From Cholesteatoma to Squamous Cell Carcinoma: A Case Report

 

Squamous cell carcinoma of the temporal bone (SCCTB) is a rare malignancy with relatively poor prognosis. Affected patients typically present with locally advanced disease. Although a few reports have implicated cholesteatoma as an etiologic factor for SCCTB, a formal association between both entities remains unproven.

We present a case of SCCTB in a 62-year-old female, who underwent surgery for cholesteatoma of the left ear, 54 years prior. The patient presented at our institution with a long history of left-sided hearing loss as well as persistent ipsilateral otorrhea and vertigo. All symptoms had reportedly been present since her ear surgery but had intensified significantly over several months prior to her first visit. Imaging revealed a large left temporal bone mass with dural involvement and tegmen erosion. The decision was made to take the patient to the operating theater to approach the lesion via a left middle cranial fossa approach and left mastoidectomy.

Intraoperative frozen sections came back positive for squamous cell carcinoma. The tumor was continuous with the skin of the external acoustic canal and also extended into the left jugular bulb and sigmoid sinus. The vestibule and facial nerve remained uninvolved. Given the confirmed dural invasion, complete excision of the lesion was not pursued. The patient was started on radiation therapy, but due to intolerance of side effects, the patient chose to undergo comfort measures.

This case demonstrates that long-standing cholesteatoma may degenerate to SCCTB. Early detection may increase the likelihood of successful surgical and adjuvant management. A high index of suspicion should be kept in patients with prior history of cholesteatoma and evidence of temporal bone mass with persistent symptoms.