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Gioacchini FM, Kaleci S, Chiarella G, Viola P, Pisani D, Scarpa A, Tulli M, Pace A, Iannella G, Re M. Symptoms and clinical features in patients affected by endolymphatic sac tumor: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2022; 279:5081-5088. [PMID: 35704074 DOI: 10.1007/s00405-022-07469-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Most ELST data in the literature are case studies or limited to small cohorts (< 16 patients). We evaluated the main clinical signs observed at endolymphatic sac tumor (ELST) diagnosis in patients with or without Von Hippel-Lindau disease. METHODS We conducted a comprehensive literature search in PubMed, Scopus, and Web of Science. We included studies with at least 1 patient, of any age, affected by sporadic or VHL-related ELSTs reporting levels of hearing loss and facial nerve function and a comprehensive description of presenting symptoms at ELST diagnosis. We combined data for proportional meta-analysis. p values of 0.05 were considered statistically significant. Methodological quality was evaluated. Analyses were performed with MedCalc 14.8.1 software. RESULTS A total of 26 studies, including 113 patients and 118 cases of ELSTs were included. Pooled proportion rates (95% CI) of overall hearing loss was 88.7%, (82.4-93.4), severe hearing loss was 21.6% (12.8-32.1) profound hearing loss was 39.8% (28.7-51.5), vertigo/imbalance was 42.0% (33.8-50.5), tinnitus was 61.8% (53.4-69.8) and facial nerve palsy was 30.6% (23.2-38.9). Generally, symptoms were homogeneous or moderately heterogeneous among included studies. CONCLUSION This is the first systematic review of clinical presentations at ELST diagnosis. The most serious clinical events include profound hearing loss and facial impairment. Fluctuating hearing loss, tinnitus and vertigo are frequently reported and may confound correct and prompt ELST diagnosis.
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Affiliation(s)
- Federico Maria Gioacchini
- Department of Clinical and Molecular Sciences, ENT Unit, Polytechnic University of Marche, Ancona, Italy.
| | - Shaniko Kaleci
- Department of Diagnostic Medicine, Clinical and Public Health, University Hospital of Modena, Modena, Italy
| | - Giuseppe Chiarella
- Unit of Audiology, Department of Experimental and Clinical Medicine, Regional Centre of Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Pasquale Viola
- Unit of Audiology, Department of Experimental and Clinical Medicine, Regional Centre of Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Davide Pisani
- Unit of Audiology, Department of Experimental and Clinical Medicine, Regional Centre of Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Michele Tulli
- Department of Clinical and Molecular Sciences, ENT Unit, Polytechnic University of Marche, Ancona, Italy
| | - Annalisa Pace
- Department of Sense Organs, Sapienza University Rome, Rome, Italy
| | | | - Massimo Re
- Department of Clinical and Molecular Sciences, ENT Unit, Polytechnic University of Marche, Ancona, Italy
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Grading system and surgical approaches for endolymphatic sac tumors. Eur Arch Otorhinolaryngol 2020; 278:1345-1353. [PMID: 32632613 DOI: 10.1007/s00405-020-06185-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Endolymphatic sac tumors (ELSTs) are rare, low-grade adenocarcinomas arising from the endolymphatic sac. This study aims to present a novel grading system for ELSTs to determine the optimal management strategy. METHODS We performed a retrospective analysis of 16 patients with 17 ELSTs. The tumor location and involved adjacent neurovascular structures on CT and MRI were selected to establish the grading system. RESULTS Based on the novel grading system, grade III a tumors were most common (7/17), followed by grade I (4/17), grade II (3/17), and grade III b (3/17) tumors. Eight advanced ELSTs (grade III a and III b) received an infra-temporal fossa approach, while the other 6 early stage ELSTs (grade I and II) underwent either a retrolabyrinthine approach with posterior petrosectomy or a translabyrinthine approach combined with subtotal temporal bone resection. Hearing preservation was achieved in 2 grade I patients. Postoperative facial nerve function was HB II in 1 grade III a patient who underwent anterior facial nerve transposition and was HB III in 4 advanced patients who received facial nerve grafts with the great auricular nerve or facial-hypoglossal nerve anastomosis. The mean follow-up time was 35.1 months. Two grade III patients and 1 grade II patient had tumor recurrence during follow-up, among whom 1 grade III b patient had two cases of recurrence. CONCLUSION A correct initial diagnosis was established in all patients after meticulous imaging studies. Surgical resection is still the first choice to manage patients with ELSTs. The novel grading system enables surgeons to select tailored surgical approaches. Long-term follow-up is necessary following surgical intervention.
