Tumors Of External Auditory Canal Research Articles

Clinical characteristics of intradermal nevus in the external auditory canal.

Melanocytic nevus occurring in the external auditory canal (EAC) is uncommon. Therefore, in the absence of sufficient clinical experience, this disease may be challenging to be suspected even with a physical examination. Herein, clinical and demographic features of intradermal nevus in the EAC were investigated. Patients with an intradermal nevus on histopathological examination (n = 15; 2 men and 13 women; P = .005) were included from a pool of patients who underwent surgical resection for EAC tumors between November 2011 and March 2022. Data were retrospectively collected on their sex, appearance of the lesions, surgical method, and outcomes. Nine patients had a dome shape and 6 patients had a papillomatous shape. Ten patients had dark colors and 5 patients had pale colors. All pale colors appeared only in the dome-shaped nevus, and only dark colored papillomatous nevi were observed. A significant difference was noted in terms of the frequency of occurrence by colors (dark or pale) according to shape (dome or papillomatous) (P = .044). No patient showed recurrence or EAC stenosis after circumferential excision. In women, a dome-shaped or papillomatous mass with dark color in the EAC may likely be predicted as the nevus. However, it can also occur in men, and even if it is a pale color, in the case of a dome shape, taking the nevus into account is important. Moreover, successful treatment outcomes were achieved through circumferential excision.

Clinical Analysis of 85 Cases of External Auditory Canal Cholesteatoma Surgery under Specialized Endoscopy.

Objective To investigate the clinical characteristics, surgical experience, and surgical outcomes of external auditory canal cholesteatoma (EACC) surgery under endoscopic otolaryngoscopy. Methods A retrospective analysis of 85 EACC cases admitted to the Department of Otolaryngology, Renji Hospital, Shanghai Jiaotong University School of Medicine, from January 2016 to February 2021 was performed, followed by retrospective analysis of clinical data to explore the feasibility and clinical characteristics of all-oral endoscopic EACC surgery. A total of 85 EACC patients (90 ears) with a mean age of 49.93 ± 14.87 years were included in the study. According to Udayabhanu staging, 43 ears (47.78%) were stage I, 40 ears (44.44%) were stage II, and 7 ears (7.78%) were stage III. All patients underwent transendoscopic surgery. Results 79 ears (87.78%) underwent endoscopic EACC resection alone (+external auditory canal tumor resection/tympanostomy tube insertion), 9 ears (10%) underwent endoscopic EACC resection+tympanostomy+tympanoplasty, 1 ear (1.11%) underwent endoscopic EACC resection+tympanoplasty, and 2 ears (2.22%) underwent EACC resection+otolaryngotomy+tympanoplasty+auditory chain reconstruction endoscopically. Of these, 7 ears (7.78%) underwent auricular cartilage-chondroplasty and 2 ears (2.22%) underwent auricular cartilage membrane repair. All patients were reviewed at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year postoperatively. One patient with stage II external auditory atresia had a recurrence after 6 months and underwent endoscopic ear surgery (ESS) again. One patient with stage 2 atresia recurred after 1 year and again underwent endoscopic ear surgery. The rest of the patients recovered well after the surgery, and the grafts healed well. Conclusion EACC surgery through the external ear canal under a dedicated endoscope is a safe, reliable, and effective method. Patients with stage I and II external auditory canal cholesteatoma surgery under endoscopy have a rapid postoperative recovery with significant hearing improvement, and stage IIIA patients can also achieve good results under strict evaluation of indications.

외이도 연골부 및 골부의 변형을 동반한 이구선종 1예

Ceruminous adenoma is a well-circumscribed tumor that originates from apocrine glands located in the external auditory canal (EAC). It is a rare disease that accounts for 5.7% of all EAC and auricular tumors. It usually presents as slow-growing tumor accompanying several ear symptoms; mass, fullness, hearing loss, pruritus and otorrhea. If the detection of the tumor is delayed, the tumor can obstruct the EAC completely and its further growth may lead to deformation of surrounding structures such as the cartilaginous or bony portion of EAC. The wide local excision is the treatment of choice for benign ceruminous gland tumors and thorough histopathologic review is essential in that there is possibility of recurrence and malignant transformation. Herein, we present a case of ceruminous adenoma with cartilage and bony deformation in the EAC with a literature review.

