Metastasis of lung cancer to the temporal bone is a very rare disease and subjective tinnitus as the present-ing symptom in these patients is even rarer. Here we report a case in which a 42-year-old male presented wit...Metastasis of lung cancer to the temporal bone is a very rare disease and subjective tinnitus as the present-ing symptom in these patients is even rarer. Here we report a case in which a 42-year-old male presented with subjective tinnitus of three months, with no pulmonary disease symptoms. Pure tone audiometry indi-cated moderate conductive deafness in left ear with an air-bone gap of 21.3 dB. HRCT temporal bone scan-ning indicated high-density shadows in the left epitympanic cavity, sinus tympani and mastoid cavity. Chron-ic otitis media with cholesteatoma was suspected and surgical treatment recommended. However, preopera-tive chest x-ray revealed high-density millet lesions scattered widely in both lungs. HRCT lung scanning confirmed the lungs lesions and indicated lung cancer. In order to determine correlations between the tempo-ral bone and pulmonary lesions, a CT-guided trans-mastoid aspiration biopsy and immunohistochemical study were conducted, which confirmed that the temporal bone lesion was metastatic from the lungs. The pa-tient was given a series of chemotherapy immediately and his tinnitus significantly improved after three months of treatment, with full recovery of his hearing and complete resolution of shadows in the mastoid cavity. Unfortunately, he subsequently developed multiple bone metastases in the 9th month and cerebral metastasis in the 18th month. Multiple organ failure resulted in death in 2.5 years.展开更多
背景BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断一直是临床医师面临的挑战,BRAF(V600E)基因检测常用于术前评估,其特异度高,但敏感度低;美国放射学会和中华医学会超声分会分别提出了美国放射学会甲状腺影像报告和数据系统(American College of...背景BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断一直是临床医师面临的挑战,BRAF(V600E)基因检测常用于术前评估,其特异度高,但敏感度低;美国放射学会和中华医学会超声分会分别提出了美国放射学会甲状腺影像报告和数据系统(American College of Radiology Thyroid Imaging Reporting and Data System,ACR-TIRADS)和中国甲状腺影像报告和数据系统(Chinese Thyroid Imaging Reporting and Data System,C-TIRADS);将TIRADS与BRAF(V600E)基因检测相结合,旨在提高BethesdaⅢ/Ⅳ/Ⅴ类结节的诊断率,并避免不必要的手术和穿刺活检。目的比较ACR-TIRADS与C-TIRADS对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断效能,并探讨BARF(V600E)检测的附加价值。方法纳入2020年1月—2023年7月于解放军总医院第一医学中心接受细针穿刺活检并行BRAF(V600E)基因检测的484例患者(484个甲状腺结节),以病理组织学为“金标准”,比较ACR-TIRADS、C-TIRADS单独及联合BRAF(V600E)基因检测对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断价值。结果两种超声分层系统中甲状腺结节的恶性风险随着分级的升高逐渐增加(趋势χ2检验,P均<0.001),ACR-TIRADS、C-TIRADS的最佳截断值分别为5类、4c类。BRAF(V600E)基因检测在不降低诊断特异度的基础上显著提高了ACR-TIRADS(0.809 vs 0.778,P<0.001)和C-TIRADS(0.815 vs 0.783,P<0.001)对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节良恶性的诊断效能。ACR-TIRADS与C-TIRADS单独及联合BRAF(V600E)基因检测的曲线下面积(area under the curve,AUC)差异无统计学意义(0.778 vs 0.783,P=0.755;0.809 vs 0.815,P=0.675),但C-TIRADS单独及联合BRAF(V600E)基因检测的敏感度(88.83%vs 83.90%,P<0.001;95.33%vs 90.13%,P<0.001)和准确度(84.50%vs 81.41%,P<0.001;89.67%vs86.36%,P<0.001)高于ACR-TIRADS单独及联合诊断,而ACR-TIRADS单独及联合诊断的特异度相等,均高于C-TIRADS(71.72%vs 67.68%,P<0.001)。结论BRAF(V600E)基因检测可以在不降低特异度的基础上显著提高ACR-TIRADS、C-TIRADS对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节良恶性的诊断性能,其中C-TIRADS单独及联合整体诊断性能最佳,在临床实践中具有一定的应用潜力。展开更多
