"Neuroendocrine adenoma of the middle ear with the history of otitis media and carcinoma of the cheek: a case report"

Abstract

Background: Neuroendocrine adenomas of the middle ear are rare benign tumors deriving from middle ear mucosal cell with both neuroendocrine and epithelial properties. Approximately one hundred cases have been reported in the literature. Here we report a patient with neuroendocrine adenoma of the middle ear with the history of otitis media; the patient earlier had received radiotherapy for the treatment of basal cell carcinoma.

Case presentation: A 49- year- old Saudi man presented with a progressive hearing loss and fullness in the left ear with the history of otitis media for which he had undergone myringotomy and ventilating tubes insertion. Earlier at the age of 45 years this patient was given radiotherapy for the treatment of basal cell carcinoma in his cheek. The otoscopy showed a protruded external ear mass obscuring the tympanic membrane. Microscopy and histological examination suggested an endocrine adenoma of the middle ear. The computerized tomography scan of the temporal bone showed an extensive soft tissue mass without any osteolysis. Histological and immunohistochemical examination following surgical excision confirmed the diagnosis of neuroendocrine adenoma of the middle ear.

Conclusion: A rare case of neuroendocrine adenoma of the middle ear with earlier history of otitis media and carcinoma of the cheek is presented here. Surgical excision of mass resulted in uneventful recovery. Although the etiologic factors leading to the disease is far from clear, the role of radiotherapy given for the treatment of basal cell carcinoma may not be ruled out.

Figure 1

Otoscopic view scan of left external auditory canal. Polypoidal mass in the posterior wall of the left external auditory canal that was occluding the tympanic membrane.

Figure 2

Computed tomography scan of inner part of left external auditory canal. An irregular soft tissue lesion seen in the inner part of the left external auditory canal just lateral to the tympanic membrane, soft tissue density is also seen implicating the Prussak’s space, epitympanum, mesotympanum and hypotympanum.

Figure 3

Microscopic examination of tumor cells. Tumor composed of glands and trabecule, uniform cuboidal cells, abundant cytoplasm, eccentrically nuclei, chromatin display a “salt-and-pepper” pattern, no mitotic activity or necrosis.

Figure 4

Immunohistochemistry (positive for): Pancytokeratin CKAE l/3, Neuroendocrine markers (synaptophysin and chromogranin) and Vimentin.

Figure 5

Immunohistochemistry (negative for): S100, Desmin, CK20/CK7, TTF1 and P63.