Surgical management of brain metastasis as a part of systematic metastases from adenoid cystic carcinoma of the external auditory canal: illustrative case.

BACKGROUNDAdenoid cystic carcinoma (ACC) of the external auditory canal (EAC) is a rare tumor that accounts for approximately 5% of all EAC tumors. ACC is generally known as a slow-growing tumor, but patients often experience recurrence or distant metastasis in the long clinical course. While the major pattern of recurrence is pulmonary metastasis, brain metastasis of ACC of the EAC is rare.OBSERVATIONSThe authors describe the case of a 72-year-old male who was diagnosed with ACC of the EAC. Approximately 7 years later, brain magnetic resonance imaging revealed an intra-axial homogenously enhancing mass lesion that had no direct connection with the skull base in the left frontal lobe. The patient underwent tumor resection and histopathological examination revealed a mixture of cribriform and tubular patterns. The image and pathological characteristics of the tumor were similar to those of primary ACC or ACC from other sites of origin.LESSONSWhile patients with ACC of the EAC often experience recurrence or distant metastasis in the long clinical course, they survive for a relatively long period of time, even though an optimal treatment has not been established. The authors therefore recommend surgical resection for brain metastasis of ACC of the EAC to improve neurological symptoms.

Ear canal and middle-ear tumors: a single-institution series of 87 patients

Background Ear canal and middle ear tumors are rare and exhibit variability in histology and clinical manifestation. Surgical resection remains the treatment of choice, but individualized approach is needed to preserve function when possible. Aims/objectives To review the management and outcome of ear canal and middle ear tumors at an academic referral center. Materials and methods Helsinki University Hospital (HUS) patient files were searched for clinically and histologically confirmed ear canal and middle ear tumors over a 14-year period. The minimum follow-up time was 2 years. Results Eighty-seven patients with 88 tumors were identified. There were 20 (23%) benign external auditory canal (EAC), 36 (41%) benign middle ear space (MES), 29 (33%) malignant EAC, and 3 (3%) malignant MES tumors. Most (92%) tumors were managed with primary resection. Thirty-five percent of the operatively managed patients had a residual or a recurrent tumor. Conclusions and significance EAC and MES tumors show great diagnostic and histologic heterogeneity with need for individualized investigative and treatment approaches. In benign tumors, we advocate aggressive local surgical control without sacrificing vital structures. In malignant tumors, we recommend local surgical control with or without adjunct RT.

A Case of Merkel Cell Carcinoma of the External Auditory Canal Skin with Annulus and Tympanic Membrane

Merkel cell carcinoma is an extremely rare neuroendocrine neoplasm of the external auditory canal (EAC) skin, which requires wide excision and adjuvant radiation due to a high recurrence rate. In this report, we describe a case of Merkel cell carcinoma arising from the EAC which was successfully treated with endoscopic excision. A 32-years-old female patient with a history of papillary thyroid cancer was diagnosed with an EAC tumor incidentally. There was a erythematous papular lesion on the posterior EAC without any evidence of locoregional metastasis. The patient underwent endoscopic tumor resection under general anesthesia, and the final pathologic report confirmed the diagnosis of Merkel cell carcinoma. There was no clinical or radiographic evidence of recurrence or metastasis of Merkel cell tumor for 41 months after surgical resection alone.

Syringocystadenocarcinoma Papilliferum of External Auditory Canal: First Case Report in English Literature.

