Squamous Cell Carcinoma of the Temporal Bone Arising from Cholesteatoma: A Case Report and Review of the Literature

Abstract

Objective Present a case of squamous cell carcinoma of the temporal bone (SCCTB) arising in a 61-year-old female with a prior history of cholesteatoma and persistent otologic symptoms and review the current literature regarding this disease presentation. Setting Tertiary academic center. Patient A 61-year-old female with a history of left ear cholesteatoma for which she had undergone surgery 54 years prior. The patient presented with a persistent history of otorrhea since first surgery and developed exacerbation of symptoms just prior to presentation at our department. The clinical picture was highly suspicious of cholesteatoma recurrence. However, the biopsy was consistent with squamous cell carcinoma. Intervention Surgical debulking of the lesion was followed by a brief course of radiation therapy later halted by the patient due to side effect intolerance. Conclusion SCCTB may arise from cholesteatoma. A high index of suspicion for SCCTB should be maintained in patients with a prior history of cholesteatoma and evidence of a temporal bone mass with persistent otologic symptoms.

Keywords: cholesteatoma; chronic otorrhea; skull base; squamous cell carcinoma of temporal bone.

Fig. 1

Invasive keratinizing squamous cell carcinoma ( A – D ) with background cholesteatoma ( E – F ). Microscopic examination showing keratinizing squamous cell carcinoma with invasive nests of neoplastic cells surrounded by desmoplastic stromal reaction ( A , hematoxylin and eosin [H&E] at 10x), temporal bone invasion ( B , H&E at 10x), and perineural invasion ( C , H&E at 20x). The carcinoma was moderately differentiated with pleomorphic nuclei and numerous dyskeratinocytes ( D , H&E at 60x). Adjacent to the invasive component there is a background of squamous epithelium, fibrosis, chronic inflammation, and flakey keratin with foci of dysplasia and bone destruction ( E , H&E at 10x).