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Signorelli F, Piscopo G, Giraud S, Guerriero S, Laborante A, Latronico ME, Chimenti G, Maduri R, Chirchiglia D, Lavano A, Guyotat J, Alessio G, Gesualdo L. Von Hippel-Lindau disease: when neurosurgery meets nephrology, ophthalmology and genetics. J Neurosurg Sci 2019; 63:548-565. [DOI: 10.23736/s0390-5616.17.04153-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Chang WT, Tam KY, Yao H, Chow KH, Fai Tong MC. Transcanal endoscopic assisted skull base endolymphatic sac tumor resection: A rare disease with advanced technology. J Otol 2019; 15:1-5. [PMID: 32110234 PMCID: PMC7033593 DOI: 10.1016/j.joto.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/21/2019] [Accepted: 06/24/2019] [Indexed: 11/22/2022] Open
Abstract
Endolymphatic sac tumors (ELSTs) are rare, papillary adenomatous tumors that arise from the endothelium of the endolymphatic sac. We demonstrate a difficult case of endolymphatic sac tumor and how it is managed via transcanal endoscopic assisted technique, with discussion of feasibility of transcanal approach to lateral skull base tumor.
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Affiliation(s)
- Wai Tsz Chang
- Department of Otorhinolaryngology, Head and Neck Surgery, the Chinese University of Hong Kong, Hong Kong
| | - Ka Yue Tam
- Department of Otorhinolaryngology, Head and Neck Surgery, the Chinese University of Hong Kong, Hong Kong
| | - Hung Yao
- Department of Pathology, Princess Margaret Hospital, Hong Kong
| | - Kwan Ho Chow
- Department of Neurosurgery, Princess Margaret Hospital, Hong Kong
| | - Michael Chi Fai Tong
- Department of Otorhinolaryngology, Head and Neck Surgery, the Chinese University of Hong Kong, Hong Kong
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Le H, Zhang H, Tao W, Lin L, Li J, Ma L, Hong G, Lou X. Clinicoradiologic characteristics of endolymphatic sac tumors. Eur Arch Otorhinolaryngol 2019; 276:2705-2714. [DOI: 10.1007/s00405-019-05511-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/08/2019] [Indexed: 12/17/2022]
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Ferri E, Amadori M, Armato E, Pavon I. A rare case of endolymphatic sac tumour: clinicopathologic study and surgical management. Case Rep Otolaryngol 2014; 2014:376761. [PMID: 24991442 PMCID: PMC4065704 DOI: 10.1155/2014/376761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 05/21/2014] [Accepted: 05/21/2014] [Indexed: 11/17/2022] Open
Abstract
Objective. Endolymphatic sac tumor (ELST) is a rare neoplasm arising from the intrapetrous portion of the endolymphatic sac, either isolated or in association with the von Hippel-Lindau disease. We report a sporadic case of ELST with an overview of the literature and a discussion of clinic-radiological, histopathologic, and surgical findings. Case Report. A young woman presented with a progressive hearing loss in the left ear. Otoscopy showed a reddish, bleeding hypotympanic mass. CT demonstrated an expansile lytic mastoid lesion extending to the middle ear, with bone erosion. MRI confirmed a lesion of increased signal on T1-weighted sequences. The patient underwent a canal wall-down tympanoplasty with complete removal of the tumor. Histopathology was consistent with a papillary ELST. Immunohistochemistry was positive for cytokeratin and chromogranin A. Conclusion. This paper highlights the rarity of ELST, the need for an accurate neuroradiological and immunohistochemical study at the early stages, and the timeliness of surgical treatment.
