Vaz Marco Antônio S, Gonçalves Rafaela F, Lavinsky Joel, Rassier Isolan Gustavo
Department of Neurosurgery, The Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, BRA.
Department of Neurology, The Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, BRA.
Cureus. 2023 Dec 22;15(12):e50965. doi: 10.7759/cureus.50965. eCollection 2023 Dec.
Progressive unilateral hearing loss and an MRI are usually enough to diagnose vestibular schwannoma (VS). We were consulted by a 45-year-old man with otalgia and left-sided hearing loss as well as ipsilateral facial paralysis that had begun two weeks prior. Due to a possible atypical presentation of VS, an MRI was ordered, which revealed an intracanalicular lesion occupying the left cerebellopontine angle cistern. With no signs of systemic disease and considering the total left ear deafness, the patient underwent retrolabyrinthine mastoidectomy. During the procedure, a mass incompatible with VS was found and a biopsy was performed, which led to a diagnosis of non-Hodgkin's lymphoma (NHL). The patient was referred to an oncologist for treatment and, in time, achieved complete remission of the lesion. This case shows us that symptoms of VS may vary in tumor size and location and that atypical presentations warrant investigation. Non-Hodgkin's lymphoma (NHL), although not among the most common differential diagnoses, should be remembered due to its varied clinical presentation broadly dependent on its subtype and dissemination.
进行性单侧听力丧失和磁共振成像（MRI）通常足以诊断前庭神经鞘瘤（VS）。我们会诊了一名45岁男性，他在两周前开始出现耳痛、左侧听力丧失以及同侧面部麻痹。由于VS可能存在非典型表现，因此进行了MRI检查，结果显示左侧内听道病变占据了小脑脑桥角池。由于没有全身疾病的迹象，且考虑到左耳完全失聪，患者接受了迷路后乳突切除术。手术过程中，发现了一个与VS不符的肿块，并进行了活检，结果诊断为非霍奇金淋巴瘤（NHL）。该患者被转诊给肿瘤学家进行治疗，并及时实现了病变的完全缓解。这个病例告诉我们，VS的症状可能因肿瘤大小和位置而异，非典型表现值得进一步检查。非霍奇金淋巴瘤（NHL）虽然不是最常见的鉴别诊断之一，但由于其临床表现广泛取决于其亚型和扩散情况，因此应予以考虑。
