Presentation
The patient presented with episodic vestibular dysfunction.
Patient Data
Small tumour with hyperdense foci centred in fovea of the left endolymphatic sac. Subtle adjacent permeative bone changes.
Small slightly lobulated intrinsic T1 hyperintense and mildly T2 hyperintense tumour centred in fovea of the left endolymphatic sac.
The tumour demonstrates solid enhancement. It contacts the left sigmoid sinus without invading the sinus. It protrudes slightly into the posterior cranial fossa.
The tumour has slightly increased in size.
Post retro labyrinthine resection.
Case Discussion
The patient went on to have a resection.
Histology
MACROSCOPIC DESCRIPTION:
An irregularly shaped piece of tan tissue, 14x9x6mm.
MICROSCOPIC DESCRIPTION:
The sections show a moderately cellular tumour. It forms elongated nests and acinar-like structures. Some contain calcific deposits and psammoma bodies. The tumour cells have round nuclei, inconspicuous nucleoli and moderate amounts of 'oncocytic type' eosinophilic cytoplasm.
The tumour cells are CAM5.2, AE1/3, CK7, EMA, S-100 and SOX-10 positive. Progesterone receptor, melan-A, synaptophysin, TTF-1 and thyroglobulin are negative.
The PAS stain shows no fungi. The Ziehl-Neelsen stain shows no acid fast bacilli.
Though the architecture is not quite papillary but given the immunoprofile and the site, the features are consistent with papillary tumour of the endolymphatic sac.
DIAGNOSIS:
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