Abstract
Metastasis to the internal auditory canal from breast carcinoma is extremely rare and difficult to diagnose. It radiologically mimics vestibular schwannoma and can occur as a first manifestation of systemic relapse after a long disease-free interval in patients previously treated for early breast cancer. The diagnosis is usually made retrospectively and the optimal management of such metastasis following complete resection remains undefined.
Highlights
The most common lesion within the internal auditory canal is vestibular schwannoma accounting for approximately 90% of all cases in this area
A 66-year-old woman presented with rapidly deteriorating left-sided hearing loss, vertigo and mild intermittent dull ache in her left ear of 2 months' duration, followed by a left-sided lower motor neurone facial nerve weakness
Marques et al reported on a case of an isolated metastasis in the left cerebellopontine angle and internal auditory canal 16 years after treatment for a breast adenocarcinoma [1] and Guilemany et al described a patient with a pT2 pN1 M0 invasive ductal carcinoma of the breast who relapsed 5 years later with again an isolated metastasis to the left internal auditory canal and cerebellopontine angle [2]
Summary
The most common lesion within the internal auditory canal is vestibular schwannoma accounting for approximately 90% of all cases in this area. A 66-year-old woman presented with rapidly deteriorating left-sided hearing loss, vertigo and mild intermittent dull ache in her left ear of 2 months' duration, followed by a left-sided lower motor neurone facial nerve weakness. She recalled 2 or 3 similar episodes of vertigo 2 years previously that resolved spontaneously. MRI revealed a 1.1 × 0.3 cm intracanalicular mass within the left internal auditory canal which enhanced with gadolinum, consistent with a schwannoma (Figure 1). It did not extend into the cerebellopontine cistern and the cerebellopontine angle appeared normal. There was no evidence of intracranial tumor recurrence on repeat MRI 6 months after surgery
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