Small nodules that are stable in size for more than 365 days are unlikely to be pulmonary metastasis. This increase in size tends to occur early, and follow-up CT in 3 months and 6 months would be appropriate in further evaluation. In oncologic patients, 28% of small pulmonary nodules detected at initial CT will increase in size, suggesting metastasis. Combined, 28% of patient' s nodules increased (90% were within 365 days 25% within 203 days and 14% within 14 days). For those with greater than 365 days follow-up, the observed nodule was increased (3, 5%) stable (51, 93%) and stable but new nodule developed (1). For those with less than 365 days, the observed nodule was increased (17, 36%), increased and new nodules (9, 19%) stable (19, 40%) stable but new nodules developed (1) and decreased (1). 2,12,13 The cochlear division continues in the anterior-inferior quadrant of the canal beneath the facial nerve, and the vestibular nerves are located posterior to these two structures within the. There were 102 cases that met criteria for inclusion.įorty-seven had follow-up CT of less than 365 days, and 55 had follow-up CT for more than 365 days. Only in the lateralmost 3 to 4 mm of the internal auditory canal do the vestibular and cochlear nerves divide into separate identifiable structures. All CT images were evaluated by two thoracic radiologists for nodules 4 mm or less. Radiology reports of thoracic CTs from a 2-year period were searched for keywords indicating a small pulmonary nodule. We evaluated a group of oncology patients to determine the outcome of small pulmonary nodules and whether they can be ignored in the therapeutic decision process. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.It is often not possible to determine whether small nodules detected on computed tomography (CT) in oncology patients are metastatic. For the developmental research the left-right asymmetry might be a field of research. For the physician this differentiation represents a clinical and radiological challenge. Choristomas These benign tumors grow slowly and tend to produce few symptoms other than a conductive hearing loss in the affected ear correlating with the degree of ossicular involvement. The differentiation between benign and malign lesions in the CPA and IAC is important, as it requires diverse treatment protocols. In view of the sparse literature on treatment of single intracanalicular metastases, the review is broadened to the current treatment recommendations of single brain metastases. We address the issue of a possible regulation of CPA lesion laterality by asymmetrically expressed genes. The discussion focuses on the incidence of extra-axial CPA and IAC lesions with their clinical presentations and their radiological findings. The patient was treated with intrathecal chemotherapy. MRI showed an increase of the residual tumor and meningeosis carcinomatosa, and cerebrospinal fluid (CSF) examination was positive for tumor cells. The patient's condition deteriorated gradually. The investigations for the primary tumor site were all negative. Histological examination revealed blennogenic cylindrical adenocarcinoma. Due to progressive headaches and dizziness, the patient underwent a left transtemporal craniotomy with subtotal tumor resection. The follow-up MRI showed an unchanged pattern of contrast enhancement. Magnetic resonance imaging (MRI) showed an extra-axial mass most likely representing a left-sided vestibular schwannoma with characteristic contrast enhancement in the IAC. (B) An axial contrast-enhanced T1-weighted image demonstrates an enhancing mass in the basal turn of the left cochlea with extension into the fundus of the internal auditory canal (arrow). He presented 8 months later with left-sided tinnitus, progressive hearing loss, and attacks of vertigo. (A) An axial T2-weighted image shows a hypointense filling defect in the basal turn of the left cochlea and fundus of the internal auditory canal (arrow). Cranial computed tomography scan revealed bilateral nonspecific periventricular and subcortical vascular lesions. We provide a review of uncommon lesions in the IAC and describe to our knowledge the first instance of a primary adenocarcinoma.Ī 60-year-old man presented with nausea and vomiting. Intracanalicular metastases of adenocarcinoma are documented, but a primary adenocarcinoma remains unreported. Despite the relatively frequent occurrence of multiple primary tumors, namely, 10% of intracranial tumors, metastasis is a rare occurrence within the internal auditory canal (IAC) and cerebellopontine angle (CPA).
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