|
1: Rev Laryngol Otol Rhinol (Bord). 2006;127(3):145-9.
[Amphicrine adenoma of the middle ear: three cases reports and a review of the literature]
Aubry K, Sauvage JP, Puyraud S.
CHU de Limoges, Service d'ORL, France. aubry.k@caramail.com
Amphicrine adenoma is an extremely rare tumor of the middle ear. We report three cases obtained over a twenty year period. THE AIM OF THIS STUDY: is to discuss our clinical cases and review the literature. MATERIALS AND METHODS: Three cases of middle ear amphicrine tumour were reviewed. RESULTS: During a 10 year period (1986-2006) three cases of middle ear amphicrine tumour were treated at our unit (2 male, 1 female). The presenting complaint was hearing loss in all 3 cases. Amphicrine adenoma is diagnosed by an immuno-histological examination of pathological specimens. Differential diagnosis can be difficult and one individual was initially treated as an adenocarcinoma by radiotherapy. This patient succumbed to cerebral mycosis two years post-radiotherapy. The other two patients have no evidence of recurrence eight and nine years post treatment. CONCLUSION: Historically, differential diagnosis between amphicrine adenoma and adenocarcinoma of the middle ear has been very difficult. Carcinoid tumour is considered to be a more agressive form of amphicrine adenoma. Tumour progression is through loco regional invasion. Complete excision by surgical management with long term follow up is the treatment of choice.
2: Arch Pathol Lab Med. 2006 Jul;130(7):1067-9.
Middle ear adenoma.
Berns S, Pearl G.
Orlando Regional Healthcare System Department of Pathology/M. D. Anderson Cancer Center, Orlando, Florida 32806, USA. stephenmberns@hotmail.com
Middle ear adenoma is a benign tumor of the middle ear that can have exocrine (mucinous) and/or neuroendocrine differentiation. Early authors described a separate tumor with predominantly neuroendocrine differentiation as a middle ear carcinoid tumor, but these are now known to be the same tumor. We review the literature of this tumor, including the clinical presentation, gross pathology, histopathology, immunohistochemistry, differential diagnosis, and prognosis
3: Laryngoscope. 2005 Sep;115(9):1660-6
Carcinoid tumor of the middle ear: clinical features, recurrences, and metastases.
Ramsey MJ, Nadol JB Jr, Pilch BZ, McKenna MJ.
Division of Otolaryngology, Tripler Army Medical Center, Honolulu, HI, USA.
OBJECTIVE: Present four new cases of carcinoid tumor of the middle ear, two of which developed late recurrences and regional metastases. Review the literature to identify the clinical features, rate of recurrence, and incidence of metastasis of carcinoid tumor of the middle ear. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral hospital. PATIENTS: Eligibility criteria consist of a diagnosis of carcinoid tumor of middle ear. INTERVENTION: Surgical excision of primary and metastatic disease. MAIN OUTCOME MEASURE: Clinical characteristics, rate of recurrence, and incidence of metastasis of carcinoid tumor of the middle ear. RESULTS: Forty-six patients with carcinoid tumor of the middle ear are included in this report, 42 patients were identified from a review of the literature, and 4 new patients are presented. The most common presenting symptom was hearing loss. Surgical excision was the treatment with radical mastoidectomy being the most common procedure. Ten (22%) patients developed locally recurrent disease, and four (9%) developed regional metastases. CONCLUSIONS: Carcinoid tumor of the middle ear is an infrequent cause of a middle ear mass, with only 46 cases published. Despite previous assertions of benignancy, the findings of this study suggest that carcinoid tumor of the middle ear is indeed a potential low-grade malignancy with documented metastatic potential. Almost all middle ear adenomatous tumors ("adenoma" and "carcinoid") show evidence of neuroendocrine differentiation, and so at least some middle ear carcinoids ("adenomas") appear to represent well-differentiated neuroendocrine carcinomas. Presentation and symptoms are consistent with a middle ear mass and rarely include carcinoid syndrome. Surgical treatment is recommended and tailored to the extent of disease. Patients with carcinoid tumor of the middle ear require indefinite follow-up for possible recurrence or metastasis.
