 7-day history of right ear fullness, otalgia, and hearing loss. Gross examination and histopathological studies confirmed that the mass was a recurrent pleomorphic adenoma. Magnetic resonance imaging revealed a massive transcranial tumor invading the mastoid cavity, the dura of the posterior fossa, the fallopian and semicircular canals, the jugular foramen, the lateral infratemporal fossa skull base, the sigmoid and transverse sinuses, and the superior parapharyngeal region. Here we present the case of a 53-year-old man who presented to our clinic with ear fullness, otalgia, and hearing loss 30 years after undergoing total parotidectomy and external beam radiotherapy for pleomorphic adenoma. Recurrence of pleomorphic adenoma after excision is a well-known phenomenon and can present decades after resection of the primary tumor. Pleomorphic adenoma, also known as benign mixed tumor, is the most common tumor affecting the parotid gland and can reach massive size however, intracranial invasion is rare.