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Affiliation(s)
- Emanuele Ferri
- Emergency Department, Otorhinolaryngology Unit, Otosurgery and Audiovestibology Section, General Hospital of Monselice, Via G. Marconi 19, Padua, 35043 Monselice, Italy
| | - Maurizio Amadori
- Surgical Department, Otorhinolaryngology Unit, Otosurgery, Audiology and Vestibology Section, General Hospitals of Dolo and Mirano, Via Mariutto 76, Venice, 30035 Mirano, Italy
| | - Enrico Armato
- Surgical Department, Otorhinolaryngology Unit, Otosurgery, Audiology and Vestibology Section, General Hospitals of Dolo and Mirano, Via Mariutto 76, Venice, 30035 Mirano, Italy
| | - Ida Pavon
- Surgical Pathology Unit, General Hospitals of Dolo and Mirano, Via Mariutto 76, Venice, 30035 Mirano, Italy
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Eze N, Huber A, Schuknecht B. De novo development and progression of endolymphatic sac tumour in von hippel-lindau disease: an observational study and literature review. J Neurol Surg B Skull Base 2014; 74:259-65. [PMID: 24436921 DOI: 10.1055/s-0033-1347900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 03/11/2013] [Indexed: 10/26/2022] Open
Abstract
Endolymphatic sac tumors (ELST) are rare invasive lesions of the temporal bone that are commonly associated with von Hippel-Lindau disease. This report describes serial magnetic resonance imaging (MRI) and computed tomography (CT) findings over a period of 6 years in a 12-year-old patient who developed an ELST after 3.5 years surveillance for a cerebellar hemangioblastoma. A 1.5 × 8 mm tumor was identified on MRI within the endolymphatic duct when the patient presented with audiovestibular symptoms due to intralabyrinthine hemorrhage. The tumor demonstrated subsequent growth over 25 months until the patient agreed to undergo surgical resection by subtotal petrosectomy. De novo development and the natural history have been described only in six previous cases. MRI is regarded to be unreliable with respect to the ability to demonstrate an ELST in the presence of intralabyrinthine hemorrhage, with only two out of four previously reported patients demonstrating positive MRI findings. Little is known about the precise origin (endolymphatic duct versus sac), growth, and symptom correlation. This case highlights that new audiovestibular symptoms are a potential clinical clue and intralabyrinthine hemorrhage is a neuroimaging indicator for the presence of an ELST, which based on high-resolution MRI appears to originate in the endolymphatic duct rather than sac.
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Affiliation(s)
- Nwaneka Eze
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Alexander Huber
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Bernhard Schuknecht
- Department of Radiology, MRI Zurich, Medical Radiological Institute, Zurich, Switzerland
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Partial Recovery of Audiological, Vestibular, and Radiological Findings following Spontaneous Intralabyrinthine Haemorrhage. Case Rep Otolaryngol 2013; 2013:941530. [PMID: 24455375 PMCID: PMC3884635 DOI: 10.1155/2013/941530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/05/2013] [Indexed: 11/30/2022] Open
Abstract
The diagnosis, work-up, and treatment of sudden sensorineural hearing loss and sudden vestibular loss vary widely between units. With the increasing access to both magnetic resonance imaging and objective vestibular testing, our understanding of the various aetiologies at hand is increasing. Despite this, the therapeutic options are limited and without a particularly strong evidence base. We present a rare, yet increasingly diagnosed, case of intralabyrinthine haemorrhage (ILH) together with radiological, audiological, and vestibular test results. Of note, this occurred spontaneously and has shown partial recovery in all the mentioned modalities.
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Butman JA, Nduom E, Kim HJ, Lonser RR. Imaging detection of endolymphatic sac tumor–associated hydrops. J Neurosurg 2013; 119:406-11. [DOI: 10.3171/2013.2.jns12608] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Object
To determine if physiologically based MRI sequences can be used to detect endolymphatic sac tumor (ELST)–associated hydrops, the authors performed contrast-enhanced delayed FLAIR imaging in consecutive ELST patients with clinical findings consistent with hydrops.
Methods
Consecutive patients with von Hippel-Lindau (VHL) disease and clinical findings of endolymphatic hydrops and ELSTs underwent contrast-enhanced delayed FLAIR MRI. Clinical, audiological, operative, and imaging findings were analyzed.
