Atypical Intratemporal Meningioma Masquerading as Otitis Media—Clinical and Radiological Diagnostic Dilemma

Meningiomas are the most common intracranial extra-axial neoplasms with mostly straightforward radiological diagnosis; however, they can have unusual clinical and imaging manifestations posing diagnostic dilemma for radiologists and clinicians. The objective of this case report is to highlight the infrequent and misleading presentations of meningiomas to make an accurate diagnosis. A 65-year-old male patient presented with complaints of left recurrent otitis media and facial nerve palsy for past 6 months. On imaging, an aggressive predominantly cystic intracranial neoplasm was found in the left temporal fossa extending into the middle and external ear. Histopathological examination of the excised tumor revealed WHO grade I meningothelial meningioma. Meningiomas can show atypical imaging features such as large meningeal cysts, heterogenous or ring enhancement and aggressive features such as bone erosion. They can invade the middle ear and should be thought of while dealing with nonresponsive cases of otitis media.

Taxane Use for Breast Cancer in Pregnancy: Neonatal Follow-Up Of Infants with Positive Detection of Intact Paclitaxel and Metabolites in Meconium at Birth

Paclitaxel is often excluded during pregnancy for women with breast cancer due to limited neonatal follow-up. We confirmed in utero fetal Paclitaxel exposure for 8 newborns. Birth details and follow-up to 36 months of age is reported. Meconium samples from newborns exposed to chemotherapy were screened by liquid chromatography-high resolution mass spectrometry while blinded to maternal treatment during pregnancy. Newborn information at birth and annually was obtained. Mean gestational age (GA) at cancer diagnosis and start of chemotherapy was 8.7 + 6.2 weeks and 17.1 +/- 3.5 weeks. Paclitaxel was started at a mean GA of 27.0 +/- 5.8 weeks. Paclitaxel followed Doxorubicin/Cyclophosphamide in 6 cases, 5-Fluouracil/Doxorubicin/Cyclophosphamide in 1, and was used alone in 1. Mean number of days between Paclitaxel and birth was 23 +/- 15. Identification of Paclitaxel and/or metabolites was made in all taxane exposed samples. Birthweight was < 10% for GA in 3 infants. Three anomalies occurred: hip dysplasia and mitral valve stenosis. The 3rd child was diagnosed with Cleidocranial Dysostosis, a familial anomaly. Mean age at pediatric follow-up is 18.7 + 9.3 months. Pediatricians report eczema and recurrent otitis media in 1 child, iron deficiency anemia and sinusitis in 2. One child is < 10% for height and weight at 15 months. All are meeting developmental milestones at median age of 18.7 months, range: 6–36 months. Conclusion: Up to 3 years of age, follow-up of neonates exposed to Paclitaxel in utero is reassuring. Continued observation of neonatal development is essential.