Neuro-endocrine adenoma of the middle ear: a case study

Management and outcome of middle ear adenomatous neuroendocrine tumours: A systematic review

Middle ear adenomatous neuroendocrine tumours (MEANTs) are rare, unpredictable tumours. Although most MEANTs are characterized by a benign biological behaviour and indolent growth pattern, some studies have reported locally invasive and metastastic disease. Currently, the optimal management strategy for MEANTs remains subject of debate. The aim of this study is to review the literature on MEANTs with focus on its clinical characteristics, treatment strategies and outcome. A systematic review was conducted using PubMed, Embase and Cochrane databases. A total of 111 studies comprising 198 patients with MEANT were included. Treatment modalities comprised surgery (90%), surgery with adjuvant radiotherapy (9%) and palliative (chemo)radiotherapy in (1%). Local recurrence was observed in 25% of the patients and 7% of the patients developed metastasis, over a median period of 5.7 years (range 7 months - 32 years). Twelve of 13 patients (92%) who developed metastases had a local recurrence. Four patients (2%) died of MEANT: three due to distant metastases and one due to extensive local recurrence. Reliable histopathologic predictors of outcome could not be identified. These findings indicate that the clinical presentations of MEANT vary substantially, the overall recurrence rate is considerable and initial local tumour control is paramount. Because of the unpredictable clinical course, prolonged follow-up is warranted.

"Neuroendocrine adenoma of the middle ear with the history of otitis media and carcinoma of the cheek: a case report"

BACKGROUND

Neuroendocrine adenomas of the middle ear are rare benign tumors deriving from middle ear mucosal cell with both neuroendocrine and epithelial properties. Approximately one hundred cases have been reported in the literature. Here we report a patient with neuroendocrine adenoma of the middle ear with the history of otitis media; the patient earlier had received radiotherapy for the treatment of basal cell carcinoma.

CASE PRESENTATION

A 49- year- old Saudi man presented with a progressive hearing loss and fullness in the left ear with the history of otitis media for which he had undergone myringotomy and ventilating tubes insertion. Earlier at the age of 45 years this patient was given radiotherapy for the treatment of basal cell carcinoma in his cheek. The otoscopy showed a protruded external ear mass obscuring the tympanic membrane. Microscopy and histological examination suggested an endocrine adenoma of the middle ear. The computerized tomography scan of the temporal bone showed an extensive soft tissue mass without any osteolysis. Histological and immunohistochemical examination following surgical excision confirmed the diagnosis of neuroendocrine adenoma of the middle ear.

CONCLUSION

A rare case of neuroendocrine adenoma of the middle ear with earlier history of otitis media and carcinoma of the cheek is presented here. Surgical excision of mass resulted in uneventful recovery. Although the etiologic factors leading to the disease is far from clear, the role of radiotherapy given for the treatment of basal cell carcinoma may not be ruled out.