PMC5220405_01
Axial (a) and coronal (b) HRCT images reveal extensive permeative destructive lesions involving both temporal bones (white asterisks). Axial postcontrast fat suppressed T1W axial (c) and coronal (d) images reveal postcontrast enhancement of large associated subgaleal and extracranial intradural soft tissue mass (arrows) on the right side and a moderately large lobulated soft tissue mass along undersurface of left temporal bone (asterisk) causing compression of the extracranial segment of left facial nerve.
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Similar lesions were also noted involving the base of the left temporal bone (Figures 1(a) and 1(b)). MRI scan showed diffuse signal alteration in both temporal bones with associated lobulated, extradural, and subgaleal enhancing soft tissue lesions (Figures 1(c) and 1(d)).
Microscopy showing sheets of medium to large lymphoid cells with hyperchromatic nuclei and scanty cytoplasm (a-d). The cells stained positive for CD3 (e), CD20 (f), Ki67 (g), LCA1 (h), and LCA2 (i).
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Microscopy showed sheets of medium to large lymphoid cells with hyperchromatic nuclei and scanty cytoplasm (Figures 2(a)-2(d)). These cells stained positive for CD3 (Figure 2(e)), CD20 (Figure 2(f)), Ki67 (Figure 2(g)), LCA1, (Figure 2(h)), and LCA 2 (Figure 2(i)) and negative for CyclinD1 (clone Polyclonal), CD5 (Clone 4C7), and CD138 (clone MI-15).
Whole body PET-CT scan revealed FDG-avid lesions (SUV max. 3.6) in both mastoids and along left styloid process (a, b). No other FDG-avid lesions were detected in the rest of the body (c).
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The PET-CT scan revealed FDG-avid lesions (SUV max. 3.6) in both mastoids, in the extradural soft tissue mass on the right side and extracranial mass along left styloid process (Figures 3(a) and 3(b)). No other FDG-avid lesions were detected in the rest of the body (Figure 3(c)).
Posttherapy PET-CT scan (a, b) showing significant resolution in the metabolic activity of the mastoid lesions. Contrast enhanced MRI scan (c, d) also showed regression in the size of the enhancing soft tissue masses on both sides.
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A PET-CT scan was performed three months after the end of radiation therapy which showed significant resolution in the metabolic activity of the mastoid lesions. (Figures 4(a) and 4(b)). The repeat MRI scan also showed regression in the size of the enhancing soft tissue masses on both sides (Figures 4(c) and 4(d)).