![]() ![]() ![]() The discussion focuses on the incidence of extra-axial CPA and IAC lesions with their clinical presentations and their radiological findings. The patient was treated with intrathecal chemotherapy. MRI showed an increase of the residual tumor and meningeosis carcinomatosa, and cerebrospinal fluid (CSF) examination was positive for tumor cells. The patient's condition deteriorated gradually. ![]() The investigations for the primary tumor site were all negative. Histological examination revealed blennogenic cylindrical adenocarcinoma. Due to progressive headaches and dizziness, the patient underwent a left transtemporal craniotomy with subtotal tumor resection. The follow-up MRI showed an unchanged pattern of contrast enhancement. Magnetic resonance imaging (MRI) showed an extra-axial mass most likely representing a left-sided vestibular schwannoma with characteristic contrast enhancement in the IAC. He presented 8 months later with left-sided tinnitus, progressive hearing loss, and attacks of vertigo. Cranial computed tomography scan revealed bilateral nonspecific periventricular and subcortical vascular lesions. We provide a review of uncommon lesions in the IAC and describe to our knowledge the first instance of a primary adenocarcinoma.Ī 60-year-old man presented with nausea and vomiting. Intracanalicular metastases of adenocarcinoma are documented, but a primary adenocarcinoma remains unreported. Should have an explanation (e.g.Despite the relatively frequent occurrence of multiple primary tumors, namely, 10% of intracranial tumors, metastasis is a rare occurrence within the internal auditory canal (IAC) and cerebellopontine angle (CPA). Surgical referral reserved for patients with symptomatic tumors 17 * MRI can demonstrate depth of the lesion 16Ĭonservative treatment can include observation or intravascular sclerotherapy 17 Radiography and ultrasonography may reveal lesions containing phleboliths and mixed echogenicity Soft, compressible masses diffuse blue or purple skin discoloration 17 Observation if no functional impairment 15Ĭonsider aspiration, steroid injection, or surgical excision if functional impairment or recurrent 14, 15Ĭapillary hemangiomas are the most common type 12, 16 Ultrasonography to distinguish between cystic and solid masses, locate adjacent blood vessels, and distinguish between other diagnoses, including a ruptured Baker cyst and deep venous thrombosis Most often on hands, wrists, feet, or ankles 13, 14 MRI: well-defined T2 hyperintense lesions, may depend on presence of internal debris ruptured cysts have a more varied appearance 12įor mildly inflamed epidermal inclusion cysts, incision and drainage with culture 12Īrises from joint, ligament, or tendon injuries 13 Hallmark feature is central punctate 1, 12 ![]() Incision and drainage with ultrasound guidance 7Ĭonsider antibiotics if recurrent or patient is immunocompromised 8 – 10 Ultrasonography showing focal collection vs. Progressive, subcutaneous, erythematous swelling with possible drainage 6 Because of the high mortality rate of soft tissue sarcomas, evaluation of high-risk masses with magnetic resonance imaging with contrast should be expedited with a referral to orthopedic oncology. Lipomas and epidermal cysts may be excised if they are painful or if there is concern for malignancy. Incisional biopsy of a concerning soft tissue mass can also be useful for establishing a diagnosis. Although less commonly used, computed tomography is an alternative in the initial evaluation of concerning masses and can assist with staging of retroperitoneal and visceral sarcomas. Magnetic resonance imaging with contrast provides spatial orientation and delineation of soft tissue sarcomas from surrounding tissues such as muscles. Ultrasonography can be used to assess size, depth, solid or cystic nature, and associated vasculature. Imaging for concerning lesions may include ultrasonography, radiography, and sometimes magnetic resonance imaging with contrast. Masses that are deep to the fascia, are 5 cm in diameter or larger, grow rapidly, or present suddenly without explanation should prompt further workup. Although most lesions, including lipomas, fibromas, and epidermal and ganglion cysts, are benign, rare lesions such as soft tissue sarcomas may have serious consequences. Soft tissue masses are a common presentation in family physician offices. ![]()
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