ABSTRACT
Congenital cholesteatoma may originate at various sites in the temporal bone. Congenital cholesteatoma of the mastoid origin shows a variable clinical presentation, although the least common site is the mastoid process. We report an extremely rare case of congenital cholesteatoma isolated to the mastoid presenting as stricture of the external auditory canal. A 10-year-old boy presented with stricture of the left-sided external auditory canal caused by bulging of the posterior wall of the external auditory canal. Computed tomography showed destruction of the posterior wall of the external auditory canal by a lesion of soft tissue density in the left mastoid cells. At surgery, cholesteatoma was observed in the mastoid cavity. Although destruction of the posterior wall of the external auditory canal was identified, the external auditory canal skin and tympanic membrane were intact, and the aditus ad antrum mucosa was normal. Congenital cholesteatoma isolated to the mastoid was diagnosed. Diagnosis of congenital cholesteatoma isolated to the mastoid should be based on clinical examination, radiological evaluation, and surgical findings. In addition, the possibility of congenital cholesteatoma isolated to the mastoid should be considered in patients with stricture of the external auditory canal.
Subject(s)
Cholesteatoma/congenital , Ear Canal/pathology , Mastoid/diagnostic imaging , Child , Cholesteatoma/diagnosis , Cholesteatoma/surgery , Constriction, Pathologic/etiology , Ear Canal/diagnostic imaging , Ear Canal/surgery , Humans , Male , Mastoid/surgery , Tomography, X-Ray Computed , Tympanic Membrane/diagnostic imaging , Tympanic Membrane/pathologySubject(s)
Mucocutaneous Lymph Node Syndrome/diagnostic imaging , Retropharyngeal Abscess/diagnostic imaging , Tomography, X-Ray Computed , Child , Child, Preschool , Diagnosis, Differential , Female , Humans , Male , Mucocutaneous Lymph Node Syndrome/diagnosis , Pharynx/diagnostic imaging , Retropharyngeal Abscess/diagnosisSubject(s)
Granuloma, Lethal Midline/diagnosis , Granulomatosis with Polyangiitis/diagnosis , Otitis Media/diagnosis , Antibodies, Antineutrophil Cytoplasmic/analysis , Cyclophosphamide/therapeutic use , Female , Glucocorticoids/therapeutic use , Granuloma, Lethal Midline/drug therapy , Granuloma, Lethal Midline/etiology , Granulomatosis with Polyangiitis/complications , Granulomatosis with Polyangiitis/drug therapy , Humans , Immunosuppressive Agents/therapeutic use , Middle Aged , Nasal Mucosa/metabolism , Nasal Mucosa/pathology , Otitis Media/drug therapy , Otitis Media/etiology , Prednisolone/therapeutic use , Serine Endopeptidases/immunology , Serine Endopeptidases/metabolism , Treatment OutcomeABSTRACT
Methotrexate (MTX) has been increasingly administered to patients with rheumatoid arthritis (RA), resulting in methotrexate-associated lymphoproliferative disorder (MTX-LPD) in patients. We reported three case of rheumatoid arthritis (RA) undergoing methotrexate (MTX) therapy who developed MTX-LPD. A 72-year-old woman treated with MTX since December 1997 (total dose 3684 mg) presented with swelling of the right tonsil in October 2006, and diffuse large B-cell lymphoma was diagnosed by tonsil biopsy and positive EBER1. When MTX therapy was interrupted, the tonsil was shrank and chemotherapy was not necessary. She followed a good clinical course for 12 months. Two other patients treated with MTX for RA for several years presented with enlarged neck lymph nodes and were diagnosed with MTX-LPD. Neck lymph nodes shrank upon MTX withdrawal in several weeks. There have been no signs of recurrence in these cases and they followed a good clinical course. The oncogenic potential of MTX and RA is reviewed.
