0:01

This is another patient who had a malignancy that

0:04

led to spread to the middle ear cavity.

0:08

When we look at the temporal bone

0:10

CT scan on the left side,

0:12

we can see that there is partial opacification of

0:19

the middle ear cavity, as well as

0:21

the mastoid air cells. In fact,

0:23

it looks like it's completely opacified.

0:25

The middle ear ossicles are completely encased by

0:30

soft tissue. It doesn't look that destructive.

0:33

It actually looks more, you know, there's no loss of

0:37

the septations of the mastoid air cells,

0:41

the middle ear cavity.

0:42

Although, it's filled with clearly

0:44

a soft tissue mass,

0:46

it doesn't look all that destructive as far

0:48

as the bony reaction around it.

0:50

However,

0:51

the biopsy of this proved to represent a non-

0:55

keratinizing undifferentiated carcinoma.

0:58

So, this is an adult.

1:01

And what we should have done is to pay a little

1:05

bit more clear attention to the nasopharynx.

1:09

You can see here, on the left side,

1:11

you have a large mass which is infiltrating the

1:16

tensor and levator veli palatini muscles.

1:20

It's causing blockage of the fossa of rosenmüller.

1:23

It extends to the pterygoid plate.

1:27

There is some parapharyngeal soft tissue

1:29

associated with it here.

1:31

And this indeed turned out to

1:34

be nasopharyngeal carcinoma,

1:36

which had grown posterolaterally along the

1:39

eustachian tube and presented as a middle ear

1:43

malignancy from nasopharyngeal carcinoma.