Jong Kyu Han

Gastric carcinoma metastasis to the internal auditory canal.

A 41-year-old man underwent a radical total gastrectomy and postoperative chemotherapy for advanced gastric carcinoma (Borrmann Type IV, adenocarcinoma). Two years later, a bone scan and abdominal computed tomography were performed as part of the regular followup, and they showed multiple metastases to the bone and the liver. The patient refused further treatment. Three months later, he was referred to the Department of Otolaryngology for an evaluation of a sudden hearing loss and facial weakness on the left side, which had developed 2 days earlier. The physical examination revealed peripheral facial palsy of House-Brackmann grade IV on the left side with no spontaneous nystagmus; there was a normal external auditory canal and tympanic membrane. Pure tone audiometry demonstrated normal right-sided hearing, although there was severe sensorineural hearing loss on the left side with a pure tone average of 80 dB HL. The bone scan revealed multiple areas of uptake in the left temporal bone, 2 ribs, the spine, and the pelvic bones (Fig. 1). These clinical manifestations and the bone scan results suggested the possibility of metastasis to the internal auditory canal (IAC), so magnetic resonance imaging (MRI) of the temporal bone with a contrast study was performed. Fat-suppressed gadolinium-enhanced T1-weighted MRI showed a diffuse enhancing mass in the left petrous apex, clivus, and IAC, which was suggestive of extensive metastasis (Fig. 2, A and B). Direct invasion of the left IAC from the lesion in the petrous apex (Fig. 2C) and an enhancing lesion involving the left IAC and labyrinthine segment of the facial nerve (Fig. 2D) were noticed on the gadoliniumenhanced T1-weighted axial MRI, but there was no abnormal signal intensity or mass formation at the cerebellopontine angle. He was diagnosed with metastasis to the IAC, and he refused further evaluation and management. He is now being managed conservatively. His facial weakness and hearing loss have not improved.

Clinical analysis of an ultrasound system in the evaluation of skin cancers: correlation with histology.

BackgroundThe assessment of skin cancers in the clinical setting is often difficult, with important features such as depth and width remaining unknown until the biopsy with pathology reports are received. When we remove skin cancers, with those especially involving the face, aesthetics and invasion to surrounding structures such as bone and cartilage are important features for deciding the optimal surgical procedure and future reconstructive options. The aim of the study was to compare the accuracy of the ultrasound system in vivo and to correlate the results with the histopathological tumor thickness measured in skin cancer patients. Patients and MethodsFrom March 2010 to February 2012, we reviewed 40 patients who comprised a total of 49 skin lesions involving the face, neck, and scalp. Each skin lesions were classified by 9 facial aesthetic units. The patient’s various skin lesions were scanned using an ultrasound system device (Philips iU22 xMatrix US), with a 5–17-MHz compact linear transducer. Using the ultrasound system, we analyzed the shape, depth, echogenicity, size, invasion skin level, and vascularity of the skin cancer lesions. The results were correlated with the histology, with special note to the depth of involvement. ResultsOf the 40 patients recruited, 15 were male and 25 were female, ranging in age from 53 to 92 years (mean ± SD 78.7 ± 13.7 years). Clinically, 49 lesions suspicious of skin cancer were identified and ultrasounds were performed preoperatively. Depth was measured by ultrasound and histology. Mean ultrasound depth of skin lesion was 3.97 ± 3.15 mm (range 0.80–14.00), and it was found to be 4.04 ± 2.92 mm (range 1.00–14.00) based off of histology. There was excellent correlation (interclass correlation coefficient, 0.953) between the depth of the skin lesions measured histologically and by using the ultrasound. ConclusionThe ultrasound is not meant to replace histologic evaluations, but it can be used as another diagnostic tool to provide improved preoperative planning. It can be used as a noninvasive, easy, and low-cost screening method for various skin cancers, and provides valuable information such as lesion margins, shape, layers of involvement, and vascularity patterns.

Volumetric Changes in the Bony External Auditory Canal in Unilateral Chronic Otitis Media

Background and Objectives Pneumatization of air cells in the mastoid bone is decreased in chronic otitis media (COM). A decrease in the size of the external auditory canal (EAC) is also found frequently in patients with COM, but this has been little studied. We compared the size of affected bony EACs and the contralateral side in patients with single-side COM using high-resolution computed tomography. Subjects and Methods In total, 99 patients with single-side COM were included. Four indicators related to the size of the bony EAC and IAC were measured using high-resolution computed tomography: the axial and coronal lengths of the tympanic membrane, the length of the isthmus, and the area of the bony ear canal. We also compared both internal auditory canals as negative controls. These assessments were made by radiologists who were blinded to the objective of this study. Results In patients with single-side COM, the axial length of the tympanic membrane was significantly shorter than normal, and the volume of the EAC was also significantly smaller. The length of the isthmus of the EAC was shorter on the affected side, but the difference was not significant. The IAC volume showed no difference between the two sides. Conclusions COM affects general temporal bony development, including the bony EAC and mastoid bone. Therefore, whether to correct this should be considered when preparing for COM surgery.