颞骨巨大胆固醇肉芽肿1例及文献复习

1病历资料患者,男,29岁,因“左耳反复胀痛伴听力下降5月余”于2019年8月22日入院,患者无耳流脓、耳鸣,无头痛及意识障碍,无眩晕及恶心、呕吐,无畏寒、发热、面瘫等病史,曾经到当地医院就诊,诊断为“左耳胆脂瘤”,予以药物治疗(具体不详)后,上述症状无明显好转。     

中耳胆固醇肉芽肿的探讨

本文就３５例经病理证实为中耳乳突胆固醇肉芽肿的病例资料，对本病的发生，诊断，侵犯部位及治疗和术后复发之原因等问题进行探讨。认为中耳胆固醇肉芽肿的主要病因是咽鼓管通道受阻，好发部位主要是鼓窦入口和鼓窦、上鼓室、乳突气房及鼓室窦。     

上颌窦胆固醇肉芽肿(附2例报告)

为探讨胆固醇肉芽肿形成的机理，报告２例发生于上颌窦的胆固醇肉芽肿。该病的常见症状是鼻阻塞，严重者可引起骨质破坏。其病因可能源于上颌窦窦口阻塞、粘膜息肉样病变内部出血或上颌窦囊肿瘤壁内胆固醇沉积。文献复习表明：窦腔通气不良，长期的炎症渗出或出血可导致胆固醇肉芽肿的形成。治疗主要是行上颌窦根治术，以达到永久治愈的目的。     

岩尖胆固醇肉芽肿1例

患者 ,女 ,5 8岁。 1 975年始觉右耳鸣、耳聋 ,9个月后出现右侧周围性面瘫。 1 979年 7月行颞下经脑幕右侧桥脑小脑角肿物切除术。术后病理报告 :“神经脑膜瘤” ;耳鸣、耳聋、面瘫无改善。同年1 0月行中耳探查术 ,病理诊断 :“中耳乳头状息肉伴急性炎症” ,外院会诊 :“脉络膜乳头状瘤”。 1个月后面瘫减轻。 1年后面瘫又逐渐加重 ,曾 4次在耳科行乳突腔肉芽清理术 ,术后病理检查皆为“纤维结缔组织 ,炎性肉芽伴坏死组织”。每次术后面瘫减轻。 1 986年 6月再次手术治疗 ,此时听力已丧失。术中见右耳乳突腔内有一紫红色软组织 ,质韧 ,易出…     

中耳胆固醇肉芽肿的诊断及治疗

目的:探讨中耳胆固醇肉芽肿的发病原因、诊断和接受中耳乳突手术治疗后的效果。方法:回顾性分析我院1999年8月～2004年4月接受中耳乳突手术治疗和经病理证实的18例(19耳)中耳胆固醇肉芽肿患者的临床资料,其中,接受完壁式乳突根治加鼓室探查加中耳置管术7耳,完壁式乳突根治加鼓室探查加听骨链成形加中耳置管术2耳,完壁式乳突根治加鼓室探查术3耳,完壁式乳突根治加鼓膜成形术2耳,开放式乳突根治加鼓室成形术4耳,单纯乳突切除术1耳。结果:置管者术后1～3个月拔除中耳通气管,鼓膜愈合良好;未置中耳通气管者,1～2个月鼓膜颜色正常。术后听力均有不同程度提高,纯音测听达到应用水平(语频气导平均听阈30dB以内)15耳(79%)。所有患者随访0.5～2年,除1耳因咽鼓管不通,长期留置中耳通气管外,其余患者无复发。结论:中耳胆固醇肉芽肿的病因为中耳炎症引起含气腔通气受阻,引流障碍及含气腔出血。确诊有赖于病理诊断。中耳乳突手术彻底去除病变,建立乳突鼓室咽鼓管良好的通气系统,是手术成功的关键。     

慢性化脓性中耳炎胆固醇肉芽肿6例临床观察

目的 :探讨慢性化脓性中耳炎胆固醇肉芽肿的发病机制 ,临床及影像学的诊断与鉴别。方法 :对 6例经手术和病理证实的、继发于慢性化脓性中耳炎的胆固醇肉芽肿患者的病例资料进行分析。结果 :胆固醇肉芽肿可与多种中耳疾病同时存在 ,MRI检查 T1 W与 T2 W皆为高信号。结论 :胆固醇肉芽肿的发病机制为中耳的其它疾病如胆脂瘤、硬化灶等导致的通气受阻 ,仅凭 CT及临床体征不能区别胆固醇肉芽肿与胆脂瘤 ,MRI对本病诊断有极大的价值。     