Malignant tumors of external auditory canal (EAC) constitute less than 0.2% of all head and neck cancers. The incidence of carcinoma of the EAC is estimated to be between one in six per million populations. Majority of cancers of EAC are squamous cell carcinomas and basal cell carcinomas. Some rare and unusual tumors do occur within the ear canal including malignant melanoma, merkel cell carcinoma, angiosarcoma, lymphoma and adnexal carcinomas like ceruminous adenocaricinoma and adenoid cystic carcinoma. Ceruminous glands tumors constitute about 5% of all external auditory canal tumors. Carcinoma of the external auditory canal is a difficult diagnosis unless the tumors presents as a fungating mass protruding from the external auditory canal. Syringocystadenocarcinoma Papilliferum (SCACP) is an extremely rare cutaneous adnexal neoplasm. Syringocystadenoma papilliferum (SCAP) is thought to be precursor of SCACP. About 50 cases of SCACP have been reported in literature all over the body. The diagnosis is difficult and excisional biopsy becomes mandatory for diagnosis and treatment. We present a case of SCACP in the external auditory canal in a middle-aged female. To the best of our knowledge and belief, this is the first case of SCACP in the external auditory canal in the English literature. This prompted us to report this case.

Basal Cell Carcinoma of the External Auditory Canal – Unusual Site: A Case Report

Malignant tumor originated from external auditory canal (EAC) is very rare with an annual incidence of around 1 per million. Yet, basal cell carcinomas are less frequent than squamous cell carcinomas. Nevertheless, it is difficult to determine if their prognosis is better, as in other areas of the body. Due to the rarity of malignant tumor of EAC, there is no widely accepted treatment modality yet. But basal cell carcinoma, is known to be less aggressive tumor than squamous cell carcinoma and can be removed with a minimal safety margin and has a better treatment result. In this case report, we experienced a case of basal cell carcinoma (BCC) in the EAC, confined in the cartilaginous portion of EAC, presented with intermittent otorrhea and pruritis in the right ear. The patient was treated with local excision of the lesion with a safety margin and direct closure. No recurrence or complications were noted in the first postoperative year.

Ceruminous Neoplasms of the Ear.

Ceruminous glands are modified apocrine glands located in the external auditory canal (EAC). Neoplastic lesions arising from these glands are rare in humans and constitute a major differential diagnosis for glandular neoplasms of the EAC. Due to anatomic restrictions, benign and malignant neoplasms present with similar symptoms and to some extent even comparable radiologic features, particularly when the tumors are localized. Biopsies are frequently limited by small size, fragmentation and improper anatomic and architectural orientation, thereby hampering our ability to appreciate the relationship of peripheral edges of the tumor to the surrounding tissue. Benign and malignant tumors may also have overlapping histomorphologic features, which further magnifies the challenges in accurate diagnosis and management strategies. This article summarizes the salient clinical, radiologic and histologic features of common ceruminous gland tumors, in addition to discussing features that can aid in differentiating ceruminous tumors from other EAC tumors and to distinguish benign from malignant entities.

A rare tumor of external auditory canal originated from ceruminous glands: A case raport

The external auditory canal neoplasms comprise less than 1 percent of all head and neck tumors. 2,4 percent of them originate from ceruminous glands. In the past all these tumours were called ceruminomas. In 1972 Wetli et al. classiffed these neoplasms into four groups: ceruminous adenomas, ceruminous carcinoma, adenoid cystic carcinomas and pleomorphic adenomas. Ceruminous adenocarcinoma is very rare. It has no specific symptoms, so an appropriate, quick diagnosis is difficult. It is very agressive. The treatment should be based on tumor resection and radiotherapy afterwards. We presented a case of 56 years old female with a mass in external ear canal, who underwent diagnostic surgical excision of external auditor canal tumour. The postoperative histopathological diagnosis was ceruminous adenocarcinoma (complete excision) and the patient received radiation therapy. Control CT and MR - performed one year after the surgery - showed possible local recurrence of pathology. The patient undergo maximal surgical resection with subtotal petrosectomy but in the postoperative histological examination there was no malignant cells. Treatment of neoplasms of external auditory canal should be based on radical surgical resection. Imaging diagnostic is very important in follow up but it can have limited value in term of its specifity.

