[Recurrent facial paresis with facial neurinoma]

PATIENT

A clinical case of a 49-year-old man is described who presented with a right facial paresis for 4 weeks. The patient had undergone a decompression of facial nerve and a radical mastoidectomy elsewhere in 1998 because of a facial paresis and acute mastoiditis. In the following years a complete right facial paresis occurred several times improving with prednisolone. In addition to topognostic examinations a high resolution computed tomography of the temporal bone was made. CT showed a mass in the right tympanic cavity with close contact to the ossicular chain. Diagnostic tympanotomy disclosed a tumor of the tympanic segment of the facial nerve. Pathological examination indicated a diagnosis of neurinoma with an Antoni B architecture. In a second operation the tumor was resected totally and a facial nerve reconstruction was performed by a greater auricular nerve interposition graft. Seven month postoperative beginning nerve reinnervation was seen proceeding continually until the control examination after 1 1/2 year.

DISCUSSION

Facial neurinoma are a rare course of facial paresis. There are no specific symptoms. That's why the diagnosis is difficult. But it is necessary to think of with differential diagnosis of facial paresis.

[Benign tumors of the external and middle ear from data collected at the Otolaryngologyst Department of the Jagiellonian University in Cracow between 1992-2001]

26 patients with benign tumors of the external and middle ear were treated at the Otolaryngology Department of the Jagiellonian University in Cracow between 1992-2001. Benign tumors of the external and middle ear are rare diseases, and it is usually easy to establish final diagnosis. Various histopathological types of these tumors are found. We discuss different kinds of tumors, their location and performed treatment. In our population the most common tumor was osteoma located in external ear canal. The best kind of treatment is radical surgical resection of the lesion. In cases when surgical treatment is impossible because of local progression of the disease, radiotherapy should be considered.

Endolymphatic sac tumor: a report of 3 cases and discussion of management

Patients with an endolymphatic sac tumor (ELST) typically present with palsy of cranial nerves VII and/or VIII; other presenting symptoms include hearing loss, otalgia, occipital headaches, cranial nerve palsies, vertigo, gait ataxia, tinnitus, and otorrhea. ELSTs are extremely vascular, and they can invade and destroy temporal bone. Because of these characteristics, they are often mistaken for glomus tumors of the skull base. We describe the clinical presentation, evaluation, and management of ELSTs based on our review of the limited literature and our experience with 3 adults who presented to our tertiary care referral center with large ELSTs. Although these patients presented late in the course of their disease, their symptoms were relatively minor. Preoperative tumor embolization was performed, anda near-complete resection was achieved via an extended transotic approach in all 3 patients. The facial nerve was preserved without transposition in the first patient, the second patient underwent a primary nerve anastomosis, and the third required a cable graft of the facial nerve. Postoperative radiation therapy was administered to 2 of these patients. Follow-up by MRI detected no evidence of recurrence in any of the 3 patients.

[Acoustic neurinoma shown as a facial palsy]

Acoustic neurinoma is the most frequent benign tumour at the cerebellopontile angle. It causes compressive type lesions in adjacent cerebral structures. Its usual symptoms are sensorineural hearing loss and tinnitus with or without unilateral vertigo, which is why we have to know the wide variety of clinical signs it can present from its beginning, including facial palsy. We present the case of a vestibular schwannoma in a pregnant lady diagnosed by a peripheral facial palsy.

Ceruminous gland carcinoma of the external auditory canal presenting as chronic otitis media

OBJECTIVE

Ceruminous neoplasms of the external ear canal are rare. Classification, clinical behavior, and management of these tumours are controversial. We report a case of carcinoma originating from the ceruminous glands of the external ear canal (EAC), operated based on a diagnosis of chronic otitis media with polyp.

CASE REPORT

A 48-year-old man presented with left ear discharge and hearing loss. Clinical examination showed a well-circumscribed polypoid mass limited to the EAC. There was no history of bloody ear discharge or radiological findings of bony erosion suggestive of malignancy. Our preliminary diagnosis was chronic otitis media with polyp formation. Tympanoplasty was performed. Histopathology revealed a ceruminous carcinoma, and an additional operation involving lateral temporal bone dissection was performed, followed by 60 Gy radiation therapy.