中耳胆固醇肉芽肿手术治疗策略探讨

目的:探讨中耳胆固醇肉芽肿手术治疗的策略。方法:对19例中耳胆固醇肉芽肿患者的临床资料进行回顾性分析。其中4例行单纯鼓膜置管术,8例行完壁式乳突切除+后鼓室切开+鼓膜置管术,7例行开放式乳突切除+鼓膜置管术。结果:术后随访0.5～3.3年。4例行单纯鼓膜置管术的患儿中,2例术后复发;8例行完壁式乳突切除+后鼓室切开+鼓膜置管术的患者中,3例术后复发;7例行开放式乳突切除+鼓膜置管术的患者无一例复发。在目前情况良好的14例患者中,有12例患者听力较术前明显改善。结论:对初发、病变范围局限的青少年患者,术前应完善检查以排除咽鼓管机械性阻塞因素,可选择单纯鼓膜置管术,术后定期观察;对症状反复发作、单纯置管或完壁式乳突切除+后鼓室切开+鼓膜置管术无效、病程较长或病变范围广泛的患者,应选择做保留鼓室完整性的开放式乳突切除+鼓膜置管术。     

中耳胆固醇肉芽肿8例报告

目的 :探讨中耳胆固醇肉芽肿 (CG)的病因、发病机制、诊断及治疗。方法 :回顾性分析 8例 (9耳 )CG患者的临床资料。 8例 (9耳 )均为轻～中度传导性聋 ,鼓膜呈“蓝鼓膜”征 ,鼓室压曲线图为B型 (除 1例鼓膜紧张部穿孔外 ) ,其中 7例 (8耳 )行鼓室探查术 ,开放上鼓室、鼓窦及乳突气房 ,彻底清除肉芽组织 ,有 5例行中耳置管术 ,2例行中耳乳突改良根治术 ;另 1例仅行鼓膜穿刺抽液。结果 :1例失访。 7例 (8耳 )术后随访 0 .5～ 6年 ,6例 (7耳 )无复发 ;1例 (1耳 )复发 ,再次行手术治疗 ,术后 1年无复发。结论 :对不明原因的血性耳溢液及蓝鼓膜 ,应结合CT提高术前诊断率。对CG应采取手术治疗 ,清除病变 ,建立鼓室及乳突的通气、引流。     

中耳胆固醇肉芽肿的诊断与手术治疗

目的探讨中耳胆固醇肉芽肿的诊断与手术治疗方法。方法分析14例（15耳）经手术并病理证实的中耳胆固醇肉芽肿患者的病例资料。其中,行完壁式乳突根治加鼓室探查加中耳置管术6耳;完壁式乳突根治加听骨链重建6耳;改良乳突根治加鼓室成形3耳。结果1耳改良乳突根治加鼓室成形术后仍间断溢液;1耳中耳置管术后2周通气管脱落,中耳积液复发,需通气管重新置入半年病情缓解后取出。所有病例术后随访0．5～3年,14耳术后语频听力提高15dBHL以上,1耳术后听力无改变。结论中耳胆固醇肉芽肿应及早手术治疗。根据病变的程度、部位及范围,采取不同的手术方法。原则是彻底清除病变,建立咽鼓管、鼓室、鼓窦、乳突的通气系统。     

颞骨岩尖胆固醇肉芽肿

胆固醇肉芽肿不是一种临床独立疾病，而是组织对胆固醇结晶的异物反应，是膨胀性生长的良性病变，可发生在颞骨任何部位，以中耳或乳突区域最常见，位于岩尖者少见，且起病隐匿，临床表现缺乏特异性。本文报告2例经手术证实的胆固醇肉芽肿，就其临床表现、影像学、组织病理学特点及治疗方法报告如下。     

Giant-cell reparative granuloma of the temporal bone: a case report and review of the literature

Giant-cell reparative granuloma (GCRG) is an unusual, non-neoplastic fibrous lesion that most often arises in the mandible and maxilla. GCRG of the temporal bone is exceedingly rare. To the best of our knowledge, only 17 cases have been previously reported in the international medical literature. Although no case of metastasis has been reported, this malignancy can be locally aggressive, and it often recurs following incomplete excision. We report the case of a young woman with a very large GCRG of the right temporal bone. We discuss the clinical picture, differential diagnosis, histologic evaluation, appearance on computed tomography and magnetic resonance imaging, and treatment options. We also review the cases of temporal bone GCRG that have been reported in the literature so far.     

