Limits...
Middle ear glandular neoplasms: adenoma, carcinoma or adenoma with neuroendocrine differentiation: a case series.

Saliba I, Evrard AS - Cases J (2009)

Bottom Line: Local recurrence following complete excision is quite uncommon and metastases are rare.Based on the presence or absence of immunohistochemical markers and metastasis, we have classified these lesions into three types.Complete surgical treatment is recommended with an indefinite follow-up for possible recurrence.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otorhinolaryngology, Head & Neck surgery, Montreal University Hospital Center (CHUM), Hôtel-Dieu Hospital, Montreal, Quebec, Canada.

ABSTRACT

Introduction: Middle ear glandular neoplasms are infrequent causes of a middle ear mass. They can have exocrine and/or neuroendocrine differentiation. It is currently thought that these tumors are indistinguishable each from another. Herein, we present a new case of a middle ear glandular neoplasm. Our objective is to review all cases described in the literature in order to identify the clinical features, the gross pathology, the histopathology, the immunohistochemistry, to discuss the differential diagnosis, the treatment, the rate of recurrence, the follow-up, the incidence of metastasis, the prognosis and to present a new classification of middle ear glandular neoplasm.

Methods: We performed a MEDLINE database search for MEA-related articles published between 1950 and March 2008. The information from the reports was analyzed.

Results: Ninety-four patients with a middle ear adenoma are included in this report. We uncovered 75 patients with a carcinoid tumor and 19 patients with a middle ear adenoma diagnosis; the most common presenting symptom was a conductive hearing loss. Middle ear adenomas are lesions that are typically white, gray or reddish brown. They are grossly vascular and well circumscribed, but not encapsulated, and can entrap and destroy the ossicles. Histologically, the cuboidal to low columnar cells are arranged in a solid, trabecular or glandular architecture. The tumor's cells are immunohistochemically positive for a variety of keratin antibodies and most of them are also positive for neuroendocrine markers. Surgical excision is the treatment of choice. Local recurrence following complete excision is quite uncommon and metastases are rare.

Conclusions: Our study and the review of the literature showed adenomas and carcinoid tumors of the middle ear to be essentially indistinguishable benign tumors with metastatic potential. Based on the presence or absence of immunohistochemical markers and metastasis, we have classified these lesions into three types. Complete surgical treatment is recommended with an indefinite follow-up for possible recurrence.

No MeSH data available.


Related in: MedlinePlus

Middle ear adenoma. Minor foci of tumor composed of sheets of loosely cohesive cells with moderate to abundant eosinophilic cytoplasm and eccentrically placed nuclei (plasmacytoid morphology) (original magnification 200X).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2812983&req=5

Figure 3: Middle ear adenoma. Minor foci of tumor composed of sheets of loosely cohesive cells with moderate to abundant eosinophilic cytoplasm and eccentrically placed nuclei (plasmacytoid morphology) (original magnification 200X).

Mentions: Histologic examination of the excised tumor showed an epithelial neoplasm with a predominantly glandular architecture embedded in fibrous tissue. The tumor was composed of cuboidal cells with uniform nuclei and no identifiable mitotic activity or necrosis (Figure 2). Focally, the tumor cells had a well-developed plasmacytoid morphology (Figure 3). Single cells were also seen infiltrating into the fibrous stroma. An immunohistochemical evaluation showed strong positivity for neuron specific enolase (NSE) and synaptophysin and weak positivity for chromogranin (Figure 4). The tumor was suspected of having the typical morphology and immunophenotype of a middle ear adenoma/carcinoid. The patient was clinically monitored for two years through the T1 and T2-weighted magnetic resonance imaging (MRI) images of the temporal bones with the administration of a paramagnetic contrast material. He is currently disease free (Figure 5).


Middle ear glandular neoplasms: adenoma, carcinoma or adenoma with neuroendocrine differentiation: a case series.

Saliba I, Evrard AS - Cases J (2009)

Middle ear adenoma. Minor foci of tumor composed of sheets of loosely cohesive cells with moderate to abundant eosinophilic cytoplasm and eccentrically placed nuclei (plasmacytoid morphology) (original magnification 200X).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2812983&req=5

Figure 3: Middle ear adenoma. Minor foci of tumor composed of sheets of loosely cohesive cells with moderate to abundant eosinophilic cytoplasm and eccentrically placed nuclei (plasmacytoid morphology) (original magnification 200X).
Mentions: Histologic examination of the excised tumor showed an epithelial neoplasm with a predominantly glandular architecture embedded in fibrous tissue. The tumor was composed of cuboidal cells with uniform nuclei and no identifiable mitotic activity or necrosis (Figure 2). Focally, the tumor cells had a well-developed plasmacytoid morphology (Figure 3). Single cells were also seen infiltrating into the fibrous stroma. An immunohistochemical evaluation showed strong positivity for neuron specific enolase (NSE) and synaptophysin and weak positivity for chromogranin (Figure 4). The tumor was suspected of having the typical morphology and immunophenotype of a middle ear adenoma/carcinoid. The patient was clinically monitored for two years through the T1 and T2-weighted magnetic resonance imaging (MRI) images of the temporal bones with the administration of a paramagnetic contrast material. He is currently disease free (Figure 5).

Bottom Line: Local recurrence following complete excision is quite uncommon and metastases are rare.Based on the presence or absence of immunohistochemical markers and metastasis, we have classified these lesions into three types.Complete surgical treatment is recommended with an indefinite follow-up for possible recurrence.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otorhinolaryngology, Head & Neck surgery, Montreal University Hospital Center (CHUM), Hôtel-Dieu Hospital, Montreal, Quebec, Canada.

ABSTRACT

Introduction: Middle ear glandular neoplasms are infrequent causes of a middle ear mass. They can have exocrine and/or neuroendocrine differentiation. It is currently thought that these tumors are indistinguishable each from another. Herein, we present a new case of a middle ear glandular neoplasm. Our objective is to review all cases described in the literature in order to identify the clinical features, the gross pathology, the histopathology, the immunohistochemistry, to discuss the differential diagnosis, the treatment, the rate of recurrence, the follow-up, the incidence of metastasis, the prognosis and to present a new classification of middle ear glandular neoplasm.

Methods: We performed a MEDLINE database search for MEA-related articles published between 1950 and March 2008. The information from the reports was analyzed.

Results: Ninety-four patients with a middle ear adenoma are included in this report. We uncovered 75 patients with a carcinoid tumor and 19 patients with a middle ear adenoma diagnosis; the most common presenting symptom was a conductive hearing loss. Middle ear adenomas are lesions that are typically white, gray or reddish brown. They are grossly vascular and well circumscribed, but not encapsulated, and can entrap and destroy the ossicles. Histologically, the cuboidal to low columnar cells are arranged in a solid, trabecular or glandular architecture. The tumor's cells are immunohistochemically positive for a variety of keratin antibodies and most of them are also positive for neuroendocrine markers. Surgical excision is the treatment of choice. Local recurrence following complete excision is quite uncommon and metastases are rare.

Conclusions: Our study and the review of the literature showed adenomas and carcinoid tumors of the middle ear to be essentially indistinguishable benign tumors with metastatic potential. Based on the presence or absence of immunohistochemical markers and metastasis, we have classified these lesions into three types. Complete surgical treatment is recommended with an indefinite follow-up for possible recurrence.

No MeSH data available.


Related in: MedlinePlus