PMC6495091_01
The tumor arising from the Petrous Bone and extending all the way down to the Base of the posterior fossa.
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Erosion of the petrous bone was observed as the tumor extended through the left sided CP angle (Fig. 1) to the jugular foramen at the base of the skull.
Selected Images of Lesion T1 with contrast (A,B,C) and T2 axial section (D).
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A MRI, a MRA and a MRV of the lesion were obtained to provide more detailed information about the lesion, revealing a mixed intensity tumor with multiple flow voids in the center with heterogeneous contrast enhancement (Fig. 2a-d).
Defining the Blood Supply of the Tumor and Successful Embolization resulting in complete obliteration of the blood supply of tumor.
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The catheter was advanced to the tumor bed and embolization (Fig. 3a and b) was performed with PVA particles measuring 300-500 microns.
Post operative MRI Study with Contrast showing the main bulk of the tumor in Posterior Fossa removed with no compression on fourth ventricle. The remaining tumor is mainly with the internal auditory canal, which was subjected to radiotherapy.
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A final MRI performed 6 months post-operatively revealed marked reduction of the tumor mass with a normal left cerebellar hemisphere and brainstem and no compression on the 4th ventricle yet residual tumor persisted within the petrous bone (Fig. 4a-c).
a. Low magnification showing variably-sized cystic spaces. Original magnification: 40x. b. High magnification showing epithelial-lined spaces with some papillary areas. The lining epithelium is columnar cells with clear cytoplasm and small uniform nuclei that are situated mainly at the luminal side. Original magnification: 200x. c. Immunohistochemistry showing positivity for Pankeratin. d. Immunohistochemistry showing positivity for Ber-Ep4.
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The histopathology report revealed an epithelial tumor that was consistent with an endolymphatic-sac tumor (Fig. 5a-d).
No associated finding seen in abdominal CT confirming the sporadic type of ELST.
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Considering the association of endolymphatic-sac tumors with VHL disease, a CT scan of the abdomen and the pelvis was performed revealing no associated tumor (Fig. 6).