CONCLUSION

Ceruminous carcinomas should be considered in the differentialdiagnosis of middle and external ear pathologies in cases of soft tissue mass in the EAC.

Cavernous angiomas within the internal auditory canal

OBJECT

The aim of this study was to describe the symptomatology, radiological features, and surgical treatment of patients with cavernous angiomas within the internal auditory canal (IAC).

METHODS

The authors reviewed the cases of seven patients with cavernous angiomas in the IAC that had been surgically treated in the 22-year period between 1983 and 2005. All the patients had presented with sensorineural hearing loss, and four suffered from tinnitus. Four patients also reported facial symptoms such as hemispasm or progressive palsy; one of these patients had presented with sudden facial paresis due to intrameatal tumor hemorrhage. According to computed tomography (CT) results, the lesions caused enlargement of the IAC. Interestingly, these same angiomas showed variable features on magnetic resonance (MR) imaging, making their differentiation from intrameatal vestibular schwannomas (VSs) sometimes impossible. In all patients the lesions were totally removed via the suboccipital retrosigmoid approach. They could be dissected away from the facial nerve in five cases, whereas in two cases, because of the location of the lesion, the seventh cranial nerve had to be sectioned and repaired with a sural nerve graft. Transient worsening of seventh cranial nerve symptoms occurred in two patients, with postoperative improvement in each of them. The cochlear nerve could not be functionally preserved because of its extreme adherence to the tumor, although its continuity was preserved in four patients. Complete deafness was the only postoperative complication.

CONCLUSIONS

Cavernous angiomas of the IAC are very uncommon lesions that can imitate the symptoms of VSs. Although it is the most sensitive study available, MR imaging does not show sufficiently specific findings to differentiate the two lesion types. Thus, the preoperative diagnosis must be based on patient symptoms plus the CT and MR imaging features.

Merkel cell tumour of the external ear. Report of a case

Merkel cells carcinoma (MCC) is an uncommon skin lesion, considered a malignancy of the neuroendocrine system, which is found mainly in elderly people. Its incidence is highly correlated with sun exposure or immunodeficiency syndromes. MCC is often an aggressive tumour with high tendency for local recurrence, lymph node involvement and distant metastasis. To our best knowledge 20 cases originated from the auricle have been described, 2 of them arising from external ear canal. The authors report a case of the ear canal characterized by two others synchronous tumours and the occurrence of a malignant high grade lymphoma, in which contribute of the pathologist was essential for a critical review. MCC diagnosis is not always easy for its pathological and clinical features and it should always be considered in presence of lymphoma. A multidisciplinary approach is basic.

Nasopharyngeal extension of glomus tympanicum: an unusual clinical and imaging manifestation

Nasopharyngeal extension of the glomus tympanicum is rare. Only 2 cases have been reported in the literature to date. We present a reported case of a large nasopharyngeal extension of recurrent glomus tympanicum, with various kinds of imaging and histopathology and a review of the literature.

Adenoid cystic carcinoma of ceruminous gland: a case report

Adenoid cystic carcinoma of the external auditory canal (EAC) is a very rare malignant tumor and its diagnosis is frequently missed because of the superficial nature of biopsies. A 30 year old male presented with 6 months history of recurrent painful right ear discharge. On examination there was a nodule of 2 cms in diameter. The microscopic examination of the punch biopsy specimen of tumor revealed typical features of an adenoid cystic carcinoma. While reporting the biopsies of external auditory canal one should keep the adenoid cystic carcinoma as one of the possible differentials, especially if the biopsy is superficial, problem is recurrent and histopathological features suggest the granulation tissue.

[Cavernous hemangioma in internal auditory canal: case report and review of the literature]

OBJECTIVE

To discuss the diagnosis and treatment of cavernous hemangioma in internal auditory canal (IAC).

METHOD

One case of cavernous hemangioma in IAC was diagnosed and treated. The clinical data including clinical manifestation, hearing tests, imaging findings and pathology diagnosis were reviewed.