Results
Three patients (2 male, 1 female) with 4 ELSTs (1 patient had bilateral ELSTs) were identified who had clinical findings consistent with endolymphatic hydrops. Computed tomography and MRI evidence of an ELST was found in all patients. Their mean age at initial evaluation was 39.7 years (range 28–51 years). All patients demonstrated progressive sensorineural hearing loss that was associated with episodic vertigo and tinnitus. Contrast-enhanced delayed FLAIR MRI clearly demonstrated dilation of the membranous labyrinth consistent with hydrops in the affected ears but not the unaffected ears. Two patients underwent resection of the associated ELST that resulted in stabilization of progressive hearing loss, as well as amelioration of tinnitus and vertigo.
Conclusions
Contrast-enhanced delayed FLAIR MRI can be used to detect ELST-associated hydrops. Noninvasive MRI detection of hydrops can permit earlier detection of ELSTs in patients with VHL disease and provides direct insight into a mechanism that underlies ELST-associated audiovestibular morbidity.
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Affiliation(s)
- John A. Butman
- 1Diagnostic Radiology Department, National Institutes of Health Clinical Center
| | - Edjah Nduom
- 2Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke
- 3Department of Neurological Surgery, Emory University, Atlanta, Georgia
| | - H. Jeffrey Kim
- 4Head and Neck Surgery Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
- 5Department of Otolaryngology–Head and Neck Surgery, Georgetown University Medical Center, Georgetown University, Washington, DC; and
| | - Russell R. Lonser
- 2Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke
- 6Department of Neurological Surgery, The Ohio State University, Columbus, Ohio
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Endolymphatic sac tumors: experience of three cases. Eur Arch Otorhinolaryngol 2012; 270:1551-7. [DOI: 10.1007/s00405-012-2298-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 11/21/2012] [Indexed: 10/27/2022]
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Kim HJ, Hagan M, Butman JA, Baggenstos M, Brewer C, Zalewski C, Linehan WM, Lonser RR. Surgical resection of endolymphatic sac tumors in von Hippel-Lindau disease: findings, results, and indications. Laryngoscope 2012; 123:477-83. [PMID: 23070752 DOI: 10.1002/lary.23646] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 07/15/2012] [Accepted: 07/17/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVES/HYPOTHESIS To define the surgical treatment and outcomes of von Hippel-Lindau (VHL) disease-associated endolymphatic sac tumors (ELSTs), we analyzed consecutive VHL patients who underwent ELST resection. STUDY DESIGN Retrospective investigation of consecutive VHL patients who underwent resection of ELSTs at a clinical research center between 1999 and 2010. METHODS Analysis of serial clinical examinations, audiograms, imaging studies, and operative findings were analyzed. RESULTS Thirty-one consecutive patients with ELSTs (15 males, 16 females) underwent resection of 33 tumors (mean follow-up, 49.9 ± 48.0 months; range, 1.0-116 months). One patient had bilateral ELST resections and one patient underwent reoperation for recurrence. Mean age at surgery was 38.2 ± 10.2 years (range, 12-67 years). Whereas 29 ears (88%) had direct radiographic evidence of an ELST, four ears (12%) did not. Mean tumor size was 1.3 ± 1.1 cm (range, 0.2-5.2 cm). Whereas two patients (two ears, 6%) were asymptomatic, 29 patients (31 ears, 94% of ears) had associated audiovestibular symptoms, including sensorineural hearing loss (28 ears, 84%), tinnitus (24 ears,73%), and vertigo (21 patients, 68%). Postoperatively, hearing was stabilized (27) or improved (three) in 97% of 31 ears. Complete tumor resection was achieved in 30 ears (91% of 33 ears). Complications included cerebrospinal fluid leak in two ears (6%) and transient lower cranial nerve palsy in one ear (3%). CONCLUSIONS Surgical resection of ELSTs can be performed with hearing preservation and a reduction in audiovestibular dysfunction. Early surgical resection can prevent or decrease disabling audiovestibular symptoms, enhance the opportunity for complete resection, and preserve hearing.
