This 11 year old FS DSH cat presented for anorexia, ocular discharge and inability to open mouth, bleeding from right ear, of 3 months duration
This 11 year old FS DSH cat presented for anorexia, ocular discharge and inability to open mouth, bleeding from right ear, of 3 months duration
CT of the skull:
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In the region of the right external ear canal there is an ovoid ill-defined soft tissue mass lesion with marked irregular contrast enhancement and amorphous mineralization, measuring 5.2 x 3.4 x 3.1 cm in size. The mass lesion presents invasion of the right external ear canal and tympanic bulla. There is marked permeative osteolysis of the right tympanic bulla, the temporal bone, pterygoidal bone, occipital bone and the ramus mandibulae. Perforation of the neurocranium is noted level with the right tympanic bulla. The zygomatic process of the temporal bone, remaining osseous lining of the tympanic bulla, right ramus mandibulae and the right pterygoidal bone present marked palisading ill-defined periosteal reaction. The mass has a severe mass effect on the naso- and oropharynx that are partially obliterated. |
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The right medial retropharyngeal lymph node is markedly enlarged with moderate contrast enhancement and presents an increased short-to-long-axis-ratio of >0.5. |
Possible differentials include ceruminal cell adenocarcinoma, squamous cell carcinoma, fibrosarcoma, osteosarcoma, chondrosarcoma other.
There is evidence of metastatic spread to the right medial retropharyngeal and cervical superficial lymph-node. FNA sampling or biopsy is recommended for further workup. Therapeutic options are limited to the local aggressive invasive behavior with bone involvement and perforation of the neurocranium. Possible radiative treatment with or without cytoreductive surgery may be discussed with the oncologist. Full tumor staging should include thoracic radiographs in 3 views and FNA sampling of the tributary lymph nodes as well as abdominal ultrasound.
The prognosis guarded to poor.