RESULT

The tumor was totally removed by translabyrinthine approach without any complication, such as facial paralysis or cerebrospinal fluid otorrhea.

CONCLUSION

Cavernous hemangioma of the IAC have arisen from vascular plexuses surrounding Scarpa's ganglion. It is a rare occupying lesion in IAC of benign nature. Early diagnosis depends on clinical manifestation and imaging findings. Subtle radiographic findings may help in differentiating these lesions from schwannomas. The ultimate diagnosis is made on pathologic examination of the tissues after surgical extirpation.

Low-grade adenocarcinoma of endolymphatic sac origin

We present a case of papillary cystic low-grade adenocarcinoma of endolymphatic sac origin. These tumors are very rare and only a few cases have been reported in literature. They have a protracted clinical course causing progressive invasion and bony destruction. Radiologically, they appear as a heterogenous lobulated vascular mass, invading bone and compressing surrounding structures. Histologically, these tumors are composed of uniform population of cells, resembling normal endolymphatic sac epithelium. This causes considerable diagnostic difficulty. A strong index of suspicion along with clinical and radiological correlation is essential to arrive at a correct diagnosis. In some bilateral cases, association with von Hippel-Lindau disease has been noted. Radical mastoidectomy and temporal bone resection, which may sometimes necessitate sacrifice of cranial nerves, is the treatment of choice.

Pleomorphic adenoma of the external auditory canal

Pleomorphic adenoma of the external auditory canal is a rare disease. It is considered to derive from the ceruminous glands. The objective of this study is to familiarize the clinician with the clinical presentation and treatment of this disease. We report the case of a 58-year-old woman. Complete resection should be applied for cases in which magnetic resonanace imaging (MRI) and computerize tomography (CT) examination indicate no erosion in the bone and cartilage tissue. The patient should be seen regularly for recurrence.

[Middle ear adenoma: our casuistry and revision of the literature]

Tumours of the middle ear are rare. Among them glomus tympanicum is the most frequent, followed by adenoma of the middle ear (AME). This insidious pathology entity displays unspecific clinical and audiological features. Advances in histology and immunohistochemistry have greatly contributed to an accurate diagnosis. We report our experience with two patients, a middle-aged man and a woman, diagnosed in our hospital. Both patients underwent surgical treatment and have shown no signs of recurrence after a 27- and 28-month follow-up. In both cases an accurate diagnosis was confirmed by histological and immunohistochemical analysis.

Endolymphatic sac tumour: a rare cause of recurrent vertigo

Endolymphatic sac tumour occurring in a 32-year-old man presenting with Meniere's like symptoms of recurrent vertigo, hearing loss and tinnitus is described. Magnetic resonance imaging and computed tomography showed a vascular bone tumour centred over the retrolabyrinthine aspect of the temporal bone where the endolymphatic sac was located. Surgical excision via a translabyrinthine approach was performed. Endolymphatic sac tumours are rare papillary adenocarcinomas that arise from the endolympatic sac. It can be mistaken both on radiology and histology for other tumours such as paragangliomas, renal or papillary thyroid carcinoma metastases. Surgical excision is the treatment of choice but sacrifice of the auditory and facial nerve may be needed in advanced cases to achieve tumour clearance.

Giant cell tumor of the petrous temporal bone with direct invasion into the middle ear

Giant cell tumor (GCT) is an uncommon primary bone tumor. The GCT mostly involves the extremity long bones. Rare is a GCT with tumoral growth in the cranium, especially other than the sphenoid bone. We herein report a 31-year-old male patient presenting with ipsilateral hearing loss and episodes of vertigo due to a large lobulated GCT of the right petrous temporal bone extending into the contiguous middle cranial fossa, infratemporal space, middle ear and external ear canal. He was treated with a macroscopically radical tumor excision followed by conventional megavoltage radiotherapy. The patient remains free of clinical and radiological evidences of tumoral recurrence six years after treatment. This experience supports the rationale for the combined treatment with radical excision plus irradiation toward this rare neoplasm when vigorous invasion of the skull base is encountered.