A Case of Squamous Cell Carcinoma Occurred in the External Auditory Canal Misdiagnosed as a Keratoacanthoma after Radiotherapy for Kimura’s Disease

Malignancy of the external auditory canal (EAC) is a rare tumor. Among the malignancies of EAC, squamous cell carcinoma (SCC) is the most common pathologic type. The causes of SCC of EAC may be exposure to ultraviolet rays, cholesteatoma, chronic otitis externa, and rarely radiotherapy. SCC of EAC has the diverse and non-specific clinical features including mass of tissue, otorrhea, otalgia, tinnitus, and facial palsy which make it difficult to distinguish between SCC and benign tumor. Recently, we experienced a case of SCC of EAC occurred in the left external auditory canal after radiotherapy for Kimura’s disease, which was misdiagnosed as keratoacanthoma at first. The findings of this case suggest that when it is difficult to distinguish SCC from benign tumor of EAC, the excisional biopsy including enough resected margin and base of tumor is needed for an exact diagnosis. Key words: Keratoacanthoma ㆍ Radiotherapy ㆍ Squamous cell carcinoma

Intraoperative radiation therapy as adjuvant treatment in locally advanced stage tumours involving the middle ear: a hypothesis-generating retrospective study.

SUMMARYThe objective of this study was to evaluate the safety, effectiveness and functional outcomes of intraoperative radiotherapy (IORT) followed by intensity-modulated radiation therapy (IMRT) in locally advanced stage tumours involving the middle ear. Data on 13 consecutive patients treated for malignant tumor of external auditory canal involving the middle ear were retrospectively reviewed. Median follow-up was 33 months (range 6-133). Five (38%) patients were stage III and 8 (62%) were Stage IV according to the University of Pittsburgh staging system. Lateral temporal bone resection (LTBR) was performed in all cases. LTBR was associated with parotidectomy in 5 (38%) cases, and with neck dissection and parotidectomy in 6 (46%) cases. No patients had gross residual tumour. Surgical treatment was followed by IORT (12 Gy) and IMRT (50 Gy). Adjuvant chemotherapy was used in 4 (30%) cases. Preoperative and postoperative audiometric tests were performed to assess hearing loss. 5-year local-control (LC), 5-year distant-metastasis (DM), 5-year disease-free-survival (DFS) and 5-year overall-survival (OS) were calculated with Kaplan-Meyer method. Significant changes in bone conduction were reported after treatment. Partial flap necrosis was the only early complication observed in three (23%) cases, while meningeal fistula was seen in one (7.6%) case as a late complication. The 5-year LC-rate was 68%. The 5-year DM-rate was 90%. The 5-year DFS-rate was 61%. The 5-year OS-rate was 69%. IORT followed by IMRT for the treatment of advanced external auditory canal and middle ear tumours seems to be safe. No intraoperative death was reported. IORT may reduce the postoperative irradiation of remnant tissue obtaining the same full dose on the tumour bed. No complications of the residual external ear were observed. Detriment of neurosensory hearing may be expected. Future studies are required to confirm the benefit of this procedure in the ear.

Prostatic carcinoma whose initial manifestation was a tumor of external auditory canal

BackgroundMetastatic carcinoma manifesting as a mass in external auditory canal (EAC) is very rare, and prostatic adenocarcinoma (PA) presenting firstly as a mass of EAC has not been reported. AimTo report a case of PA manifesting as only a mass of EAC. Case reportA 77-year-old man presented a right EAC mass. Otoscope identified a small mass approximately 7mm in right EAC neat to the external orifice. Biopsy showed well differentiated adenocarcinoma with cribriform appearances. The author highly suspected metastatic prostatic PA (Gleason 4+4=8) and performed an immunohistochemical (IHC) study. The IHC showed positive prostate-specific antigen, prostatic acid phosphatase, alpha-methylacyl-CoA racemase, cytokeratin (CK) 7, and CK20. The tumor was negative for TTF-1, CDK2, and NCAM. The definite diagnosis of PA metastatic to EAC was made. The patient was referred to Urology and prostatic needle biopsy showed PA with immune-expressions of PSA, PAP, and AMACR. Serum PSA was high (63ng/L). Imaging techniques showed a few metastases in bones of vertebula and ribs. The skull appeared free of metastasis, and head and neck soft tissue showed no metastatic areas except for the shadow of EAC. The patient is now treated with hormone and chemotherapy. ConclusionThe first case of an EAC mass that is a metastatic lesion of prostatic adenocarcinoma, was reported.

