Tumors Of Ear Research Articles

Three-dimensional MP-RAGE--an alternative to conventional three-dimensional FLASH sequences for the diagnosis of viscerocranial tumours?

Imaging with three-dimensional (3D) sequences is a frequently used magnetic resonance (MR) technique in the assessment of ear, nose and throat (ENT) tumours near the skull base. Few reports on the contrast behaviour of 3D magnetization prepared rapid gradient echo (MP-RAGE) sequences and their application in ENT tumours exist in the published literature. This paper discusses whether 3D MP-RAGE is an alternative to conventional 3D gradient echo (3D GE) sequences for the diagnostic evaluation of the visceral cranum. Measurements were performed with a Magnetom SP 63 MR system (Siemens) at 1.5 T. 10 healthy volunteers were examined using 3D FLASH sequences with varied flip angles (90 degrees, 70 degrees, 40 degrees, 20 degrees, 10 degrees) and using 3D MP-RAGE to optimize the signal-to-noise ratio (SNR) of muscle, fat and gland tissue. After this optimization 25 patients with ENT tumours near the skull base were examined with 3D FLASH 40 degrees, 3D MP-RAGE 10 degrees (both before and after application of contrast medium) and with 3D FISP 70 degrees (without contrast medium). SNR and contrast-to-noise ratio (CNR) of tumour, inflammatory disease, brain (white and grey matter), compact bone, fat and muscle were calculated. The advantages of 3D MP-RAGE over 3D FLASH 40 degrees include decreased imaging time with decreased motion artifacts and a relatively high contrast between tumour and surrounding tissues. The tissue contrast yielded by the T1/T2* weighted 3D gradient echo sequence FISP with a flip angle of 70 degrees was not as good as that yielded by 3D MP-RAGE with and without contrast together. In conclusion a combination of contrast enhanced and unenhanced 3D MP-RAGE sequences is the technique of choice for the examination of ENT tumours near the base of the skull.

Venules and arterioles in xenotransplanted human colon adenocarcinoma critically constrict with hyperthermia and serotonin.

Local and regional hyperthermia for treatment of cancer is often combined with radio- and chemotherapy. In this study we tested whether topically applied serotonin (5-HT) modulates tumor blood flow during local hyperthermia. The surgically unprepared ear microcirculation of anesthetized (75 mg/kg pentobarbital sodium) female nude athymic (nu/nu) mice (18-25 g) was used. Between 5 and 10 days after passaged pieces of human colon adenocarcinoma cells (1 microliter) had been implanted under the dorsal epidermis of the ear, that ear (tumor diameter 1.5 mm) was fixed on a temperature-regulated stage for measurement (via closed-circuit videomicroscopy) of the diameters of large and small (A1-3) arterioles and venules (V1-4), and capillaries, during local hyperthermia (28 degrees C-45 degrees C) and during local hyperthermia plus 1 mmol/l 5-HT. In the hyperthermia-alone group all skin vessels dilated, whereas all tumor vessels constricted with increasing temperatures. Hyperthermia combined with 5-HT caused dilation of skin arterioles, but skin venules constricted. In contrast, we observed constriction of all microvessels in human tumor xenografts with the combination of hyperthermia and 5-HT. We conclude that hyperthermia and 5-HT, applied intratumorally, could be clinically effective, since normal skin microcirculation is best protected with this treatment, while tumor blood flow is widely reduced.

Current issues of middle ear microsurgery

Ear microsurgery, which has more than 40 years of history, is associated with the name of S. Rosen (1952). To improve hearing in patients with otosclerosis, he proposed an operation to mobilize the stirrup, which led to the rapid development of stapedoplasty. Currently, microsurgical techniques are widely used for atresia, trauma and benign tumors of the external auditory canal, for congenital anomalies, trauma and benign tumors of the middle ear, in addition to otosclerosis and inflammatory pathology, for traumatic fistulas of the labyrinth windows, Meniere's disease, peripheral paralysis of the facial nerve, noise, otogenic liquorrhea, with cochlear implantation, etc.

