Metastatic Lung Adenocarcinoma of the Temporal Bone

肺腺癌轉移至顳骨

林孝陽(Hsiao-Yang Lin) ； 劉家妤(Chia-Yu Liu) ； 王懋哲(Mao-Che Wang) ； 王泰隆(Tyrone Wang)

《台灣耳鼻喉頭頸外科雜誌》 44卷1期 (2009/02) Pp. 16-20

https://doi.org/10.6286/2009.44.1.16

摘要

轉移至顳骨的癌症並不多見，文獻上以乳癌及肺癌爲最多，本病例爲64歲女性病患，在2005年10月被診斷爲肺腺癌第3期，而於2005年10月11日接受左下肺葉切除術及縱隔腔淋巴廓清術，術後並接受輔助性的化學治療，在2005年12月主訴右側眼睛不能閉合及高燒數日而會診耳鼻喉科，理學檢查發現右側中耳積水，右側外耳道後壁有個突出的腫塊，右側面神經麻痺（House Brackmann第5級），以及在乳突的位置突出約6×4cm大小腫塊，當初懷疑是急性乳突炎合併面神經麻痺，於是實行了右側耳膜切開術，把一些血水般物質引流出來，並合併抗生素治療，電腦斷層檢查發現約4.6×4.6×6.0cm的腫瘤在右側乳突的地方，懷疑是顳骨骨頭轉移，故安排了超音波導引下切片檢查，證實是肺腺癌右側顳骨轉移。本病例在臨床上較爲罕見，且不易正確診斷，故在此提出報告。

關鍵字

肺腺癌 ； 轉移 ； 顳骨 ； 面神經麻痺

並列摘要

Metastases involving the temporal bone are uncommon. Most literature review consists of case reports, and the majority of the cases being breast and lung cancer. In this case report, a 64 year old female was diagnosed with Stage Ⅲ lung adenocarcinoma. The patient received left lower lobe lobectomy and mediastinal lymph node dissection on October 11(superscript th), 2005 followed by post-operative chemotherapy. In December, 2005, ENT specialist was consulted because of having difficulty in closing her right eye and persistent high fever. Physical examination revealed right hemotympanum with bulging tumor over posterior wall of external ear canal, right side facial palsy (House Brackmann Grade V), and a 6×4cm hard and fixed mass over the mastoid process. Under the first impression of acute mastoiditis associated with facial nerve palsy, right myringotomy was performed. Some bloody discharge was noted, and antibiotics were administered. Computed tomography revealed a 4.6×4.6×6.0 cm mass over the right mastoid area, and sono-guided biopsy was performed under the tentative diagnosis of temporal bone metastasis. Pathology report confirmed the diagnosis of lung adenocarcinoma with right temporal bone metastasis.

並列關鍵字

lung adenocarcinoma ； metastasis ； temporal bone ； facial palsy