[Expansion of an ceruminous adenoma into the middle ear]

A 37-year-old female presented for surgery with central perforation of the eardrum with granulation. Mastoidectomy had been performed 18 years ago following chronic mastoiditis. As the clinical picture now suggested a suspected cholesteatoma, radiological imaging was performed. The CT scan revealed specification of the mastoid and the tympanic cavity. In addition, MRI scan showed signal enhancement in the same areas. However, the suspected cholesteatoma could not be confirmed intraoperatively. Pathohistology revealed a ceruminal gland adenoma. They are a rare phenomenon and should be distinguished from middle ear adenomas, pleomorph ceruminal gland adenomas, ceruminal gland adenocarcinomas and cylindromas of the ceruminal glands. Owing to a high recurrence rate, complete surgical removal is necessary. Despite its rare occurrence, a ceruminal gland adenoma must be taken into consideration in the differential diagnosis of individual cholesteatoma cases.

Intrakochleäres Schwannom als Ursache für eine Surditas

Inner ear extension caused by schwannomas, which can cause hearing loss, tinnitus and vertigo, is an extremely rare finding. We report a male patient who presented with progressive hearing loss as well as tinnitus in the right ear. Despite rheologic infusion therapy with glucocorticosteroids at another hospital, the patient showed an explicit hearing loss and vertigo related to the right ear. In the pure tone audiogram, we found complete deafness of the right ear, the equilibriometry with caloric testing showed complete loss of the labyrinth. In the HR-MRI, a structure appeared in ranges of the basal and middle cochlea with enhancement of the contrast medium. From the MRI aspect, this appeared to be a small intracochlear schwannoma. As a differential diagnosis, a chronic granulation is also possible. In agreement with the patient, we decided to control the structure clinically every 6 months using MRI; no further growth of the structure appeared. A precise imaging via HR-MRI is required to detect intracochlear schwannomas. Observation is an appropriate option for patients who have serviceable hearing. Surgical exploration can be recommended in cases of progressive diseases and growth into the inner ear with recurrent vertigo attacks. The option of radiotherapy for the treatment of intrameatal acoustic neurinomas should be considered.

Temporal bone secretory meningioma presenting as a middle ear mass

A 44-year-old woman presented with a history of increasing left hypoacusis and sporadic vertigo. CT scan revealed a tumor occupying the mastoid, middle ear, and external auditory canal. After surgical removal, a typical secretory meningioma was diagnosed. The histological hallmark and the immunohistochemical profile of secretory meningiomas are reviewed. The differential diagnosis of this tumor in this location is also commented on. As far as we know, primary temporal bone meningiomas with secretory histology have not been previously reported in the medical literature.

Atypical haemangioma of the internal auditory meatus: a case report

Haemangiomas involving the internal auditory meatus (IAM) are rare and can mimic other frequent lesions of the IAM such as schwannomas by their clinical and imaging aspects. The case of a patient with an atypical IAM haemangioma fluctuating in size is reported to highlight this diagnostic possibility. A 36-year-old female presented with a sudden and recurrent left sensorineural hearing loss (SNHL). Three consecutive MRIs were performed in a 10-month period of preoperative observation. They showed a fluctuation of the tumour signal and size. The surgical removal was performed via a translabyrinthine approach. Pathological findings were consistent with the diagnosis of a heamangioma. MRI and CT findings suggested the diagnosis of IAM heamangioma, but the rapid variation in size and signal was misleading. This phenomenon may be due to haemorrhage or oedema, and can be accompanied by a deterioration of the hearing function. Early surgical resection is the treatment of choice and allows to confirm the diagnosis.

Solitary metastasis of lung carcinoma to the internal auditory canal

We report a case of solitary metastasis of lung carcinoma into the internal auditory canal. On admission, the 60-year-old patient was complaining about a rapidly developing hearing loss with ipsilateral facial nerve paralysis. Magnetic resonance imaging revealed an intracanalicular tumor, which was interpreted as vestibular schwannoma. After tumor resection, the histopathologic examination revealed a metastasis of a squamous cell carcinoma. Computed tomographic scan and bronchoscopy identified an asymptomatic primary pulmonary neoplasm.

