title: Management of endolymphatic sac tumors: sporadic cases and von Hippel-Lindau disease.
abstract: OBJECTIVE
  To analyze the difference between the endolymphatic sac tumors (ELSTs) in sporadic cases and in von Hippel-Lindau (VHL) disease.
  
  
  METHODS
  Retrospective case review in a tertiary referral center.
  
  
  METHODS
  Fourteen cases of ELST, occurring since 1998, were reviewed. We analyzed the initial symptoms, characteristics of the tumor, treatment, sequelae, and follow-up for each group.
  
  
  RESULTS
  The ELSTs were sporadic in 6 cases and associated with VHL disease in 8 cases. The mean age at the time of the first surgery was 26 years (range, 12-41). All except two of the patients presented with a unilateral tumor. The initial symptoms were hearing loss (n = 9), tinnitus (n = 7), and/or vertigo (n = 5). Hearing loss was more prevalent in the sporadic cases. Preoperative arteriography was performed for 4 patients, with embolization performed for 1 patient. The size of the tumor was significantly larger in the sporadic cases (31.7 mm) than in the cases of VHL disease (19.3 mm). The surgical approach was more extensive in the sporadic cases. The surgeons found 2 types of tumors. Cystic tumors with massive bleeding invading the surrounding structures (the dura mater or jugular bulb) were more common in the sporadic cases. Fibrous tumors that infiltrate the bone and have moderate bleeding were more common in the cases associated with VHL disease.Two patients with small lesions were not operated on but were followed for 6 years without tumor growth. They died of metastasis from gastric and kidney cancer. Four recurrences occurred during the 14 years of follow-up. Four facial palsies and 8 cases of profound deafness were encountered postoperatively.
  
  
  CONCLUSIONS
  Sporadic tumors are more aggressive than those associated with VHL disease. Complete surgical resection should be the goal of treatment. Preoperative angiography with embolization is recommended. In some cases, embolization may be impossible, and preoperative or postoperative radiotherapy should be discussed.
authors.affiliation: *Service d'ORL, AP-HP, Hôpital Bicêtre, Service ORL; and †U.693 INSERM, Faculté de Médecine Paris Sud, Le Kremlin-Bicêtre; ‡Service d'ORL, AP-HP, Hôpital Beaujon, Service ORL; §U.867 INSERM, Faculté de Médecine Xavier Bichat, Paris; ∥Centre de Référence Cancers Rares INCa "PREDIR" and Réseau National INCa, AP-HP, Service d'Urologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre; and ¶Génétique Oncologique EPHE, U.743, INSERM, Institut de Cancérologie Gustave Roussy, Villejuif and Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Nevoux
authors.forename: Catherine
authors.initials: C
authors.lastname: Nowak
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Vellin
authors.forename: Christine
authors.initials: C
authors.lastname: Lepajolec
authors.forename: Olivier
authors.initials: O
authors.lastname: Sterkers
authors.forename: Stéphane
authors.initials: S
authors.lastname: Richard
authors.forename: Serge
authors.initials: S
authors.lastname: Bobin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004428:Ear Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D004712:Endolymphatic Sac / Q000473:pathology / Q000601:surgery*; D005260:Female; D034381:Hearing Loss / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D018325:Hemangioblastoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014012:Tinnitus / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014717:Vertigo / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D055815:Young Adult; D006623:von Hippel-Lindau Disease / Q000150:complications / Q000473:pathology / Q000601:surgery*