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Affiliation(s)
- H Jeffrey Kim
- Office of the Clinical Director and Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, Georgetown University Medical Center, Washington, DC, USA.
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Papillary endolymphatic sac tumor: a case report. Case Rep Otolaryngol 2012; 2012:163851. [PMID: 22953101 PMCID: PMC3420372 DOI: 10.1155/2012/163851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 06/20/2012] [Indexed: 11/25/2022] Open
Abstract
Glandular tumors involving the middle ear are rare and distinguishing between adenoma and adenocarcinoma remains difficult. A distinct subclass of these tumors demonstrates microscopic papillary architecture and has a propensity to erode the petrous bone and extend intracranially. The term “aggressive papillary middle ear tumor” has recently been proposed to describe this more invasive type of middle ear tumor. These tumors cause symptoms even when microscopic in size. Although histologically benign, they have been locally destructive with frequent intracranial extension and patients may die of uncontrolled local disease. These tumors do not metastasize but there is single case report of drop metastasis to the spine in the literature. Hence this tumor must be distinguished from other benign tumors of the middle ear. These rare neoplasms constitute a distinct pathological entity and deserve wider recognition.
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Abstract
PURPOSE : Up to 16% of patients with the hereditary von Hippel-Lindau disease develop endolymphatic sac tumors of the inner ear. Early diagnosis and treatment of endolymphatic sac tumors can prevent audiovestibular morbidity, but optimal endolymphatic sac tumor surveillance strategy has yet to be determined. We aimed to evaluate endolymphatic sac tumor surveillance to determine the best surveillance strategy. METHODS : In a national prospective study, 40 VHL mutation carriers were interviewed about audiovestibular symptoms and had audiological examinations and magnetic resonance imaging of the inner ear. Further, we performed a meta-analysis including all reported endolymphatic sac tumor von Hippel-Lindau disease cases in the literature (N = 140 with 156 endolymphatic sac tumors). RESULTS : In the prospective study, endolymphatic sac tumors were suspected based on audiovestibular symptoms, audiometry, and magnetic resonance imaging in 34%, 30%, and 12.5% of subjects, respectively. In total, more than 90% of radiologically diagnosed endolymphatic sac tumors were associated with abnormal audiometric findings. No endolymphatic sac tumor genotype-phenotype correlations were found. CONCLUSION : We recommend annual audiometry as a first-line endolymphatic sac tumor screening tool, and in countries where periodic surveillance magnetic resonance imaging of the central nervous system is performed, specific images of the inner ear should be included. Audiometric abnormalities in patients with von Hippel-Lindau disease without magnetic resonance imaging-visible endolymphatic sac tumors could be due to microscopic endolymphatic sac tumors. Determination of audiometric endolymphatic sac tumor characteristics could further target screening and improve endolymphatic sac tumor diagnosis.
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Sun YH, Wen W, Wu JH, Song JM, Guan H, Wang KX, Xu MQ. Endolymphatic sac tumor: case report and review of the literature. Diagn Pathol 2012; 7:36. [PMID: 22472343 PMCID: PMC3368761 DOI: 10.1186/1746-1596-7-36] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 04/02/2012] [Indexed: 11/10/2022] Open
Abstract
Endolymphatic sac tumor (ELST) is a rare neoplasm which can be encountered sporadically or in Von Hippel-Lindau (VHL) disease. Here we report a sporadic case of ELST in 31-year-old man. Neither the symptoms nor a family history of VHL disease were found in the patient. CT imaging demonstrated an expansile lytic lesion of the mastoid process of the left petrous bone. MR scanning revealed a 5.2 cm × 4.7 cm × 4.2 cm mass which showed hyperintensity on T1- and T2-weighted images. Histologic sections showed a papillary, cystic or glandular architecture. The papillary and glandular structures were lined by a single layer of flattened cuboidal-to-columnar cells. The stroma of the papillary fronds was richly vascularized and chronically inflamed. The tumor showed diffusely positive reactivity with cytokeratin (Pan), cytokeratin 19, cytokeratin 5/6, cytokeratin 7, EMA, vimentin, CD56, and NSE and also showed variable reactivity with glial fibrillary acidic protein (GFAP) and VEGF. The Ki-67 immunostain showed a proliferation index of < 1%. Because the mass was large, it was difficult to extirpate surgically. After surgery, the patient underwent gamma-knife radiosurgery for residual tumor. The findings indicate that ELST is a rare neoplasm with benign histopathological appearance and clinically destructive behavior. Because of the rarity of this tumor, it can easily be confused with other tumors such as paraganglioma, middle ear adenoma, adenocarcinoma, papillary carcinoma of thyroid or choroid plexus papilloma. Owing to its locally aggressive nature, it is difficult to extirpate surgically when it is large.
