case_images: PMC5821296_01
case_images: Radiographs of the tympanic bullae (arrows). (a) Left lateral oblique and (b) ventrodorsal images. The tympanic bullae are thickened and irregular, and filled with soft tissue-dense material
case_images: 10.1177_2055116918756724-fig1.jpg
case_images: PMC5821296_01_10.1177_2055116918756724-fig1.jpg
case_images: fig1-2055116918756724
case_images: Radiographs showed that both tympanic bullae were thickened and irregular, and filled with soft tissue-dense material (Figure 1).
case_images: Histologic features of neoplastic lymphocytes. (a) Middle ear and (b) brain. There are neoplastic lymphocytes in the dorsolateral and ventromedial compartments of the middle ear, the semicircular canals, and eroding the petrous bone and tympanic bullae. Also filling the middle ear is abundant cellular debris, hemorrhage and acicular clefts. The ceruminous glands are hyperplastic. Neoplastic lymphocytes are frequently multinucleate, with marked anisocytosis and anisokaryosis, and display marked mitotic activity. Hematoxylin and eosin (x 400). (Inset) Hematoxylin and eosin (x 20); asterisk indicates the location where higher magnification image is taken from
case_images: 10.1177_2055116918756724-fig2.jpg
case_images: PMC5821296_01_10.1177_2055116918756724-fig2.jpg
case_images: fig2-2055116918756724
case_images: However, histologically the soft material in both bullae was composed primarily of neoplastic lymphocytes (Figure 2). The neoplastic lymphocytes partially effaced cranial nerves in the bullae bilaterally, and were also found in the leptomeninges, brain parenchyma, submandibular lymph nodes and pancreas, supporting a diagnosis of extranodal lymphoma (Figure 2).