Facial nerve schwannomas presenting as occluding external auditory canal masses: a therapeutic dilemma.

To present a series of patients with facial nerve schwannomas (FNSs) presenting as occluding external auditory canal (EAC) masses. Retrospective case series. Four patients were identified with mastoid segment FNSs occluding the EAC. Three patients presented with conductive hearing loss (CHL), and the fourth presented with facial paralysis, later developing CHL. One patient underwent conservative debulking, removing the EAC component only. Two patients were managed nonoperatively with periodic cleaning of entrapped keratin. The fourth patient received radiation therapy. Facial nerve function, canal cholesteatoma formation, and hearing. Among the patients managed with serial cleaning of entrapped keratin, one maintained normal facial function and one worsened to House-Brackmann II/VI. Facial function worsened to House-Brackmann II/VI in the patient who underwent surgical debulking. The fourth patient, who received radiation, developed complete facial paralysis. All patients accumulated keratin medial to the tumor, and all had CHL. When evaluating an EAC tumor, it is important to obtain imaging before biopsy because biopsy of a schwannoma can result in paralysis. EAC occlusion by a schwannoma presents a challenging management issue, particularly when cholesteatoma forms between the tumor and the tympanic membrane. The primary goal is maintaining normal facial function as long as possible and avoiding secondary ear canal complications. The presence of canal occlusion limits the choice of stereotactic radiation because this leads to a month-long period of tumor swelling and cutaneous sloughing. Resection and grafting are indicated when substantial facial weakness or twitch develops.

Intra-temporal facial nerve abscess due to basal cell carcinoma of external auditory canal: A unique presentation

Infranuclear facial palsy following facial nerve abscess in intra-temporal course has not been described in literature as per our knowledge. After extensive search of literature, only one case of facial nerve sheath abscess was found in a case of leprosy, but the abscess was in the intra-parotid course of the nerve. Basal cell carcinoma (BCC) is a rare malignant tumor of external auditory canal (EAC). Facial nerve palsy in BCC occurs only in advance stages when the tumor erodes the floor of EAC to involve the nerve. Contrast enhanced computed tomography of the temporal bone is useful in diagnosing the entity pre-operatively and in planning the management in such cases. This case is being reported as facial nerve sheath abscess in intra-temporal course due to malignancy of the EAC has not been reported as yet.

Surgical Approach for Treatment of Carcinoma of the Anterior Wall of the External Auditory Canal

Treatment outcomes for carcinomas of the external auditory canal (EAC) were evaluated regarding radiologic and pathologic factors. Retrospective case review. University hospital. Fifteen patients histologically diagnosed with carcinomas of the EAC. A radiologic and pathologic analysis was performed on these patients histologically diagnosed with carcinomas of the EAC and treated surgically at our institution. We evaluated the size of focal defects in the anteroinferior (AI) canal wall of the tympanic bone with preoperative computed tomographic (CT) scans. Histopathologic slides for the same patients were evaluated according to the same criteria as the CT scans. Pathologic features and estimated survival rate. Preoperative CT scans of 15 temporal bones demonstrated an AI canal wall defect ranging from less than 1 mm to full-thickness destruction. Six of 15 patients had an AI canal wall defect greater than 2 mm on preoperative CT scan. Pathologic findings in these 6 cases showed extension of the tumor through the AI defect into the anterior soft tissues. Information on patients' survival status was obtained after a median follow-up period of 78.3 months (range, 18-151 mo). Preoperative CT can be used to accurately determine the pathologic extent of tumor invasion in carcinomas of the EAC. This diagnostic method facilitates exchange of accurate clinical data in a comparable form and can be used to evaluate the efficacy of existing and proposed treatments for EAC tumors.

