No abstract

Endolymphatic sac tumors (ELST) are extremely rare neoplasms that arise in the endolymphatic sac in the posterior-medial petrous portion of the temporal bone. Although the clinicopathologic and radiographic features have been well documented, the cytologic features of ELST have not been previously described (1-5). We report the cytologic findings of an ELST from the cyst fluid of a recurrent ELST in the left temporal region of a 77-year-old man. CASE REPORTA 77-year-old white man presented in the fall of 1999 with decreased mental status and magnetic resonance imaging results demonstrating an enhancing tumor mass along the left tentorium with multiple adjacent cysts, the largest of which was approximately 4.3 cm ϫ 3.8 cm. A midline shift was present. The patient had a history of left mastoidectomy performed at another institution for an "auditory canal" tumor originally diagnosed in the 1970s. In 1989, the tumor recurred, and he underwent left petrosectomy, also at another institution where the diagnosis was a ceruminous gland tumor. A consultant's opinion of that material was that it represented an adenocarcinoma of endolymphatic sac origin. For the patient's most recent surgery, he was taken to the operating room for left temporal-parietal craniotomy for tumor debulking and cyst drainage. The cyst fluid was described by the surgeon as yellow tinged. The patient's surgery was without complications, and he was subsequently released from the hospital.

Calcifying aponeurotic fibroma (CAF) is an unusual but well-characterized soft tissue neoplasm that typically involves the digits of children and frequently recurs locally. This report describes a case from the subcutis of the lumbosacral region. A 26-year-old man initially presented at age 3 and developed three recurrences over a 23-year period each at approximately 8-year intervals (ages 10, 18, and 26). The microscopic findings in all recurrences showed a lobulated, poorly circumscribed proliferation of dense fibrous tissue containing epithelioid-like fibroblasts, multinucleated cells, and islands of metaplastic chondroid differentiation with focal calcification. Despite origin from an unusual anatomic site, this case reported herein demonstrates the classical morphologic features and clinical history of CAF which showed little in the way of morphologic evolution despite 23 years of persistence. The clinical and histologic features helpful in distinguishing CAF from infantile fibromatosis and soft tissue chondroma are discussed.