Unusual Protuberant Lesion of the Temporal Bone

Objective: Review pathology, imaging, and presentation of a rare, benign temporal bone lesion that may be confused with alternative diagnoses of higher acuity.

Patient: A 59-year-old male with a 2-year history of an exophytic, growing post-auricular lesion originating from the temporal bone.

Intervention: Surgical resection for diagnosis and therapy.

Main Outcome Measures: Diagnosis and management of a protuberant fibro-osseus lesion of the temporal bone (Bullough lesion)

Results: This lesion was initially thought to be a bony malignancy based on its aggressive-appearing calcification pattern on imaging. A small biopsy was performed, which was undiagnostic. The decision was then made to perform a wide local excision to ensure complete resection, and the craniotomy was repaired with bone cement without complications. An initial pathologic diagnosis of fibrous dysplasia was given; however, the imaging characteristics were not consistent with that diagnosis. Pathology consultation was obtained, and they gave a final diagnosis of protuberant fibro-osseus lesion of the temporal bone (Bullough lesion). To our knowledge, this is the thirteenth case reported of this lesion in the literature, and it demonstrates the diagnostic and management conundrums a surgeon might be faced with this unusual lesion. Typical treatment for this lesion is surgical resection and recurrence is not reported.

Conclusion: As this case demonstrates, the differential diagnosis for bony lesions of the temporal bone is broad. While we chose to perform a wide local excision of this lesion that required a craniotomy, enhanced recognition of protuberant fibro-osseus lesions of the temporal bone may prevent similar patients from undergoing a potentially morbid procedure. This case also highlights the importance of an interdisciplinary approach to address usual lesions of the temporal bone.

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Artikel online veröffentlicht:
15. Februar 2022