Follicular hybrid cysts with infundibular, isthmic-catagen, and pilomatrical differentiation: a report of 2 patients

The term hybrid cyst was originally coined to describe combination follicular cysts with both epidermoid and trichilemmal (pilar) epithelial zones, separated by an abrupt transition. The concept has since expanded to include many different combinations of pilosebaceous unit differentiation. Entities previously reported also include infundibular and pilomatricomal cyst, trichilemmal and pilomatricomal cyst, eruptive vellus hair cyst combined with steatocystoma or trichilemmal cyst, and trichilemmal, sebaceous, and pilomatricomal cyst. We report 2 cases of follicular hybrid cysts, all mixtures of epidermoid, trichilemmal, and matrical differentiation. The cysts, involving the ear and abdomen, occurred in one woman and one man.

Kaposiform hemangioendothelioma arising from the internal auditory canal

Kaposiform hemangioendothelioma is a rare vascular tumor and locally aggressive endothelial-derived spindle cell neoplasm, which occurs almost exclusively in infants and adolescents. Radiologically, hemangioendothelioma, including Kaposiform hemangioendothelioma, is seen as a highly vascularized well-enhancing tumor, but no characteristic findings differentiate Kaposiform hemangioendothelioma from other soft-tissue tumors, particularly when the tumor is too small to have any locally aggressive features or identifiable large vessels. We present a case of Kaposiform hemangioendothelioma in the internal auditory canal that had no differential features on initial MR images and rapidly grew into a huge mass in a few months.

Cutaneous neuroendocrine adenoma: an uncommon neoplasm

BACKGROUND

Cutaneous neuroendocrine neoplasms are typically malignant. Benign cutaneous neuroendocrine tumors are uncommon.

METHODS

We report the case of a 32-year-old female who presented with a granular mass in the right external auditory canal.

RESULTS

Microscopic examination of a shave biopsy revealed a poorly circumscribed neoplasm with glandular differentiation. While cytologic atypia and mitotic activity were not evident, pagetoid spread was observed. Immunohistochemistry was indicative of neuroendocrine origin.

CONCLUSIONS

This case report of neuroendocrine adenoma indicates that this entity should be entertained in the repertoire of conditions affecting the external ear.

Cavernous angioma of the internal auditory canal

Cavernous angiomas of the internal auditory canal are rare lesions. The authors present a case of a 29-year-old lady with multiple infratentorial cavernous angiomas, whose sister had previously undergone surgery for a similar supratentorial lesion. She initially presented with an acute brainstem haematoma, secondary to a pontine cavernous angioma. Three years later she developed progressive right-sided sensorineural hearing loss and facial nerve paresis due to an internal auditory canal lesion. This was removed via the translabyrinthine approach and was found to be a cavernous angioma.

This report underlines the multiple and dynamic nature of familial cavernous angiomas, as well as the importance of follow up to determine whether new symptoms are due to the enlargement of known angiomas or the development of new ones. As far as the authors are aware, this is the first report describing a cavernous angioma of the internal auditory canal in the context of familial and multiple infratentorial angiomas.

Metastatic carcinoma mimicking a facial nerve schwannoma: the role of computerized tomography in diagnosis

Secondary deposits in the temporal bone are uncommon but well recognized. Such tumours may involve the facial nerve by direct extension of the destructive process into the fallopian canal. We present a rare case of metastasis from a breast carcinoma in the facial nerve itself, involving the nerve in the internal acoustic meatus with extension into the labyrinthine segment, the first genu and into the middle-ear segment. The rest of the temporal bone was not involved. The lesion resembled a facial schwannoma on a routine magnetic resonance (MR) image. The diagnosis was confirmed after a post-operative computed tomography (CT) scan showed another separate secondary deposit in the basisphenoid. Histology was consistent with secondary tumour from a breast carcinoma. The case highlights the importance of keeping a high degree of suspicion for metastatic tumours in patients with a previous history of malignancy and the usefulness of CT scan in the evaluation of such cases.

