Imaging finding of malignant melanoma of Eustachian tube with extension to middle ear cavity: case report

Malignant Mucosal Melanoma of the Eustachian Tube With Extension Into the Ipsilateral External Ear Canal: A Case Report and Review of the Literature

Mucosal melanoma arising in the middle ear or eustachian tube is uncommon. We present a patient with hearing loss and otalgia found to have mucosal melanoma which occurred in the eustachian tube with extension into the middle ear cavity and external ear canal. Otologic clinics was consulted and biopsy of the mass located at the external canal was performed to ascertain the pathological diagnosis. The patient refused immunotherapy and surgery instead of undergoing radiotherapy and died from hepatic metastasis 8 months later. The mucosal melanoma originated from the eustachian tube with extension into the external ear canal is exceedingly rare, and the differential diagnosis should be considered for tumors in external ear canal.

Primary Middle Ear Mucosal Melanoma: Case Report and Comprehensive Literature Review of 21 Cases of Primary Middle Ear and Eustachian Tube Melanoma

OBJECTIVE

To present a case of primary middle ear mucosal melanoma and perform a comprehensive literature review of middle ear and eustachian tube mucosal melanoma.

PATIENT

A 61-year-old female presented with no prior history of melanoma and 3 months of aural fullness. A middle ear mass demonstrated primary mucosal melanoma. The mass extended from mesotympanum into hypotympanum, epitympanum, protympanum, eustachian tube, and mastoid antrum. Additionally, a nonenhancing expansile lesion of the petrous apex was noted on magnetic resonance imaging.

INTERVENTION

Subtotal temporal bone resection with transotic approach to the petrous abnormality was performed. Postoperative adjuvant radiation and immunotherapy were given.

RESULTS

Five months postoperatively, the patient developed an isolated cutaneous metastatic focus treated with wide local excision and has had no further evidence of recurrence to date. Upon comprehensive literature review, patients with primary middle ear melanomas (n = 10) present with otorrhea (50%), aural fullness (40%), and hearing loss (30%) most commonly, while hearing loss (81.8%) and aural fullness (54.5%) were the most common presenting symptoms for eustachian tube melanomas (n = 11). Patients were treated with combinations of surgery, radiation, and/or chemotherapy. Middle ear melanoma demonstrated particularly poor outcomes, with 70% mortality, 20% local recurrence, and 50% distant metastasis, whereas eustachian tube origin demonstrated 9.1%, 18.2%, and 36.4%, respectively.

CONCLUSIONS

Middle ear and eustachian tube mucosal melanomas are exceedingly rare, with middle ear melanomas demonstrating a worse prognosis. Multimodality therapy is commonly used; however, outcomes are poor, with high mortality among affected patients.

Primary malignant mucosal melanoma of the nasopharynx: an unusual cause of unilateral hearing loss

There are many causes of unilateral hearing loss, and making the correct differential diagnosis, especially in elderly patients, is difficult. A primary malignant mucosal melanoma of the nasopharynx is extremely rare and can cause a variety of symptoms. Hearing loss, as a presenting symptom of mucosal malignant melanoma of the nasopharynx, has not yet been defined in the literature. Herein, we report a case of primary mucosal malignant melanoma of the nasopharynx presented with unilateral hearing loss in a 70-year-old man.

Osseous hamartoma arising from the eustachian tube

A fairly quite rare case of osseous tumor arising from the Eustachian tube (ET) is described. A 56-year-old man presented with a smooth bulky mass in the nasopharynx and secretory otitis media in the right ear. Computed tomography and magnetic resonance imaging indicated a solid tumor-like region occupying the nasopharynx with apparent extension to the right ET. Transnasal endoscopic surgery demonstrated that the tumor had originated from the ET, and the tumor was partially removed in the area where it had expanded into the nasopharynx. The pathological diagnosis was an osseous hamartoma consisting of bony tissue, fat cells and fibroblasts. To our knowledge, this is the first reported case of osseous hamartoma arising from the ET in the world literature. The patient presented symptoms of nasal obstruction and unilateral aural fullness. Reduction surgery and tympanostomy tube insertion were useful for accurate diagnosis and resolution of the symptoms.