PMC5168475_01
Axial CT scan (noncontrast) showing the temporal bone. (a) Bone window and right ill-defined soft tissue density in the right mastoid air cells, middle, and inner ear, associated with bony destruction. Only the basal turn of the cochlea and part of the vestibule are visualized. (b) Soft tissue window and posterior aspect of the tegmentum tympani appear destroyed, thinned, and interrupted, with subcutaneous soft tissue swelling adjacent to the EAC and collection at the superior aspect.
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fig1
MRI of the brain, IAC, and mastoid with IV contrast. Axial and coronal views show (a) MRI T1 axial view before contrast, (b, c) MRI T1 axial view after contrast, and (d) MRI T1 coronal view after contrast. Right, large, loculated, peripheral enhancing collection is observed in the subcutaneous tissue of the auricular region, posterior and anterosuperior to the external auditory canal and extending to the mastoid air cells and middle ear cavity. The cochlea and semicircular canals are not visualized; only part of the vestibule is observed, and a focal area of dural enhancement is observed in the right temporal lobe.
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fig2
There was focal area of dural enhancement observed in the right temporal lobe (Figure 2).
Cholesteatoma.
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fig3
The histopathology results were consistent with cholesteatoma (Figure 3).
A 4 cm by 5 cm right postauricular ulcer with raised edges and a necrotic centre.
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fig4
The patient was lost to follow-up for seven months and later presented with 4 cm by 5 cm right postauricular ulcer with raised edges and a necrotic centre (base) (Figure 4).
CT scan of the temporal bone shows that, compared to previous images, the soft tissue component was increased, causing further destruction of the middle and inner ear and a right periauricular soft tissue mass lesion with an ill-defined border.
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fig5
Section shows proliferative squamous cells invading the underlying stroma. The cells are hyperchromatic with a high N/C ratio and atypical mitosis.
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fig6
The biopsy from the edges showed moderately differentiated squamous cell carcinoma, and those from the centre showed dysplasia with keratinous material (Figure 6).