Eosinophilic granuloma of the temporal bone. Case report and literature review

BACKGROUND: Eosinophilic granuloma, Hand-Schüller-Christian disease an Letterer-Siwe disease are characterised by ideopathic proliferation of histiocytes producing focal or systemic manifestations. Definitive diagnosis of histiocytosis is made by histopathology including immunohistochemical detection of S-100 and CD1a antigens. In general these diseases are summarised under the term Langerhans-cell histiocytosis (LCH). The localised form of LCH, in which the disease is limited to bones, lymphatic nodes or the lung, is commonly referred to as eosinophilic granuloma. Surgical excision, radiotherapy and chemotherapy, either alone or in combination, are the main treatment options. CASE REPORT: We present the case of a nine-year old boy with an extended eosinophilic granuloma of left temporal bone. The patient was submitted to a chemotherapeutic protocol with glucocorticoids, vinblastine and etoposide. Until today a successful treatment and a complete remission for one year can be reported. CONCLUSIONS: Unifocal eosinophilic granuloma is usually treated by local excision and low-dose irradiation. However treatment with the chemotherapeutic protocol offered an excellent alternative avoiding extensive surgical destruction of the temporal bone in this case.     

Benign osteoblastoma of the temporal bone: case report and literature review

We report a case of benign osteoblastoma of the temporal bone and a review of the literature. Osteoblastoma is a rare bony tumor that usually develops in the long bones or in the vertebral column. To our knowledge, this is the fourth reported case of benign osteoblastoma confined to the temporal bone, and it is the second such reported case to include facial paralysis as the initial symptom. Result of computed tomography scan, magnetic resonance imaging scan, and angiography are reported. The diagnosis and management of this type of lesion are also discussed.     

Plasma cell granuloma of the larynx (case report and review of the literature)

A case is reported of Plasma Cell Granuloma of the larynx treated successfully with steroids and antibiotics.     

颞骨炎性肌纤维母细胞瘤1例报告并文献复习

目的：探讨颞骨炎性肌纤维母细胞瘤的临床表现,术中所见,以及组织病理学特征。方法：结合文献复习,报告1例颞骨炎性肌纤维母细胞瘤患者的临床资料并行光镜检查和免疫组织化学染色分析。结果：肿瘤呈侵袭性生长,有明显的骨质吸收、破坏。病理组织学检查主要由梭形细胞和大量炎症细胞构成。免疫组织化学显示波形蛋白、平滑肌特异性肌动蛋白以及CD68均为阳性,S-100、CK均为阴性。结论：颞骨炎性肌纤维母细胞瘤是一种少见的呈侵袭性生长的肿瘤,容易局部复发。治疗以手术为主,辅以激素治疗。     

Chondromyxoid fibroma of the temporal bone: case report and review of the literature

OBJECTIVES: We describe the clinical presentation, imaging, and pathology results of a patient with chondromyxoid fibroma (CMF) involving the mastoid portion of the temporal bone. The literature covering CMF of the head and neck is reviewed. METHODS: The patient chart, including imaging and pathology results, was analyzed. An English-language literature review of skull base CMF was performed. RESULTS: Eighty-seven cases of CMF involving the head and neck have been reported in the scientific literature. Sixty-two cases involved the skull base, temporal bone, nasal cavity, or paranasal sinuses. Including this patient, only 8 cases of CMF isolated to the temporal bone have been reported. Most patients experience insidious onset of symptoms such as hearing loss or headache. A computed tomographic scan best shows the relationship of the tumor to surrounding bone and may show intratumoral calcification. Surgical removal was the treatment most commonly used. Although irradiation has been used in selected cases, it is usually avoided because of the potential risk for malignant transformation. CONCLUSIONS: Chondromyxoid fibroma, a slow-growing bone tumor, is exceedingly rare within the mastoid. Its differential diagnosis includes chordoma, chondroid chordoma, and low-grade myxoid chondrosarcoma. Surgical excision is the treatment of choice.     

颅骨过度气化诊治并文献复习

目的颅骨过度气化较为罕见,通过介绍诊治的颅骨过度气化患者,了解颅骨过度气化的发病机理。方法分析颅骨过度气化患者影像学表现、临床表现及治疗结果,结合国内外相关文献进行复习。结果颅骨过度气化发病机理可能与颅咽管功能障碍、球阀机制及Valsalva手法有关。颅骨过度气化多表现为颅骨气腔形成、局部膨隆、局部骨质破坏等,可涉及颅盖骨、颅底骨、上颈椎等部位。局部部位的过度气化及骨质缺损可通过手术治疗获得确切疗效。结论颅骨过度气化较为罕见,对其临床表现、影像学表现、诊断及治疗的进一步认识可为相关学科医师正确识别本病提供可靠依据。     

A case of eosinophilic granuloma in the temporal bone

The following case reports a 4-year-old boy with a solitary eosinophilic granuloma in the right temporal bone. The patient complained of an inflammatory tumor in the right external ear canal. The histopathological diagnosis made based on the first specimen of the tumor in the right ear canal was foreign body granuloma. A polyp developed again in the right ear canal with postauricular swelling. Computerized tomography of the skull at that time showed an osteolytic defect in the right temporal bone filled with soft tissue. Diagnosis was established by finding of the presence of Birbeck granules in Langerhans histiocytes by electron microscopy.