International Journal of Pediatric Otorhinolaryngology (2004) 68, 1199—1201 CASE REPORT T-cell lymphoma presenting as acute mastoiditis with a facial palsy T.P. Ho* , S. Carrie, D. Meikle, K.M. Wood Department of Otorhinolaryngology, Head and Neck Surgery, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, UK Received 12 September 2003; accepted 24 February 2004 KEYWORDS Childhood lymphoma; T-cell lymphoma; Mastoiditis; Facial palsy Summary Isolated T-cell lymphomas affecting only the mastoid are extremely rare. Presentation with oto-neurological signs prior to systemic involvement of a lympho- proliferative disease is also unusual. This is the youngest reported patient with a peripheral T-cell lymphoma with disease isolated only in the mastoid who presented with acute mastoiditis and a complete seventh cranial nerve palsy. © 2004 Published by Elsevier Ireland Ltd. 1. Case Report A 1-year-old boy presented to the paediatricians as an emergency with a history of right otorrhoea and otalgia. Past medical history included two failed hearing tests. Three months prior to admission, tympanograms had shown signs of bilateral mid- dle ear effusions. He was on the routine waiting list for insertion of bilateral middle ear ventila- tion tubes. Two weeks before admission, he had received a course of amoxycillin for presumed acute otitis media. Examination revealed a ten- der right post-auricular swelling. His white cell count showed a leucocytosis. He was transferred to the ENT surgeons with a diagnosis of acute mastoiditis. On admission to the ENT ward, he was started on intravenous antibiotics. Thirty-six hour later, he developed a right-sided lower motor neurone facial palsy. He was taken to theatre. At surgery, no cholesteatoma was seen. A circumferential myringotomy was made through a bulging tym- * Corresponding author. Tel.: +44-191-2843111. E-mail address: allantpho@hotmail.com (T.P. Ho). panic membrane. The mastoid was full of granula- tion tissue with pus filling the antrum. A cortical mastoidectomy was performed. The mastoid gran- ulations were biopsied and sent for histology. Pus was sent for culture, antibiotic sensitivities and Ziehl—Nielson (ZN) staining. Histological examination of the mastoid granu- lations showed fibrous tissue infiltrated by a tu- mour composed of pleomorphic cells, some with abundant eosinophilic cytoplasm and irregular horseshoe-shaped nuclei (Fig. 1). The morpho- logical differential diagnosis included embryonal rhabdomyosarcoma and granulocytic sarcoma as well as non-Hodgkin’s lymphoma. Immunohisto- chemistry demonstrated expression of CD45 by the tumour cells, with no expression of desmin or myoglobin. Histochemistry for chloracetate es- terase was negative. The majority of the tumour cells expressed the T cell antigen CD3 (Fig. 2) and also CD8. Occasional scattered large cells ex- pressed the B cell antigen CD20. A minority of the large cells also expressed Epstein Barr Virus LMP1 (latent membrane protein 1). There was no expression of CD30. The expression of CD45, CD3 and CD8 by the majority of the neoplastic cells indicated a diagnosis of high grade T-cell 0165-5876/$ — see front matter © 2004 Published by Elsevier Ireland Ltd. doi:10.1016/j.ijporl.2004.02.016