A clinical conundrum: Temporal bone metastases from lung adenocarcinoma.

BACKGROUND

Metastatic disease to the temporal bone is rare. Even more uncommonly, it can be the first manifestation of an underlying malignancy. Patients typically present late in the disease process with non-specific symptoms of hearing loss, facial nerve palsy and otorrhea.

CASE: A 62-year-old Chinese female presented with right facial weakness, which had near-complete improvement in response to pulse prednisolone. On examination, she had a right temporal swelling and right mild-severe conductive hearing loss. A computed tomography scan showed a destructive lesion centred in the squamous temporal bone, with an associated soft tissue component. Positron emission tomography scan revealed bony and lung metastases, but no distinct hypermetabolic primary site. An incisional biopsy unexpectedly returned as metastatic lung adenocarcinoma.

CONCLUSION

Although rare, it is important for otolaryngologists to be aware of the insidious nature of temporal bone metastases and possible atypical clinical and radiological features, to facilitate timely workup and initiation of treatment.