Thirunavukarasu V, Carter T, Dezso A, Holland C
Department of ENT, Walsall Manor Hospital, Walsall, UK.
J Laryngol Otol. 2013 Oct;127(10):1017-9. doi: 10.1017/S0022215113002120. Epub 2013 Oct 14.
We report a rare case of temporal bone metastasis from a lung primary, presenting only as post-aural tenderness.
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.
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.
我们报告一例罕见的以耳后压痛为唯一表现的肺原发性颞骨转移病例。
一名57岁男性因持续4个月的左耳后疼痛前来我院门诊就诊。临床检查发现左耳后区域压痛；耳鼻喉检查未见其他异常。计算机断层扫描和增强磁共振成像显示左侧岩颞骨侵蚀。进行了切开活检。组织病理学和免疫组织化学分析显示为肺浸润性转移性腺癌。进一步的正电子发射断层扫描成像证实右肺下叶摄取增加，提示原发性病变部位。该患者接受了放化疗。
耳后疼痛是一种非特异性症状，在临床和听力测试结果正常的情况下，像本文所呈现的这种罕见病变很容易被漏诊。必须进行全面的临床检查以识别真正的体征，并进行适当的影像学检查以排除罕见病因，如这种颞骨转移病变。
