Primary monomorphic adenoma of the middle ear

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.

A case of middle-ear cavernous lymphangioma with facial palsy

OBJECTIVE

Only a few benign tumours of the middle ear have been reported to lead to the development of facial palsy. Here, we describe a patient with middle-ear cavernous lymphangioma and facial palsy.

STUDY DESIGN

Single case study.

PATIENT

A 61-year-old man presented with left-sided hearing impairment and incomplete left facial palsy. A tumour was confirmed to be occupying the epi- to mesotympanum and to be joined to the facial nerve. The tumour was removed along with facial nerve tissue, which was resected at its horizontal portion, and the remaining facial nerve was fixed by end-to-end anastomosis. Complete facial paralysis occurred after the operation, but the patient's House-Brackmann grade gradually improved to grade III. Post-operative histopathological examination revealed infiltration of the lymphangioma into the facial nerve tissue, together with mild neural atrophy of the facial nerve.

CONCLUSION

These findings suggested that tumour invasion was the cause of facial palsy in this patient.

Adenoma of the middle ear: a rare and misleading lesion

PURPOSE

To discuss features of the adenoma of the middle ear according to the literature.

BACKGROUND

Adenoma of the middle ear is a rare tumor, which is developed from the tympanic cavity. Its histopathologic appearance is benign and is characterized by a glandular and neuroendocrine component.

METHODS

The authors report their experience with two cases, treated surgically by tympanoplasty.

RESULTS AND CONCLUSION

The treatment is exclusively surgical and must be complete to prevent recurrence.

Adenoma versus carcinoid tumor of the middle ear: a study of 48 cases and review of the literature

Carcinoid tumors and adenomas of the middle ear are rare neoplasms of indeterminate relationship to one another. Indeed, the literature is devoid of a large comprehensive series that evaluates the clinical, histologic, and immunophenotypic features of these tumors and their potential relationship. Forty-eight cases of middle ear adenoma between 1970 and 1995 were identified in the files of the Armed Forces Institute of Pathology. All cases were evaluated for cytomorphology and architectural pattern, in addition to their reactivity with various immunohistochemical reagents. Clinical follow-up was also obtained. A comprehensive review of the literature was performed with an eye toward correlating any distinct differences or similarities between carcinoid tumors and adenomas of the middle ear. The patients included 21 women and 27 men, aged 20 to 80 years (mean, 45.0 y). Patients experienced hearing loss, mass, and/or pain for a mean duration of 1.7 years. The mean tumor size was 0.8 cm, with six tumors extending beyond the middle ear. Histologically, the tumors were moderately cellular and unencapsulated, arranged in glandular, trabecular, and solid patterns composed of small cells with "salt and pepper" nuclear chromatin distribution. The tumor cells were immunoreactive with keratin, keratin 7, chromogranin, and human pancreatic polypeptide. All patients had surgery. No patients died with their disease (mean follow-up, 15.7 y). Eight patients developed recurrences that were treated surgically and were without evidence of disease at last follow-up (mean, 15.1 y). Our study and the review of the literature showed adenomas and carcinoid tumors of the middle ear to be essentially indistinguishable benign tumors. Middle ear adenoma most correctly describes their morphologic features and clinical behavior, although neuroendocrine adenoma of the middle ear may be a more accurate designation.

Adenoma of the middle ear mucosa

Benign adenomas of the middle ear are rare tumors. To date, approximately 100 cases of adenomatous neoplasms of the middle ear space have been collected in the United States Armed Forces Institute of Pathology, Washington D.C. This report describes two cases of primary adenomatous neoplasms confined to the middle ear cleft seen at the Department of Otorhinolaryngology at Ludwig Maximilians University Hospital, Munich. Although tumors are derived from lining epithelium of the middle ear mucosa, the unique feature of our first case was based on its origin in the epitympanic part of the tympanic membrane. Histopathology was characterized by an adenomatous morphology without atypia or mitoses, proving its benign behavior. No evidence was found for invasion of adjacent tissue. Simple surgical removal afforded excellent prognosis. Clinical behavior, histological appearance, origin of tumors and differential diagnosis are discussed.

