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Nasopharyngeal Extension of Glomus Tympanicum: An Unusual Clinical and Imaging Manifestation

S. Hirunpata, K. Riabroia, C. Dechsukhuma, V. Atchariyasathiana and W. Tanomkiata

a From the Department of Radiology, Prince of Songkla University Hospital, Songkla, Thailand


Figure 1
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  		Fig 1. Contiguous 3-mm contrast-enhanced axial CT scans were obtained.

A, At the level of the nasopharynx, an intense homogeneous enhancing mass was seen within the left nasopharynx.

B, At 2 upper consecutive levels, continuation with the smaller part within the left eustachian tube and middle ear cavity was noted (circle).


Figure 2
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  		Fig 2. MR images obtained at the level of nasopharynx. An isosignal intensity mass within the left nasopharynx on the spin-echo T2-weighted image (TR/TE, 6821/112) suggests a firm solid-appearing mass protruding from the smaller mass within the slightly expanded eustachian tube (A). Strong enhancement with multiple tiny vascular flow voids indicates hypervascularity on a post-gadolinium-diethylene-triaminepentaacetic acid (Gd-DTPA) spin-echo T1-weighted image (TR/TE, 874/15) (B).


Figure 3
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  		Fig 3. MR images obtained at the level of temporal bone. A, Spin-echo T2-weighted image (TR/TE, 6821/112). B, Post-Gd-DTPA spin-echo T1-weighted image (TR/TE, 874/15). Continuation with the smaller mass within the slightly expanded eustachian tube and the middle ear is demonstrated.


Figure 4
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  		Fig 4. Digital subtraction angiography of the left external carotid artery, lateral view. Hypervascular tumor blush extends further anteriorly than is usual along the course of the eustachian tube and nasopharynx (arrowhead), mainly fed by branches from the enlarged left ascending pharyngeal artery (long arrow). Also note feeding arteries from the internal maxillary artery, middle meningeal artery, and posterior auricular artery.


Figure 5
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  		Fig 5. A, Histopathology reveals a highly vascularized tumor located in the submucosal region (hematoxylin-eosin, original magnification x100).

B, At a higher magnification, formation of multiple tumor nests called "Zellballen," which are separated by the thin rims of highly vascularized fibrous stroma, is seen. The tumor cells possess granular basophilic cytoplasm and uniform round-to-ovoid nuclei (original magnification x200).

C, The reticulin stain highlights the delicate stroma around the tumor nests (original magnification x400).

D, Immunohistochemical study shows the immunoreactivity for chromogranin in the cytoplasm of the tumor cells (original magnification x400).





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X