Department of Otorhinolaryngology, Buddhist Dalin Tzu-Chi General Hospital, 2, Min-Shen Road, Da-Lin, Chiayi, Taiwan.
Jpn J Clin Oncol. 2011 Feb;41(2):272-4. doi: 10.1093/jjco/hyq175. Epub 2010 Oct 5.
Primary tympanic membrane cancer is very rare; metastatic cancer to the tympanic membrane is extremely rare and presents diagnostic challenges. We report a case of metastatic hepatocellular carcinoma in the tympanic membrane. The presenting symptom was hearing loss. Physical examination revealed a friable granulomatous mass over the left anterior tympanic membrane extended from the external auditory canal. Computed tomography scan of the temporal bone revealed one soft tissue mass involving the left external auditory canal and tympanic membrane. A left middle ear mass biopsy was performed. The tumor cells were uniformly positive for cytokeratin and hepatocyte paraffin-1, confirming a diagnosis of metastatic tympanic membrane. A tympanic membrane mass might easily be misdiagnosed and improperly treated. This case serves as a reminder that the differential diagnosis of acute hearing loss in cancer patients should include the metastasis occurring in the auditory canal or tympanic membrane, and that tissue biopsies are necessary to establish the definitive diagnosis for such lesions.
原发性鼓膜癌非常罕见；转移性癌症侵犯鼓膜极其罕见，且具有诊断挑战性。我们报告一例发生于鼓膜的转移性肝细胞癌。其主要表现为听力损失。体格检查发现左耳鼓膜前有一个易碎的肉芽肿块，从外耳道延伸。颞骨的计算机断层扫描显示一个软组织肿块累及左侧外耳道和鼓膜。行左中耳肿块活检。肿瘤细胞均对细胞角蛋白和肝细胞石蜡 1 阳性，确诊为转移性鼓膜癌。鼓膜肿块很容易被误诊和不当治疗。该病例提醒我们，在癌症患者中，急性听力损失的鉴别诊断应包括发生于外耳道或鼓膜的转移，且此类病变需要进行组织活检以明确诊断。