Aggressive Papillary Middle Ear Tumors

ADENOMATOUS TUMORS OF the middle ear are rare, with only approximately 100 cases reported. A distinct subclass of this tumor demonstrates microscopic papillary architecture and has a propensity to erode the petrous bone and extend intracranially. The term “aggressive papillary middle ear tumor” has recently been proposed to describe this more invasive type of middle ear tumor. Thirty-seven cases of aggressive papillary middle ear tumors have been reported. We present two additional cases and discuss the clinical, radiologic, histologic, and operative features of this locally aggressive neoplasm. The tumor affects adults of both sexes. The clinical prodrome is prolonged. Presenting signs and symptoms most often relate to the involvement of cranial nerves V-VIII. Imaging studies reveal large, enhancing, destructive tumors with a generous vascular supply. Intraoperatively, the tumors are bloody, fibrous, and adherent to surrounding structures. Various surgical approaches in combination or in series may be used. Preoperative embolization may be helpful. The role of adjunctive radiation is unclear. Aggressive papillary middle ear tumors are histologically benign tumors with clinically destructive behavior. However, it appears that aggressive surgical management affords prolonged survival with minimal worsening of cranial nerve deficits.

Aggressive Papillary Middle Ear Tumors

Aggressive Papillary Middle Ear Tumors

Ear tumours induced by experimental carcinogenesis in the rat: excision prevents early death

1,2-dimethylhydrazine (DMH) is widely used to induce colorectal tumours in rodents. Some of the animals develop ear as well as colorectal tumours. Rats with large, ulcerated ear tumours are usually sacrificed before the completion of the experiment. In this experiment, fourty-six male Spraque-Dawley rats were injected with 1,2-dimethylhydrazine (21 mg/kg body weight) once a week for 27 weeks to study the histogenesis of colorectal carcinoma. Thirty-six developed ear tumours. Fourteen of the 36 tumours were larger than 2 cm in diameter. These developed between 20-26 weeks and were surgically excised 1-5 weeks later. Four rats died postoperatively. The surgical removal of large ear tumours permitted the completion of the large bowel experiment on schedule (i.e. 27 weeks) in 10 (28%) of the 36 rats with ear tumours.

Zur Differentialdiagnose bläulich-roter Tumoren hinter intaktem Trommelfell

Middle ear tumours may be seen frequently as bluish-red masses behind an intact tympanic membrane. In these cases all modern methods of visualisation such as CT or NMR are required for correct diagnosis and for planing adequate treatment. Most frequent are glomus tumours, either of the glomus tympanicum or the glomus jugulare. However, differential diagnosis must be considered, e.g. a tumour in the lower parts of the tympanon. In very rare cases the internal carotid artery takes an abnormal course, running free through the middle ear and touching the tympanic membrane. More often, granulomas or other inflammatory processes may be seen through a transparent ear drum. Haemangiomas or--of course--malignant tumours must be kept in mind. The role of modern radiographic methods is described in this paper, including some of the differential diagnoses mentioned above, with special reference to a case of carotid artery anomaly.

Atlas of head and neck pathology : Wenig BM. Philadelphia, PA. Saunders, 1993, 412 pages, color illustrated

Part 1 Nasal cavity and paranasal sinuses: anatomy and histology classification of lesions of the nasal cavity and paranasal sinuses non-neoplastic lesions of the nasal cavity and paranasal sinuses neoplasms of the nasal cavity and paranasal sinuses tumour, nodes, and metastases (TNM) classification. Part 2 Oral cavity, nasopharynx and neck anatomy and histology of the oral cavity, nasopharynx and neck classification of non-neoplastic lesions of the oral cavity, nasopharynx, tonsils, neck and lymph nodes non-neoplastic lesions of the oral cavity, nasopharynx, tonsils and neck neoplasms of the oral cavity, nasopharynx, tonsils and neck TNM classification. Part 3 Larynx and hypopharynx: anatomy and histology classification of non-neoplastic lesions and neoplasms of the larynx and hypopharynx non-neoplastic lesions of the larynx neoplasms of the larynx and hypopharynx TNM classifications of laryngeal and hypopharyngeal neoplasms. Part 4 Major and minor salivary glands: anatomy and histology of the major and minor salivary glands classification of non-neoplastic salivary gland disorders and neoplasms of the salivary glands non-neoplastic diseases of salivary glands neoplasms of the salivary glands immunocytochemistry of salivary gland tumours TNM classification of salivary gland neoplasms. Part 5 External, middle and internal ear: anatomy and histology classification of non-neoplastic lesions and neoplasms of the ear non-neoplastic diseases of the ear neoplasms of the ear immunocytochemistry of middle ear neoplasms. Appendices: nasal cavity and paranasal sinuses - embryology and anatomy oral cavity, nasopharynx, and neck - embryology and anatomy larynx and hypopharynx - embryology and anatomy salivary glands - embryology and anatomy the ear - embryology and anatomy.

