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A Case of Middle Ear Cancer invading Cerebellum associated with Abscess : Differential Diagnosis between Brain Tumor and Abscess
Journal article   Open access

A Case of Middle Ear Cancer invading Cerebellum associated with Abscess : Differential Diagnosis between Brain Tumor and Abscess

Satoshi Yamaguchi, Shuichi Oki, Takashi Mikami, Yukihiko Kawamoto, Hitoshi Sato, Yoko Ito and Kentarou Kuwamoto
Japanese Journal of Neurosurgery, Vol.6(10), pp.706-710
1997
DOI: 10.7887/jcns.6.706
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https://doi.org/10.7887/jcns.6.706View
Published (Version of record) Open Access

Abstract

It is difficult to distinguish between brain tumor and brain abscess on the radiographic findings. When both occur at the same time, accurate diagnosis is very difficult. We report a case of middle ear cancer invading cerebellum with brain abscess. A 50-year-old man noticed discharge from his left ear in July 1995 but he did not consult a doctor. In January 1996, severe headache and nausea occurred in addition to the ear discharge. A cerebellar abscess was diagnosed at another hospital, and he was referred to us. He had a history of radical mastoidectomy due to left chronic otitis media in his childhood. Initial MRI showed multiple cysts in the left cerebellar hemisphere and a mass lesion in the left cerebellar hemisphere and in the left petrous bone. We considered the cystic lesions to be brain abscess and the mass lesion to be granulation tissue derived from chronic otitis media and mastoiditis. Then stereotactic aspiration of the brain abscess was performed twice. Bacteroides and Staphylococcus were isolated from pus aspirated from the cysts. Despite the administration the mass lesion enlarged and showed development to the left cerebellar hemisphere. Because of the tonsillar herniation due to the cerebellar mass, subtotal resection of the mass was performed. The histopathological diagnosis of the surgical specimen was squamous cell carcinoma. The systemic exploration failed to reveal primary lesion. We considered that the patient already had had carcinoma within the otitis media on admission and both of the lesions had invaded the cerebellum.

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