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Affiliation(s)
- Yan-Hua Sun
- Department of Pathology, Shenzhen Second People's Hospital, 3002 Sungang West Road, Shenzhen 518035, China
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Wind JJ, Lonser RR. Management of von Hippel-Lindau disease-associated CNS lesions. Expert Rev Neurother 2012; 11:1433-41. [PMID: 21955200 DOI: 10.1586/ern.11.124] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patients with von Hippel-Lindau disease (VHL) often harbor significant disease burden within the CNS, specifically craniospinal-axis hemangioblastomas and endolymphatic sac tumors (ELSTs). The majority (60-80%) of patients with VHL harbor hemangioblastomas, and 10-15% will develop ELSTs. Advances in the understanding of the natural history and outcomes associated with the surgical management of VHL-associated tumors have led to improved management of patients with VHL. Optimizing indications for surgical intervention and refining of surgical techniques for these lesions can reduce patient morbidity associated with the management of this syndrome. In this article, we review the various aspects of perioperative management of patients with VHL, surgical indications and general operative principles for the management of hemangioblastomas and ELSTs, and outcomes associated with the surgical treatment of these tumors.
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Affiliation(s)
- Joshua J Wind
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
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Frequency and diagnostic utility of intralabyrinthine FLAIR hyperintensity in the evaluation of internal auditory canal and inner ear pathology. Acad Radiol 2010; 17:992-1000. [PMID: 20605731 DOI: 10.1016/j.acra.2010.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 04/05/2010] [Accepted: 04/08/2010] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES Fluid-attenuated inversion recovery (FLAIR) imaging can detect elevated protein levels in fluid that may be difficult or impossible to detect with T1- or T2-weighted imaging. The purpose of this study is to evaluate the frequency and asses the diagnostic utility of abnormal FLAIR signal in various types of inner ear and internal auditory canal (IAC) pathology. MATERIALS AND METHODS A retrospective review of medical records and magnetic resonance images from 187 consecutive patients who underwent imaging of the temporal bones for possible inner ear or IAC pathology over a 1-year period were reviewed for abnormal increased FLAIR signal, increased intrinsic T1 signal, abnormal enhancement after gadolinium administration, and the presence of a mass lesion within the cerebellopontine angle, IAC, or inner ear. Reviewers were blinded to clinical diagnosis. RESULTS Twenty-five of 32 (78%) patients with schwannomas restricted to the IAC and cerebellopontine angle demonstrated associated increased FLAIR signal within the ipsilateral inner ear structures. The sensitivity, specificity, positive predictive value, and negative predictive value of inner ear FLAIR hyperintensity for a schwannoma were 80%, 95%, 78%, and 95%, respectively. Inner ear FLAIR hyperintensity was also seen in cases of intracochlear hemorrhage, labyrinthitis, and labyrinthitis ossificans, but these conditions did not occur with sufficient frequency in our study population to determine statistical significance. CONCLUSION Identification of inner ear FLAIR hyperintensity can alert the radiologist to scrutinize pre- and post-gadolinium T1-weighted images and T2-weighted images for subtle IAC and inner ear abnormalities. Although enhancement after the administration of gadolinium contrast media is the gold standard for detection of schwannoma, inner ear FLAIR hyperintensity may be a helpful diagnostic adjunct for vestibular schwannoma. This may be particularly helpful when gadolinium was not administered and the T2-weighted images are equivocal, especially when dedicated thin-section imaging of the IACs and temporal bones was not performed.
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