文摘Metastasis of lung cancer to the temporal bone is a very rare disease and subjective tinnitus as the present-ing symptom in these patients is even rarer. Here we report a case in which a 42-year-old male presented with subjective tinnitus of three months, with no pulmonary disease symptoms. Pure tone audiometry indi-cated moderate conductive deafness in left ear with an air-bone gap of 21.3 dB. HRCT temporal bone scan-ning indicated high-density shadows in the left epitympanic cavity, sinus tympani and mastoid cavity. Chron-ic otitis media with cholesteatoma was suspected and surgical treatment recommended. However, preopera-tive chest x-ray revealed high-density millet lesions scattered widely in both lungs. HRCT lung scanning confirmed the lungs lesions and indicated lung cancer. In order to determine correlations between the tempo-ral bone and pulmonary lesions, a CT-guided trans-mastoid aspiration biopsy and immunohistochemical study were conducted, which confirmed that the temporal bone lesion was metastatic from the lungs. The pa-tient was given a series of chemotherapy immediately and his tinnitus significantly improved after three months of treatment, with full recovery of his hearing and complete resolution of shadows in the mastoid cavity. Unfortunately, he subsequently developed multiple bone metastases in the 9th month and cerebral metastasis in the 18th month. Multiple organ failure resulted in death in 2.5 years.
文摘背景BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断一直是临床医师面临的挑战,BRAF(V600E)基因检测常用于术前评估,其特异度高,但敏感度低;美国放射学会和中华医学会超声分会分别提出了美国放射学会甲状腺影像报告和数据系统(American College of Radiology Thyroid Imaging Reporting and Data System,ACR-TIRADS)和中国甲状腺影像报告和数据系统(Chinese Thyroid Imaging Reporting and Data System,C-TIRADS);将TIRADS与BRAF(V600E)基因检测相结合,旨在提高BethesdaⅢ/Ⅳ/Ⅴ类结节的诊断率,并避免不必要的手术和穿刺活检。目的比较ACR-TIRADS与C-TIRADS对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断效能,并探讨BARF(V600E)检测的附加价值。方法纳入2020年1月—2023年7月于解放军总医院第一医学中心接受细针穿刺活检并行BRAF(V600E)基因检测的484例患者(484个甲状腺结节),以病理组织学为“金标准”,比较ACR-TIRADS、C-TIRADS单独及联合BRAF(V600E)基因检测对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断价值。结果两种超声分层系统中甲状腺结节的恶性风险随着分级的升高逐渐增加(趋势χ2检验,P均<0.001),ACR-TIRADS、C-TIRADS的最佳截断值分别为5类、4c类。BRAF(V600E)基因检测在不降低诊断特异度的基础上显著提高了ACR-TIRADS(0.809 vs 0.778,P<0.001)和C-TIRADS(0.815 vs 0.783,P<0.001)对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节良恶性的诊断效能。ACR-TIRADS与C-TIRADS单独及联合BRAF(V600E)基因检测的曲线下面积(area under the curve,AUC)差异无统计学意义(0.778 vs 0.783,P=0.755;0.809 vs 0.815,P=0.675),但C-TIRADS单独及联合BRAF(V600E)基因检测的敏感度(88.83%vs 83.90%,P<0.001;95.33%vs 90.13%,P<0.001)和准确度(84.50%vs 81.41%,P<0.001;89.67%vs86.36%,P<0.001)高于ACR-TIRADS单独及联合诊断,而ACR-TIRADS单独及联合诊断的特异度相等,均高于C-TIRADS(71.72%vs 67.68%,P<0.001)。结论BRAF(V600E)基因检测可以在不降低特异度的基础上显著提高ACR-TIRADS、C-TIRADS对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节良恶性的诊断性能,其中C-TIRADS单独及联合整体诊断性能最佳,在临床实践中具有一定的应用潜力。