Endolymphatic sac tumor in a patient with von Hippel-Lindau disease: MR imaging findings

A 29-year-old male patient with von Hippel-Lindau disease who had an operation for cerebellar hemangioblastoma six years ago is presented. The patient had a four-year history of a slow-growing, locally invasive vascularized lesion of the temporal bone involving the cerebellopontine angle. The mass, studied by MR imaging, was almost completely cystic in appearance. Pathological examination after removal of the mass confirmed a papillary endolymphatic sac tumor.

[Middle-ear adenoma]

In our case we present a 47-year old female patient, who had a history of one year of right-sided recurrent ear pain without any signs of ear-infections. A computer tomography (CT) imaging was carried out. At the mid-modiolar level, the axial CT-scan showed a small contrast-enhancing density in the middle ear space. She refused further investigation until the ear-pain increased and slight hearing loss was present. Again, six months later a CT-scan was performed, and the hyperdense tissue formation engaged the entire middle ear cleft of the right temporal bone. Typical of MEA, no osteolytic signs were present; the skull-base was intact, the air-cell system of the temporal bone showed no osteolysis or deficiency. In the case presented here, we show a MEA which has filled the middle ear with fluid retention in the mastoid with absent destruction of any structure clinically resulting in ear pain and slight conductive hearing loss. These lesions are contrast-enhancing on CT and on magnetic resonance imaging (MRI) have brain-like signal intensity T2-weighted images. In this case, the lesion was exenterated.

[Benign and malignant lesions in the region of the inner ear and cerebellopontine angle]

Tumorous lesions in the region of the inner ear and cerebellopontine angle are very rare and can be classified into benign and malignant disease forms. This contribution presents and explains the CT and MRI characteristics of these tumors.High-resolution computed tomography (HRCT) in the axial projection is applied for evaluation in the high-resolution bone window. The coronary slices can be reconstructed from the axial datasets or in individual cases examined in the coronary plane.HRCT excellently demonstrates osseous lesions and in individual cases - e.g., exostoses - it can simply suffice to perform HRCT of the temporal bone, while HRCT is also excellent for detecting osseous lesions to determine whether the tumor is benign or malignant.MRI, on the other hand, excellently shows the extent of tumor spread because of its superb soft tissue contrast. Consequently, HRCT and MRI images of the inner ear and cerebellopontine angle provide meaningful information for visualization and classification of tumorous lesions. The two methods should not be considered as competing but rather as complementary and among other aspects exert considerable influence on the therapeutic approach.

Melanoma of the ear: prognostic factors and surgical strategies

BACKGROUND

The ear's specific anatomical and lymphatic characteristics impose special requirements on the treatment of melanoma of the ear.

OBJECTIVES

The aim of this prospective study was to define prognostic factors for melanoma of the ear and to evaluate surgical strategies for excision margins, histological evaluation and sentinel lymph node biopsy (SLNB) in order to achieve better cosmetic and functional results.

PATIENTS AND METHODS

One-hundred and sixty-one patients with stage I/II melanoma of the external ear were treated in the Department of Dermatology, University of Tuebingen, from March 1976 to March 2004 (median follow-up 62 months). Malignant melanoma of the external ear represented 3% of the stage I/II cutaneous melanomas and 20% of the stage I/II head and neck melanomas recorded in the Melanoma Registry of the Department of Dermatology at the University of Tuebingen. Twenty of 42 lentigo maligna melanomas (LMM) underwent conventional histological evaluation, 22 underwent complete three-dimensional histology of excision margins (3D histology) in a paraffin-technique, i.e. micrographic surgery. SLNB was performed in 28 patients with melanomas thicker than 1.0 mm. Clinical, histological and surgical risk factors were evaluated by univariate and multivariate analysis.

RESULTS

The median thickness of the tumours in the present study was 1.08 mm (mean 1.51 mm; range 0.18-8.50 mm), and the median excision margins were 11.0 mm (mean 12.61 mm; range 2.0-31.0 mm). The 3-year disease-specific survival rate was 98%, and the 3-year recurrence-free survival rate was 83%. Tumour thickness and invasion level were the only risk factors significant for disease-specific survival. Tumour thickness, location of the tumour and extent of excision margins were independently significant risk factors for recurrence-free survival. LMMs removed surgically with accompanying 3D histology were thicker than those examined by conventional histology (median 0.93 mm vs. 0.83 mm). The use of surgery with 3D histology, i.e. micrographic surgery, made it possible to reduce the excision margins (median 5 mm vs. 10 mm) without an increased risk of recurrence. Two of 29 SLNBs were positive (6.9%). There were six preregional recurrences after negative SLNB and one after positive SLNB. None of the patients who underwent SLNB died of melanoma-related causes during the observation period.

