Temporal bone neoplasia: a rare entity

Abstract

DesCripTionA previously healthy 33-year-old pregnant woman (32 weeks of gestational age) presented to our emergency department with right peripheral facial paralysis, diplopia and ipsilateral hemifacial anaesthesia. Also, she presented a 3-month unilateral progressive hearing loss and headache episodes. On clinical examination, she presented a grade II House-Brackmann right peripheral facial paralysis and the right otoscopy (figure 1) revealed a tympanic opacity suggestive of a reddish mass in the middle ear. Tonal audiometry documented a right conductive hypoacusia with 50 dB air-bone gap with a type b tympanogram.On the same day, she underwent a temporal bone CT in a low radiation field with plumbic apron ( figure 2A,B), and an MRI without gadolinium ( figure 3A,B,C) revealed a right temporal bone infiltrative lesion extending from the petroclivus to the cerebellopontine angle and middle ear cavity. A right tympanotomy biopsy was performed and histology showed a plasmocytoma. After thoraco-abdomino-pelvic MRI staging, no other lesions were identified, and it was staged as a solitary plasmacytoma. Caesarean delivery was planned at 35 weeks by a multidisciplinary team in order to start radical stereotactic radiotherapy (46 Gy in 4,5 weeks). Afterwards, the patient reported important symptomatic improvements with substantial neoplasm regression, with lesion regression in a new MRI ( figure 4A,B,C) and without other remaining suspicious lesions in the Positron Emission Tomography (PET) scan. Presently, she and her baby are fine, and the patient is in the normal follow-up regimen.Plasma cell (PC) neoplasms represent a spectrum of diseases characterised by clonal proliferation and accumulation of immunoglobulin-producing differentiated B cells.