Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, P.R. China.
Department of Nuclear Medicine, The First Hospital of Jilin University, Changchun, Jilin, P.R. China.
World Neurosurg. 2019 Jul;127:381-386. doi: 10.1016/j.wneu.2019.02.166. Epub 2019 Mar 9.
The vast majority of cerebellopontine angle tumors are benign with a favorable prognosis. Metastatic tumors occurring in the cerebellopontine angle are extremely rare. Herein, we report a case of colon carcinoma metastasis to the bilateral internal auditory canals.
A 59-year-old man presented with a 2-week history of binaural hearing loss. One year before admission, he was diagnosed with colon carcinoma and underwent surgical resection combined with chemotherapy. Physical examination showed complete hearing loss in bilateral ears and bilateral facial palsy. Magnetic resonance imaging of the brain revealed nodules in the bilateral internal auditory canals. Middle-ear computed tomography demonstrated soft-tissue masses extending into the bilateral internal auditory canals. A diagnosis of neurofibromatosis type II was suspected. A unilateral surgical resection of the cerebellopontine angle tumor was performed. Postoperatively, the hearing loss and facial palsy remained unchanged. Pathologic examination showed metastatic, poorly differentiated carcinoma. The patient was diagnosed with metastatic colon carcinoma in the bilateral internal auditory canals. The patient refused radiotherapy and chemotherapy. The tumor progressed rapidly, and the patient developed dysphagia and choking 1 month later. The patient died of respiratory and circulatory failure 2 months after the surgery.
Clinicians should be aware of metastatic tumors in the internal auditory canals. Comprehensive clinicoradiologic evaluation should be highlighted. A history of malignancy and rapidly progressive hearing loss and facial palsy may suggest the diagnosis of metastasis to the internal auditory canal. The definitive diagnosis still depends on histopathologic examination.
绝大多数桥小脑角肿瘤为良性，预后良好。桥小脑角转移瘤极为罕见。本文报道 1 例双侧内耳道口结肠癌转移病例。
1 例 59 岁男性，双耳听力丧失 2 周。1 年前，患者被诊断为结肠癌，并接受了手术切除联合化疗。体格检查示双侧耳朵全聋，双侧面瘫。颅脑磁共振成像显示双侧内耳道口有结节。中耳计算机断层扫描显示软组织肿块延伸至双侧内耳道口。疑似神经纤维瘤病 2 型。行单侧桥小脑角肿瘤切除术。术后听力损失和面瘫无变化。病理检查显示转移性、低分化癌。患者被诊断为双侧内耳道口转移性结肠癌。患者拒绝放疗和化疗。肿瘤快速进展，1 个月后患者出现吞咽困难和窒息。术后 2 个月，患者因呼吸和循环衰竭死亡。
临床医生应注意内耳道口的转移瘤。应强调全面的临床影像学评估。有恶性肿瘤病史、听力和面瘫进行性加重可能提示内耳道口转移的诊断。明确诊断仍依赖于组织病理学检查。