A Case of Basal Cell Carcinoma of External Auditory Canal

Malignant tumor originated from external auditory canal (EAC) is very rare with an annual incidence of around 1 per million. Pathologically, squamous cell carcinoma is incidentally most common, and adenoid cystic carcinoma, basal cell carcinoma, and melanoma follow in decreasing order. Due to the rarity of malignant tumor of EAC, there is no widely accepted treatment modality yet. But basal cell carcinoma, known to be less aggressive tumor, can be removed with a minimal safety margin and have better treatment results. Recently we experienced a case of basal cell carcinoma in the EAC, confined in the cartilaginous portion of EAC, presenting with intermittent otorrhea for several years. The patient was treated with a sleeve resection of the EAC with a safety margin reconstructed with a split-thickness skin graft. No tumor recurrence or complication was noted in the first postoperative year.

Raki ucha w materiale Kliniki Otolaryngologii Warszawskiego Uniwersytetu Medycznego w latach 2004–2008

Ear carcinoma constitutes 0.5% of all cancers of the head and neck hardly, however with poor prognosis. In the study we use University of Pittsburgh Staging System. This study is retrospective analysis of the surgical treatment outcomes of the patients with external and middle ear carcinomas in the ENT Department at the Medical University of Warsaw in years from 2004 to 2008. Histopatologicallly, there were:18 squamous cell carcinoma, 17 basal cell carcinoma, 2 neuroendocrine carcinoma, basal cell adenocarcinoma and 1 metatypical carcinoma. Tumors were localised: ear concha in 19 patients, external auditory canal in 6 patients, middle ear in 3 patients, temporal bone and skull base in 9 patients. Among 19 tumors of the auricle, basal cell carcinoma occured the most often (12 patients - 63%), following squamous cell carcinoma (6 patients - 31%), in one case (6%) metatypical carcinoma was confirmed. There were 18 tumors of external auditory canal and tumors with temporal bone involvement in stage T1-T4. In this group 8 subtotal temporal bone resection were performed, however in 5 cases tumor was not totally excised. Additional radiotherapy was performed in 5 patients, 5 died of the disease, three had recurrence in the period of the study and 8 had confirmed metastasis into the breast, lung, cervical and mediastinal lymph nodes. Generally, in this group of patients, 6 died (33%) of the disease in the period from one month to 2 years after surgery. In 6 tumors with no evidence of bone involvement resection limited to the tumor was performed. In 2 tumors of external auditory canal the resection was totally and the patients have no recurrence (100%). Squamous cell carcinoma has poor prognosis, but early diagnosis gives the chance for long-term survival.

A case of middle-ear angiosarcoma

Middle-ear angiosarcoma is a rare malignant tumor that requires early diagnosis to allow satisfactory removal. The objective of the present study was to describe and discuss the diagnosis and treatment of this rare malignant middle-ear tumor. A 12-year-old girl was admitted for a left retroauricular mass and a budding left external auditory canal tumor without associated peripheral facial nerve palsy. CT scan showed a mastoid-region tumor extending to the external auditory canal with mastoid and occipital bone-loss. Tumor removal used a retroauricular approach. Postoperative diagnosis was of angiosarcoma. At 12 months' regular follow-up, there were no signs of local recurrence. Middle-ear angiosarcoma is a rare tumor, in which diagnosis is late because early symptoms are not specific. A multidisciplinary approach is essential for efficient management.

外耳道腺様嚢胞癌例

External auditory canal (EAC) carcinoma is a comparatively rare disease. We herein report a case of adenoid cystic carcinoma of the EAC. In March 2004, a 67-year-old woman was referred to our department because of swelling and pain in her left ear. We suspected an EAC tumor, and a biopsy of the lesion was performed. The presence of an adenoid cystic carcinoma was confirmed, and the patient underwent an excision of the EAC and postoperative irradiation. No evidence of recurrence was seen at a Five-year follow-up examination. Adenoid cystic carcinoma of the EAC is a rare disease. Most patients only complain of ear pain. This symptom is similar to that of otitis externa. The lack of specific clinical signs makes a diagnosis of adenoid cystic carcinoma of the EAC difficult. Early recognition by biopsy is essential because the management and prognosis of this disease are determined by the extent of the tumor. We suggest that if an EAC tumor is suspected, a biopsy should be immediately performed for the early diagnosis and treatment of this condition.