Inflammatory myofibroblastic tumor of the temporal bone presenting with pulsatile tinnitus: a case report

Journal of Medical Case Reports

Guangqian Xing¹  Zhihong Zhang²  Zhibin Chen¹  Tingting Liu¹  Xiaoli Zhou¹ 

[1] Department of Otolaryngology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China;Department of Pathology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China

关键词: Temporal Bone;    Pulsatile Tinnitus;    Middle Ear;    Inflammatory Myofibroblastic Tumor;   

Others  :  1181162
DOI  :  10.1186/1752-1947-7-157

 received in 2012-12-26, accepted in 2013-05-15,  发布年份 2013

【 摘 要 】

Introduction

Inflammatory myofibroblastic tumor of the temporal bone is an unusual but distinct disease entity. The most common presenting symptoms are otalgia, otorrhea, hearing loss, facial palsy, and vertigo. We describe here what we believe to be the first reported case of a patient presenting with persistent pulsatile tinnitus. The clinical features, radiological and histopathologic findings, and treatment outcomes of the patient are presented.

Case presentation

A 59-year-old woman of Chinese Han origin presented with complaints of left-sided pulsatile tinnitus and progressive hearing loss for several years. Clinical evaluations revealed a reddish mass behind the intact tympanic membrane, and a moderately severe conductive hearing loss in the left ear. The computed tomographic imaging of the temporal bone demonstrated a slightly ill-defined left middle ear soft tissue mass involving the posterior portion of the mesotympanum and epitympanum, and the mastoid antrum. The patient underwent surgical excision of the lesion which subsequently resolved her symptoms. Postoperative pathology was consistent with an inflammatory myofibroblastic tumor.

Conclusions

An inflammatory myofibroblastic tumor of the temporal bone can present clinically with pulsatile tinnitus and masquerade as venous hum or vascular tumors of the middle ear; therefore, it should be included in the differential diagnosis of pulsatile tinnitus.

【 授权许可】

   
2013 Zhou et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Cho KJ, Lee DH, Jung SH, Kim JH: A case of an inflammatory myofibroblastic tumor of the mastoid presenting with chronic suppurative otitis media. Auris Nasus Larynx 2007, 34:523-526.
• [2]Santaolalla-Montoya F, Ereño C, Zabala A, Carrasco A, Martínez-Ibargüen A, Sánchez-Fernández JM: Inflammatory myofibroblastic tumor of the temporal bone: A histologically nonmalignant lesion with fatal outcome. Skull Base 2008, 18:339-343.
• [3]Williamson RA, Paueksakon P, Coker NJ: Inflammatory pseudotumor of the temporal bone. Otol Neurotol 2003, 24:818-822.
• [4]Ajibade DV, Tanaka IK, Paghdal KV, Mirani N, Lee HJ, Jyung RW: Inflammatory pseudotumor (plasma cell granuloma) of the temporal bone. Ear Nose Throat J 2010, 89:E1-E13.
• [5]Gasparotti R, Zanetti D, Bolzoni A, Gamba P, Morassi ML, Ungari M: Inflammatory myofibroblastic tumor of the temporal bone. Am J Neuroradiol 2003, 24:2092-2096.
• [6]Cho AH, Lee BH, Kwak KW, Kang JK: Inflammatory pseudotumor of temporal bone with pachymeningitis, cranial neuropathies and uveitis. Eur Neurol 2004, 51:238-240.
• [7]Strasnick B, Vaughan A: Inflammatory pseudotumor of the temporal bone: A case series. Skull Base 2008, 18:49-52.
• [8]Coulson C, George A, Biswas A, Phelan C, De R: Pseudotumour of the temporal bone: an unusual [corrected] cause of otorrhoea and facial palsy. Eur Arch Otorhinolaryngol 2008, 265:713-715.
• [9]Mulder JJ, Cremers WR, Joosten F, Wiersma A, van den Broek P: Fibroinflammatory pseudotumor of the ear. A locally destructive benign lesion. Arch Otolaryngol Head Neck Surg 1995, 121:930-933.
• [10]Schönermark MP, Issing P, Stöver T, Ruh S, Lenarz T: Fibroinflammatory pseudotumor of the temporal bone. Skull base Surg 1998, 8:45-50.
• [11]Sismanis A: Pulsatile tinnitus: A 15-year experience. Am J Otol 1998, 19:472-477.
• [12]Mattox DE, Hudgins P: Algorithm for evaluation of pulsatile tinnitus. Acta Oto-Laryngologica 2008, 128:427-431.
• [13]Tokyol C, Yilmaz MD: Middle ear hemangioma: A case report. Am J Otolaryngol 2003, 24:405-407.
• [14]Liyanage SH, Singh A, Savundra P, Kalan A: Pulsatile tinnitus. J Laryngol Otol 2006, 120:93-97.
• [15]Yanagihara N, Segoe M, Gyo K, Ueda N: Inflammatory pseudotumor of the facial nerve as a cause of recurrent facial palsy: case report. Am J Otol 1991, 12:199-202.