CONCLUSIONS

This is the largest series of ear melanomas reported so far. The overall survival depended only on the tumour thickness and Clark level of invasion. Local recurrence was more frequent with smaller excision margins, but this did not influence the overall survival. Smaller excision margins under 3D-histological control did not carry an increased risk of local recurrence. Our results do not permit conclusions regarding the prognostic impact of SLNB for patients with melanoma of the ear.

Ectopic meningioma: a case report with a literature review

Ectopic (extradural) meningiomas that do not originate from either the optic fascicle or the intracranial meninges are exceedingly rare. A patient with an ectopic meningioma in the external auditory canal and mastoid was treated in our unit. The world literature of the last 20 years was reviewed.

Lipomatous pleomorphic adenoma of the ceruminous gland

A case of lipomatous pleomorphic adenoma in the ceruminous gland is reported. A 69-year-old Japanese woman presented with a mass in the posterior wall of the cartilaginous external auditory canal. Light microscopic examination revealed a well-circumscribed tumor composed of tubular structures with apocrine secretion and ceroid deposition, extensive mature adipocytes, and spindle-shaped myoepithelial cells in the myxoid and fibrous stroma. This case demonstrates the peculiar location of a lipomatous pleomorphic adenoma in the external auditory canal.

Chondroid syringoma of the external ear canal presenting as a cyst

Chondroid syringoma of the external ear canal is a rare, usually firm or polypoid tumor, representing the cutaneous counterpart of pleomorphic adenoma of salivary glands. We report a very rare case of chondroid syringoma in a 40-year-old man who presented with a fluid-containing cyst in the external ear canal. Clinical and radiological examinations showed involvement of the whole external canal to the annulus. The cystic lesion was totally excised along with the overlying skin. The postoperative course was uneventful.

Primary malignant melanoma of the middle ear mucosa: a case report

Primary involvement of the middle ear and mastoid mucosa by malignant melanoma (MM) has been rarely reported. We report an 81-year-old Caucasian woman presenting with otalgia, left-sided aural fullness, and hearing loss. Otoscopic examination revealed a purple-colored polyp that appeared to be vascular, occupy left external auditory canal (EAC). The computed tomography scanning showed a mass in soft tissue density, filling the tympanic and mastoid cavities, eroding the mastoid cortex, and invading medial and central parts of the EAC. A biopsy was performed with the diagnosis of MM. The patient underwent subtotal temporal bone resection with radical neck dissection. Dacarbazine was given postoperatively. The case presented herein emphasizes the need to be aware that MMs can arise in the middle ear and mastoid cavity. An index of suspicion in the differential diagnosis of temporal bone tumors is necessary for early recognition.

Middle-ear ceruminous adenoma as a rare cause of hearing loss and vertigo: Case reports

Middle-ear ceruminous adenomas are rare benign neoplasms arising from the epithelium of the middle ear. Progressive hearing loss, ear fullness and tinnitus are common symptoms of this tumour; facial nerve paresis and vestibular disturbances occur very infrequently. We present two cases of middle-ear ceruminous adenomas, one showed rapid unilateral hearing loss with aural fullness, followed by purulent aural discharge and vertigo. In the second case, the disease affected an already deaf ear and the only symptom of the disease was increasing vertigo. The clinical features, intraoperative findings, and histological and radiological findings are presented. The cases are compared to those described in the literature.

[Diagnostic image (252). A woman with complaints of tinnitus, hearing loss and headache]

A 42-year-old woman complained of tinnitus, hearing loss and headache. Many years ago she had been treated for a vestibular schwannoma and cutaneous neurofibroma. MRI revealed bilateral vestibular schwannomas and multiple meningiomas due to neurofibromatosis type 2.