Malignant Tumours of the External Ear

CH Karsli, OM Antonyshyn, CR Forrest, D Assaad, I Ackerman. Malignant tumours of the external ear. Can J Plast Surg 1994;1(4): 177-183. This study employs a retrospective chart review to describe the demographic features, clinical presentation and treatment of malignant tumours of the external ear. This series includes 129 tumours of the external ear in as many consecutive patients presenting to the Toronto Bayview Regional Cancer Centre between January 1986 and December 1991. Sixty-seven per cent of those tumours were basal cell carcinomas, 32% were squamous cell carcinomas, and a single case of Kaposi's sarcoma was encountered. The majority of patients was male and the mean age was 70.1 years. The helical rim was the most common site of involvement, followed by the postauricular, conchal and antihelical regions. Small tumours were located in the visually obvious areas of the ear, namely the helix and lobule, whereas larger tumours were found in the deeper central portions such as the concha and external auditory meatus. Twelve per cent of squamous cell carcinomas were metastatic at the time of treatment. Treatment methods included electrodesiccation and curettage, surgical excision with or without frozen sections, radiotherapy or combination therapy. Surgical excision, with frozen section control in carefully selected cases, remains the treatment of choice for the majority of external ear tumours. Various methods of reconstruction of the resulting defects are described.

Paragangliomas

Eleven Chinese patients with paragangliomas were studied to evaluate the clinicopath ological features in detail. Their age ranged from 19 to 68 years with a mean of 41.7 years. Carotid body paragangliomas were the most common, followed by jugulotym panic paragangliomas. The patients with carotid body tumors were younger than the other patients in the group (eg, those with retroperitoneal paragangliomas). Retroperi toneum tumors were typically larger (the largest one was 8 cm in diameter), while tumors in the middle ears were smaller (0.5 to 1 cm in diameter). All the paraganglio mas were tested by a panel of panneuroendocrine markers (neuron-specific enolase, synaptophysin, and chromogranin), and they all stained strongly with synaptophysin. Thus, synaptophysin was shown to be a useful neuroendocrine marker for paraganglio mas. Int J Surg Pathol 1 (1):111-116, 1993

Lateral temporal bone resection for extensive pinnal malignancy. Has anything changed in forty years?

This paper offers an account of the contemporary surgical approach to advanced tumours of the external ear based on a series of 11 patients. There were eight squamous, two basal cell carcinomas and one mucoepidermoid tumour. The traditional method of excision was slightly modified by performing microsurgical dissection of the lateral part of the temporal bone rather than chisel osteotomies, and then including it en bloc with the involved soft tissues. The defect was then closed using a scalp or myocutaneous flap and this combination of otological and reconstructive expertise has proved satisfactory. Four patients are alive with no evidence of disease a mean of 4.2 (range 1.0-7.0) years from surgery: two patients who remained free of disease have subsequently died of unrelated conditions 12 and 24 months post-operatively, and in three cases death from recurrent disease occurred a mean of 1.4 (range 0.9-2.1) years after our surgery. There were two post-operative deaths. Based on the actuarial survival of 36 per cent and a successful disease clearance rate of 54 per cent, our conclusion is that the outlook of this condition has not dramatically improved since the original descriptions of the management of this problem first appeared, although intervention remains justifiable because of the potential curability and relief of symptoms.

Papillary neoplasms (Heffner's tumors) of the endolymphatic sac.

The sources of adenomatous neoplasms in the temporal bones are usually metastases or direct extensions from extratemporal lesions, or primary from the middle ear cleft. In 1989, Heffner added the endolymphatic sac's epithelium as another possible generative origin. In contrast to the adenomatous tumors of the middle ear or mastoid, the papillary cystic neoplasms of the endolymphatic sac are large and locally aggressive and often involve the middle and posterior cranial fossae and bone. These biologically low-grade adenocarcinomas have not been shown to be able to metastasize.

Clinical Significance of the Galvanic Body Sway Test in Cerebellopontine Angle Tumors

Since 1984, we have been modifying a new method of recording fine body sway elicited by low current stimuli of less than 0.4 mA, and of quantitatively evaluating the responses by Fourier transform. In order to easily and early detect acoustic tumors, we have applied a test battery consisting ABR, caloric test and galvanic body sway test (GBST) to 31 cases with acoustic neurinoma, to 5 cases with other CPA-tumors, and to 24 cases suspected of having CPA tumors. Of 27 cases with acoustic neurinoma on whom the GBST was performed, 25 cases (92.6%) shows abnormal responses. On the other hand, the ABR was abnormal in all cases, except for one case in the early stage of an ear tumor. However, the ABR was positive in 12 cases out of 24 with suspected findings without tumor, but the GBST was positive in only 3 cases out of 17 tested. Moreover, 26 cases (83.9%) with acoustic tumors showed abnormal CP in their first caloric tests. Comparing these observations with the results of image diagnosis, we conclude that the GBST is as useful for detecting small acoustic neurinomas as the ABR and the carloric test. Therefore, we have routinely used a test battery consisting ABR, caloric test and GBST for evaluation of acoustic neurinomas. However, we could not differentiate between acoustic neurinoma and CPA-tumor by using the three-test battery.

