A rare cause of hearing loss: metastasis of a small cell neuroendocrine carcinoma in the external auditory canal

Introduction:

An involvement of head and neck is very rare in small cell neuroendocrine carcinomas (NEC). Allover NEC of unknown origin are quite uncommon and represent a widely spread spectrum. The progress depends on the grade of differentiation as well as on their site. Furthermore poorly differentiated NEC are characterized by rapid growth and dismal prognosis.

Methods:

A 54-year old female patient presents with sinistral hearing loss and tinnitus for about 3 weeks. In addition she reports hyperhidrosis and back pain. The ear microscopy shows a polypous-glassy tumour in the right external auditory canal and an obstructing tumour in the left external auditory canal.

Results:

The histological analysis reveals infiltrate of a small cell NEC. The FDG-PET total body CT shows malignant-typical metabolism on various sites of the whole body without detecting a primary tumour. In order to further therapy the presentation of the patient takes place at the department for hematooncology and after presentation at the tumour-board a chemotherapy following the platin/etoposid schema is carried out. Currently the chemotherapy is still processed.

Discussion:

In case of an unknown tumour located at the external auditory canal a biopsy to exclude a malignant tumour is recommended at all times. Although seldom an alleged simple hearing loss might be provoked by a fatal, complex cause such as a NCUP. In view of the rapid progress of the disease an expeditious, efficient process ensuring the histology and initiating the therapy is obligatory. To our best knowledge in the actual literature no other case is reported of a NCUP first manifestation of hearing loss due to a tumour at the external auditory canal.

Publication History

Publication Date:
18 April 2018 (online)