Coronal CT head showing soft tissue occluding right EAC bony destruction of the roof.įigure 4.
She had also CT scan of neck, thorax, abdomen and pelvis for staging that didn’t show further disease.įigure 3. The MRI detected intracranial extension into posterior fossa ( Figure 4).
#AUDITORY CANAL FUNCTION FREE#
The soft tissue pushed the tympanic membrane into the middle ear which was itself pneumatised and free of the disease ( Figure 3). The CT showed occlusion of right external auditory canal with soft tissue mass with bone destruction superiorly. Ki-67 staining shows a high proliferation index approaching 60%. The immunohistochemical confirmed infiltrating lymphoid blasts CD45 positive, CD30 negative, cytokeratin negative and CD5 negative, CD20+ B lymphoid blasts with few scattered CD3+ T lymphocytes in the background. Low/High Power H & E: Dermal infiltrate of large blastic lymphoid cells The histology was keratinised stratified squamous epithelium with underlying variable infiltrate of large atypical lymphoid cells suggestive of high grade non Hodgkin’s lymphoma ( Figure 2).įigure 2. Six Biopsies (3 mm) were taken from the mass of right ear under local anaesthesia. HIV, EBV were tested with negative results. Thiopurine Methyl Transferase (TPMT) was low (30 Um/L, N 68-150 um/L). The C-reactive protein was slightly elevated (11.8 mg/l, N 0-5mg/L at 1 hour). The electrolytes (sodium 143 mmol/L, potassium 5.4 mmol/L) were normal as well. Right ear shows reddish-purple massįractionated blood count showed mild anemia (Haemoglobin 103 g/L), slight leucocytosis 11.6x10 9/L, (N 4-11x10 9/L) with neutrophilia (Neuts 7.45×10 9/l, Lymphs 2.99×10 9/l, Mono 1.03×10 9/l, Eosins 0.14×10 9/l, Basos 0.03×10 9/l) and normal platelet count (390 x10 9/L). The audiogram showed conductive hearing loss with air-bone gap 20 dB at 1000 Hz.įigure 1. She didn’t have any weight loss nor night symptoms of increase temperature or sweat. The rest of neurological examination was normal. Her nasal and throat examination was clear. There was no redness or narrowing in external canal skin. The external canal was fully occluded with reddish-purple soft mass with bleeding on touch. When the facial nerve paralysis started, it was House-Brackmann grade V/VI.
In the early stage of her deafness, her ear examination was surprisingly normal with intact tympanic membrane evan, the tympanogram was type “A” on both sides. She also had a past history of ovarian neoplasm many years ago. She discontinued the steroid after her diagnosis of adrenal insufficiency that was few weeks prior to her ear problem. Accordingly she developed secondary adrenal insufficiency, iatrogenic Cushing syndrome, Osteopenia, osteoporosis and atrioventricular nodal reentrant tachycardia without cardiomegaly. Her medical history include essential hypertension over last 2 years, type II diabetes mellitus for 3 years and refractory asthma that was treated with a heavy dose of oral prednisolone (25 mg daily) and inhaled steroid for 3 years. No past history of trauma or any ear problems. She had a carotid Doppler check on admission which was normal. 2 week before the deafness, she had unexplained dizziness and collapse for which she was admitted to the Acute Medical Unit. Then she developed right complete facial paralysis and bleeding from right ear. The condition was associated with non nocturnal otalgia, rash in lower limbs (like livido reticularis) and right temporal headache. A 49 years old Caucasian woman presented with a 3 week history of right ear deafness without tinnitus of acute onset and rapidly progressive course.
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