World Health Organization International Classification of Tumours: Histological Typing of Tumors of the Upper Respiratory Tract and Ear, Second Edition

World Health Organization International Classification of Tumours: Histological Typing of Tumors of the Upper Respiratory Tract and Ear, Second Edition

Appearance of ear tumors in Sprague-Dawley rats treated with 1,2-dimethylhydrazine when used as a model for colonic carcinogenesis.

One of the models of colon carcinogenesis in rats is produced by s.c. injections of 1,2-dimethylhydrazine (DMH). This specific colon carcinogen provokes other tumors in the rat, notably intestinal tumors. Ear tumors are just marginally mentioned in the literature. We have studied the appearance and histologic characteristics of ear tumors produced by 19 s.c. injections of 21 mg/kg of DMH in 18 Sprague-Dawley rats: 15 tumors appeared in 13 ears of 10 rats (55% of the animals). Simultaneously there were 23 colonic tumors: four (26.6%) of the tumors were carcinomas, 10 (66.6%) papillomas and one (6.6%) pseudoepitheliomatous hyperplasia. We conclude that ear tumors induced by DMH appear in 55% of the rats and that it is not possible to distinguish macroscopically in terms of size and aspect between benign and malignant lesions.

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.

Aggressive papillary middle ear tumour

A rare middle ear tumour is reported. The clinical presentation was similar to that of a glomus tumour but the pathology that of an aggressive papillary middle ear tumour. This is a recently recognized subgroup of middle ear glandular tumours. Clinical findings, imaging, pathology and treatment are presented.

Middle ear adenoma: tumour of mixed mucinous and neuroendocrine differentiation.

Two cases of progressive hearing loss due to middle ear tumours are described. The histological characteristics numbered intraluminal mucin production and neuroendocrine features, as shown by argyrophilia and ultrastructural demonstration of dense core granules. These tumours have been known by many different names, reflecting the controversies relating to their presumed histogenesis and differentiation. The currently preferred designation is middle ear adenoma, and these two cases provide further evidence for dual lines of differentiation.

Early Diagnosis of Acoustic Neuroma (1989) After Experience of 37 Cases

Although the diagnosis of acoustic neuroma as classically described is generally thought to be easy, this is not always true for this so-called "ear tumor" which is localized within the internal auditory meatus. Recently, remarkable progress has been made in the diagnostic instrumentation and operative techniques used to treat acoustic neuroma, emphasizing the need for early diagnosis so that treatment can take place earlier than before. Through early diagnosis, some cases of total resection of acoustic neuroma have recently become possible, with preservation of not only facial nerve function, but preservation of auditory function as well. In the present report, we outline the early diagnosis of acoustic neuroma by summarizing 37 cases of acoustic neuroma experienced at our institution. We discuss historical presentations, and laboratory tests used in diagnosis including pure tone audiometry, speech audiometry, auditory brainstem evoked response (ABR), vestibular caloric stimulation, and computed tomography (CT) enhanced by introduction of air into the posterior fossa. Two representative cases are also presented. It should be emphasized that no clinical test is 100% sensitive or specific, and attention must be paid to chronological discrepancies in the patient's presentation and "cookbook"-type approaches to evaluation should be avoided.

Lateral temporal bone resections

Eighteen consecutive patients underwent a lateral temporal bone resection for the treatment of tumors originating in the auricle, the external auditory canal, the periauricular skin, or the parotid and were retrospectively analyzed. The different lateral temporal bone resections performed have been categorized into four types. The type I resection consists of the removal of the tympanic bone and the external auditory canal lateral to the tympanic membrane. The type II resection consists of the removal of the entire tympanic bone, the tympanic membrane, the incus, and the malleus, preserving the facial nerve and the inner ear. Type III resections remove, in addition to the those structures removed in type II resections, the distal facial nerve and fallopian canal, the mastoid tip, the styloid process, and the stylomastoid foramen. The type IV resection consists of the removal of only the mastoid tip and the inferior portion of the tympanic bone. When the techniques of lateral temporal bone resection are used appropriately, adequate surgical treatment of patients with selected advanced and recurrent malignant tumors of the external ear, the periauricular skin, and the parotid is possible with low morbidity and a high probability of local regional control.