Hostname: page-component-7c8c6479df-ph5wq Total loading time: 0 Render date: 2024-03-27T11:45:17.424Z Has data issue: false hasContentIssue false

Post-aural ache: an unusual presentation of a metastatic temporal bone lesion from a primary adenocarcinoma of the lung

Published online by Cambridge University Press:  14 October 2013

V Thirunavukarasu*
Affiliation:
Department of ENT, Walsall Manor Hospital, Walsall, UK
T Carter
Affiliation:
Department of ENT, Walsall Manor Hospital, Walsall, UK
A Dezso
Affiliation:
Department of ENT, Walsall Manor Hospital, Walsall, UK
C Holland
Affiliation:
Department of Radiology, Walsall Manor Hospital, Walsall, UK
*
Address for correspondence: Mr Vijay Thirunavukarasu, 27 Vicarage Road, Edgbaston, Birmingham B15 3HB, UK E-mail: teeveeraj@yahoo.com

Abstract

Objective:

We report a rare case of temporal bone metastasis from a lung primary, presenting only as post-aural tenderness.

Case report:

A 57-year-old man presented to our out-patient department with left post-aural pain of four months' duration. Clinical examination revealed tenderness in the left post-aural region; the ear, nose and throat examination was otherwise unremarkable. Computed tomography and contrast-enhanced magnetic resonance imaging showed erosion of the left petrous temporal bone. Incisional biopsy was carried out. Histopathological and immunohistochemical analysis showed infiltrative metastatic adenocarcinoma of the lung. Further imaging with positron emission tomography confirmed increased uptake from the right lower lobe of the lung, suggesting the site of the primary lesion. The patient was treated with chemo-radiotherapy.

Conclusion:

Post-aural pain is a non-specific symptom, and, with normal clinical and audiometric test results, rare lesions such as the one presented could be easily missed. A thorough clinical examination must be performed to identify genuine signs, and appropriate imaging undertaken to exclude rare causes, such as this metastatic lesion of the temporal bone.

Type
Clinical Records
Copyright
Copyright © JLO (1984) Limited 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Cumberworth, VL, Friedmann, I, Glover, GW. Late metastasis of breast carcinoma to the external auditory canal. J Laryngol Otol 1994;108:808–10CrossRefGoogle Scholar
2Hill, BA, Kohut, RI. Metastatic adenocarcinoma of the temporal bone. Arch Otolaryngol 1976;102:568–71CrossRefGoogle ScholarPubMed
3Belal, A. Metastatic tumours of the temporal bone: a histopathological report. J Laryngol Otol 1985;99:839–46CrossRefGoogle ScholarPubMed
4Nelson, EG, Hinojosa, R. Histopathology of metastatic temporal bone tumors. Arch Otolaryngol Head Neck Surg 1991;117:189–93CrossRefGoogle ScholarPubMed
5Berlinger, N, Koutroupas, S, Adams, G, Maisel, R. Patterns of involvement of the temporal bone in metastatic and systemic malignancy. Laryngoscope 1980;90:619–27CrossRefGoogle ScholarPubMed
6Proctor, B, Lindsay, JR. Tumors involving the petrous pyramid of the temporal bone. Arch Otolaryngol 1947;46:180–94CrossRefGoogle ScholarPubMed
7Schuknecht, HF, Allam, AF, Murakami, Y. Pathology of secondary malignant tumors of the temporal bone. Ann Otol 1968;77:522Google ScholarPubMed
8Cureoglu, S, Tulunay, O, Ferlito, A, Schachern, PA, Paprella, MM, Rinaldo, A. Otologic manifestations of metastatic tumors to the temporal bone. Acta Otolaryngol 2004;124:1117–23CrossRefGoogle ScholarPubMed
9Devaney, KO, Boschman, CR, Willard, SC, Ferlito, A, Rinaldo, A. Tumours of the external ear and temporal bone. Lancet Oncol 2005;6:411–20CrossRefGoogle ScholarPubMed
10Imamura, S, Murakami, Y. Secondary malignant tumours of the temporal bone. A histopathological study and review of the world literature. Journal of the Oto-Rhino-Laryngological Society of Japan 1991;94:924–37Google ScholarPubMed