Case ReportA rare location for sarcoma metastasis: The temporal bone☆
Introduction
Skeletal sarcoma metastasis is relatively rare; moreover, for this type of metastasis, the temporal bone is also a rare location. The temporal bone appears to be affected by metastatic tumors in discrete histopathologic patterns, with characteristic clinical presentations. The incidence of skeletal sarcoma metastasis to the temporal bone seems to be increasing, given the generally increasing incidence of cancer as well as the increase in life expectancy.
More effective methods of radiochemotherapy have interrupted the course of sarcoma and allowed more time for metastasis [1], [2]. The mechanism of temporal bone metastasis can be explained by 5 distinct patterns: (1) hematogenous spread of carcinoma, leading to seeding of the marrow spaces of the petrous bone; (2) access by tumor cells to the cerebrospinal fluid (CSF) and dissemination through the subarachnoid space into the internal auditory canal (IAC); (3) direct extension; (4) leptomeningeal extension from an intracranial primary tumor; and (5) leukemic or lymphomatous infiltration [1], [2], [3], [4], [5].
The 6 most common primary malignancies that metastasize to the temporal bone are breast, lung, kidney, stomach, bronchus, and prostate [4], [5], [6], and the 5 most common sites of metastasis within the temporal bone are the petrous apex, IAC, mastoid cavity, external auditory canal, and middle ear [4], [5]. Because skeletal sarcoma metastasis to the temporal bone is very rare, only a few case reports have been published in the literature, rather than a large case series. Those case reports involved synovial sarcoma, angiosarcoma, histiocytic sarcoma, reticular cell sarcoma, liposarcoma, rhabdomyosarcoma, osteosarcoma, and hemangiopericytoma [7], [8], [9], [10], [11].
Occasionally, the temporal bone is the site of origin of a sarcoma. Several petrosal sarcomas have been found in children and in young adults. Such sarcomas infiltrate rapidly, produce multiple cranial nerve palsies, and usually result in death from intracranial extension.
In this study, we analyzed the records of 6 patients with skeletal sarcoma metastasis to the temporal bone, with an emphasis on histopathologic sections of human temporal bones (HTBs).
Section snippets
Materials and methods
This study was approved by the University of Minnesota institutional review board (0206M26181).
Using the University of Minnesota temporal bone collection, we analyzed the histopathologic sections of 11 HTBs from 6 patients with different types of skeletal sarcoma metastasis to the temporal bone. All of the HTB specimens were prepared per the standard technique of light microscopy, including fixation, decalcification, and serial 20-μm sectioning in the horizontal plane; they were then stained
Discussion
The skeleton is the third most frequent site of general metastatic disease. The lungs, breast, prostate, kidney, and thyroid gland account for more than 80% of all skeletal metastases. Skeletal sarcoma metastasis is relatively rare; it is seen more frequently in children [12].
As part of the skeleton, the temporal bone can be affected by sarcoma metastasis. The metastasis to the temporal bone of other sarcomas has already been reported, including synovial sarcoma, angiosarcoma, histiocytic
Conclusion
In the light of the histologic findings of skeletal sarcoma metastasis to the temporal bone that we described in this study, physicians should keep in mind that the ear of a sarcoma patient may be the site of temporal bone metastasis. Although skeletal sarcoma metastasis to the temporal bone is rare, this diagnosis must be considered in any sarcoma patient with otologic manifestations.
Acknowledgments
This project was funded by the National Institutes of Health (NIDCD U24 DC011968-01), the International Hearing Foundation, the Starkey Hearing Foundation, and the 5M Lions International. Authors Hızlı and Kaya received the Scientific and Technological Research Council of Turkey (TUBITAK) Scholarship.
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2018, Temporal Bone Cancer
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Source of Funding: This project was funded by the National Institutes of Health (NIDCD U24 DC011968-01), the International Hearing Foundation, the Starkey Hearing Foundation, and the 5M Lions International. Authors Hızlı and Kaya received the Scientific and Technological Research Council of Turkey (TUBITAK) Scholarship.