Adeno-carcinoid or amphicrine tumors of the middle ear a new entity?

The clinicopathological, ultrastructural and immunohistochemical characteristics of four primary tumors of the middle ear are reported. These neoplasms showed a striking, heterogeneous aspect ranging from solid-trabecular (Type I) to tubulo-glandular (Type II) growth patterns. Secretory activity of the tumor cells was evaluated by immunohistochemistry and electron microscopy. Based on these procedures, three cell types were found, mainly limited to tumors with a tubulo-glandular (Type II) growth pattern. Most frequent were B-cells with an abundant pale cytoplasm containing neuroendocrine granules, both cytokeratin and vimentin as well as several endocrine marker substances. Less frequent were A-cells, which are slender, darkly staining and line the glandular lumina. They showed exocrine activity only and stained strongly with a polyclonal cytokeratin antibody. Finally, least frequent were amphicrine cells, which were characterized by both lumina and neuroendocrine granules in their cytoplasm and were interpreted as the link between A and B cells. Although this morphological description closely resembles that of carcinoids and adenocarcinoids of the respiratory tract and gut, the clinical behaviour of these middle ear tumors nevertheless seems different, with no recurrence or metastasis after a follow-up of 1 to 14 years (median 78 months). Therefore, some authors suggest that these tumors should be classified as middle ear adenomas or adenomatous tumors. However, we strongly feel that these tumours represent a distinct entity and can be classified as adenocarcinoids or amphicrine tumors, i.e. demonstrating both exocrine and endocrine activities. Further work is required to evaluate the exact proportion of neuroendocrine and amphicrine tumors in the heterogeneous group of adenomas and in the rarely described group of adenocarcinomas.

Adenomas of the temporal bone

Three cases of primary adenomas of the petrous bone are presented and compared to an adenoma arising from the external ear canal. In contrast to other adenomatous tumors, these caused slowly progressive inner ear symptoms without other signs, hence making differentiation from other benign lesions difficult. In one case, association with von Hippel-Lindau disease is suspected because of a strong family history and recent discovery of a similar lesion in the opposite ear. Bone destruction was found radiographically and clinically with vascular tumor tissue and cysts permeating the bone, causing adjacent bone destruction and remodeling. The histopathologic examination demonstrated this to be a benign process, however, with no direct tumor invasion or other signs of malignancy. Subtotal petrosectomy is a proven approach for complete removal of these tumors. Review of the literature revealed no previous reports of benign adenomas originating in the petrous bone.

Primary adenocarcinoma of the temporal bone mimicking paragangliomas: radiographic and clinical recognition

Three cases of primary adenocarcinoma of the temporal bone which simulated a glomus jugulare tumor (on the basis of a thorough preoperative evaluation) are detailed. In each case, a vascular mass was seen beneath an intact tympanic membrane and angiography revealed the presence of a highly vascular mass centered on the jugular bulb. Computed tomography revealed erosive changes within the jugular fossa that were characteristic of a glomus jugulare tumor; in two cases, a significant posterior fossa extension was documented. The intraoperative findings failed to suggest a lesion different from paraganglioma in two of the cases; in the remaining case, the erosion of both bone and dura was diffuse and more suggestive of a malignant neoplasm. A discussion of the clinical behavior of adenocarcinomas of the middle ear is included in order to emphasize the importance of differentiating these lesions preoperatively from the more commonly encountered paragangliomas.

Primary adenomatous neoplasm of the middle ear

Adenomatous lesions of the temporal bone are seldom encountered in clinical practice. Four cases of primary adenocarcinoma of the middle ear are reported. All four patients presented with a mass behind an intact tympanic membrane. Two of the four patients had received radiation to the head and neck area 10 or more years prior to their developing adenocarcinoma of the middle ear space. Although this tumor is locally invasive, it does not appear to be highly aggressive and can be treated by local excision, i.e., mastoidectomy with tympanoplasty.