4: Am J Otolaryngol. 2005 Jan-Feb;26(1):57-9.
Carcinoid tumor of the middle ear: a case report.
Chan KC, Wu CM, Huang SF.
Department of Otolaryngology, Chang Gung Memorial Hospital, Taipei, Taiwan. bobwu506@seed.net.tw
Middle ear (ME) carcinoid tumor is exceedingly rare. We present a case of ME carcinoid tumor in a 29-year-old woman whose chief complaints were right otalgia, aural fullness, hearing loss, and facial palsy of 5 days duration. A reddish bulging mass behind the right eardrum and right facial palsy staged as grade IV on the House-Brackmann scale were noted. The high-resolution computed tomography of the temporal bone showed a soft-tissue density mass in the right middle ear and antrum without bony invasion. Although the initial diagnosis was ME adenoma made by the intraoperative frozen section report, the tumor was resected completely by a modified conservative ossicles-preservation method. The patient's initial symptoms of otalgia, aural fullness, and hearing loss immediately improved after surgery, and facial palsy diminished in the following months. No recurrence was noted after 12 months of follow-up.
5: Nippon Jibiinkoka Gakkai Kaiho. 2004 Aug;107(8):756-9.
[Case of recurring middle ear adenoma]
Shirai Y, Kakizaki K, Iino Y, Kodera K.
Department of Otolaryngology, Teikyo University School of Medicine, Tokyo.
We report a case of recurring middle ear adenoma with bone formation that was histologically difficult to differentiate from adenocarcinoma. The patient was a 31-year-old female. Preoperative clinical and CT findings in the 31-years-old woman examined suggested benign tumor of the middle ear. Although intraoperative pathological examination indicated adenocarcinoma, tympanoplasty in canal reconstruction was done. Malignancy was not considered because the tumor had not increased in size for 1 year and no bone erosion had occurred in the ossicles or middle ear cleft. The definitive pathological diagnosis was middle ear adenoma. The tumor repeatedly recurred thereafter, closely resembling normal middle ear mucosa and making it difficult to remove completely. When middle ear adenoma is suspected, surgical procedures should be determined carefully based on radiological and intraoperative findings in tumor expansion.
6: Acta Otolaryngol. 2003 Aug;123(6):678-82
Epithelial tumors of the middle ear--are middle ear carcinoids really distinct from middle ear adenomas?
Devaney KO, Ferlito A, Rinaldo A.
Department of Pathology, Foote Hospital, Jackson, Michigan, USA.
Primary tumors of the middle ear are much less commonly encountered in clinical practice than non-neoplastic lesions such as inflammatory polyps (aural polyps) or cholesteatomas. The rarity of such tumors can complicate attempts, by both clinicians and pathologists, to correctly classify them. It has been customary for many authors to segregate middle ear adenomas (MEAs) from middle ear carcinoids as two discrete benign neoplastic entities. It has become apparent, however, that MEAs and carcinoids of the middle ear share a sufficient number of overlapping pathologic features and similarities of clinical behavior to warrant their collapse into a single diagnostic category. It is proposed that these tumors should be designated as MEAs, which are defined as benign, indolent epithelial tumors of the middle ear that do not invade or erode bone and do not metastasize. The individual tumor cells are cytologically bland and polygonal, columnar or plasmacytoid-shaped; they may be arranged in islands, glandular formations or trabeculae, but not in papillary structures. They are typically keratin- and vimentin-positive immunohistochemically, and are often positive as well with antibodies for chromogranin A, synaptophysin, neuron-specific enolase, Leu-7, serotonin, pancreatic polypeptide and S-100 protein. Dense core neurosecretory granules may be identifiable by electron microscopy. Conservative surgical excision is the treatment of choice, and local recurrence following complete excision is quite uncommon. |
|
