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Abstract

A 53-year-old man presented to the emergency department with a 7-day history of right ear fullness, otalgia, and hearing loss. He had recently been treated with antibiotics for sinusitis at an outside hospital but his symptoms failed to resolve. He denied vertigo, dizziness, otorrhea, or tinnitus. Physical examination demonstrated a mass behind an intact right eardrum, and tuning fork evidence of a conductive hearing loss. The remainder of his cranial nerve examination was normal, with the exception of the long-standing HouseBrackmann Grade VI/VI right facial nerve paralysis. Audiogram demonstrated a right moderate conductive hearing loss with flat (Type B) tympanogram. The left side was normal.The patient had a right parotid pleomorphic adenoma 35 years ago, which was treated by enucleation. He presented with several subcutaneous nodules 7 years after the initial treatment, which were treated by total parotidectomy. During surgery the facial nerve was sacrificed due to tumor encasement. Pathology confirmed recurrent pleomorphic adenoma. Postoperatively the tumor bed was treated with external beam radiotherapy. After this he remained asymptomatic for nearly 30 years.Magnetic resonance imaging of the head confirmed a large, irregular, heterogeneous, and variably enhancing mass in the right mastoid with extension medially along the floor of the posterior fossa measuring $5 Â 5 Â 5 cm (►Fig. 1). The mass eroded through the mastoid laterally and inferiorly into the upper cervical soft tissues. The superior portions of the mastoid were opacified with enhancement, suggesting tumor infiltration. The mass extended inferiorly into the parapharyngeal space and extrinsically compressed the right sigmoid sinus displacing it medially. In addition, a 1 Â 1 cm enhancing nodule in the right cerebellum medial to the cystic lesion was observed. The differential diagnosis at this point included carcinoma ex AbstractPleomorphic adenoma, also known as benign mixed tumor, is the most common tumor affecting the parotid gland and can reach massive size; however, intracranial invasion is rare. Recurrence of pleomorphic adenoma after excision is a well-known phenomenon and can present decades after resection of the primary tumor. Here we present the case of a 53-year-old man who presented to our clinic with ear fullness, otalgia, and hearing loss 30 years after undergoing total parotidectomy and external beam radiotherapy for pleomorphic adenoma. Magnetic resonance imaging revealed a massive transcranial tumor invading the mastoid cavity, the dura of the posterior fossa, the fallopian and semicircular canals, the jugular foramen, the lateral infratemporal fossa skull base, the sigmoid and transverse sinuses, and the superior parapharyngeal region. Gross examination and histopathological studies confirmed that the mass was a recurrent pleomorphic adenoma. Here we discuss the features of recurrent pleomorphic adenoma and review the current literature.