PMC6393903_01
CT of the temporal bone. An invasive lesion of the mastoid cavity on the left with widespread corrosion of the trabeculae of the bone expanding towards the cranial bones and the underlying meninx.
CRIOT2019-9641945.001.jpg
PMC6393903_01_CRIOT2019-9641945.001.jpg
fig1
An invasive lesion of the mastoid cavity on the left with widespread corrosion of the trabeculae of the bone was found, expanding intracranially (towards the cranial bones and the underlying meninx) (Figure 1).
Alpha retroauricular incision. Iotanfiltration with multiple friable fragments of dark-coloured subcutaneous tissue (a material similar to cuttlefish ink in colour) of the whole mastoid cavity, which had been submitted to "automated trephination." Drilling of the mastoid with debridement and removal of the corroded bone fragments.
CRIOT2019-9641945.002.jpg
PMC6393903_01_CRIOT2019-9641945.002.jpg
fig2
During the retroauricular incision, an infiltration was observed, with multiple friable fragments of dark-coloured subcutaneous tissue of the underlying corroded bone cortex and of the whole mastoid cavity, which had been submitted to "automated trephination." Characteristically, the mastoid cavity was infused with a material similar to cuttlefish ink in colour (Figure 2).
Foetal metastases in the mastoid. The biopsy shows a tumour consisting of nests of small-sized and medium-sized cells, with oval to round nuclei and poorly defined eosinophilic cytoplasms (hematoxylin-eosin, original magnification 200x).
CRIOT2019-9641945.003.jpg
PMC6393903_01_CRIOT2019-9641945.003.jpg
fig3
The history (individual and family), the clinical picture, the radiological and surgical findings, and the immunophenotype showed an intermediate level malignity of a melanocytic tumour in the mastoid, with areas of a high level of malignity (Figure 3).
First MRI: pathological magnetic signal with mild enhancement by contrast media and areas of necrosis of all cavities of the temporal bone. Whether this lesion corresponds to a residual disease or postoperative lesions remains a question
CRIOT2019-9641945.004.jpg
PMC6393903_01_CRIOT2019-9641945.004.jpg
fig4
The visceral cranium MRI showed an invasive lesion of a pathological magnetic signal with mild enhancement by contrast administration and areas of necrosis, occupying all cavities of the left temporal bone (Figure 4).
PMC6393903_02
Second MRI (one month later): clear reduction in the area of the pathological signal and of the intake of paramagnetic substance in and around the left temporal bone.
CRIOT2019-9641945.005.jpg
PMC6393903_02_CRIOT2019-9641945.005.jpg
fig5
Compared to the previous MuRI, we distinguished a clear reduction in the area of the pathological signal and of the intake of the paramagnetic substance in and around the left temporal bone (Figure 5).