A huge osteoma of the middle ear

Osteomas of the middle ear are rare benign neoplasms. Most of the cases caused conductive hearing loss and others were asymptomatic and diagnosed incidentally. We report a case of a huge middle ear osteoma along with compatible radiological findings filling the whole tympanum and the Eustachian tube, which caused intermittent otorrhea and conductive hearing loss.

Meningioma of the internal auditory canal: a case report

Meningioma of the internal auditory canal is very rare. There are only 15 previous reports of intracanalicular meningioma. The authors add a case report of a patient with meningioma of the internal auditory canal. A 31-year-old woman presented with a one-year history of headache, dizziness, hearing loss and left facial paralysis. An MRI of the temporal bone demonstrated a tiny isointense intracanalicular tumor with inhomogeneous enhancement. In the operative field carried out by translabyrinthine approach, the tumor was found in the IAC without intracranial involvement. Pathology revealed a meningioma. The patient was followed up for 2 years without recurrence.

Primary carcinosarcoma of the helix of the ear

We report our histologic and immunohistochemical findings in a rare case of cutaneous carcinosarcoma involving the helix of the ear. The tumor exhibited cellular features of both basal cell and squamous cell carcinoma and a malignant mesenchymal component that was consistent with malignant fibrous histiocytoma. The epithelial component exhibited a positive immunohistochemical reaction to cytokeratin and a negative reaction to vimentin, whereas the mesenchymal component showed a positive immunohistochemical reaction to vimentin and a negative reaction to cytokeratin. To the best of our knowledge, this is only the third reported case of a carcinosarcoma of the ear and the second case in which it developed on the helix.

Malignant melanoma of the auricle

Malignant melanomas are found in a variety of locations, ranging from sun-exposed skin to the nasal cavity and paranasal sinuses. Melanomas arising in the head and neck region comprise some 20% of all melanomas; of these, 7-15% occur in the vicinity of the external ear (most often on the helix). Auricular melanomas, like those arising elsewhere, are rare in childhood and are most often first diagnosed in men in their 50s. Melanomas of the external ear may present as flat pigmented lesions or as raised mass lesions; amelanotic (non-pigmented) variants exist as well. Auricular melanomas are frequently recognized pathologically as either superficial spreading melanomas or nodular melanomas. These tumors are aggressive, with a propensity for spreading to both regional lymph nodes and distant sites. Key pathologic prognostic features of auricular melanomas include the histological subtype, tumor thickness, level of invasion and presence of ulceration. Therapy includes both aggressive surgical attempts at excision in combination with sentinel node sampling in some instances and perhaps, adjuvant therapy as well. This is a tumor which is often overlooked until late in its course, with tragic consequences; vigilance and aggressive attempts at identifying these tumors at earlier stages are strongly advocated.

Renal cell carcinoma with cutaneous metastases

An 86-year-old man presented with multiple papules on his face, neck, lips and ears 4 years after a left nephrectomy for renal cell carcinoma. Shave biopsies and excisions of the cutaneous lesions revealed findings consistent with metastatic renal cell carcinoma of clear cell type. The patient continued to present to the clinic over the next 3 years with similar eruptions, and biopsies continued to confirm renal cell carcinoma. During this time, metastases to the bone, lung, soft palate and posterior leg were also diagnosed. This case represents an unusual clinical presentation of metastatic renal cell carcinoma. It shows that a high index of suspicion should be maintained as cutaneous metastases can mimic other skin conditions.

[Diagnostic difficulties in a patient with middle ear tumor]

Authors present the case of a 57-years old female patient with middle ear tumour, with the history of middle ear operations and reoperations due to chronic inflammatory process. Difficulties in diagnostic procedure related to the kind and size of tumour and to the destruction of surrounding tissues are described as well as operative difficulties connected with the extent and type of surgical intervention. The newest diagnostic methods show with great accuracy the vascular supply of middle ear tumour and the directions of its dissemination within temporal bone. The presence of vast vascularization of middle ear tumour suggests the diagnosis of chemodectoma.