The Adenom of the middle ear – A rare tumor of the Head and Neck Region

Introduction:

Cholesteatoma is the most common space occupying lesion of the middle ear. However, the present case shows that the clear assessment of a neoplasm preoperatively can be difficult, as the symptoms and the ENT examination can often be nonspecific.

Methods:

Representation of a case study

Results:

We report on a 38-year-old woman who presented with pressure in the ear and normal hearing to our outpatient department. A spherical shaped mass was found behind the intact eardrum of the right ear. The primary suspicion of a cholesteatoma could not be confirmed intraoperatively. There was a smoothly bordered, yellowish mass reminding morphologically of a facial nerve neuroma with directly derived EMG potentials of the VII cranial nerve after stimulation. Therefore, only a tiny sample was taken for histological examination, which resulted in the diagnosis of an adenoma. Following in a second session, the tumor was removed, which seemed to derive cranially from the oval window of the exposed facial nerve. Postoperatively, the facial nerve function was intact. A conductive hearing loss resulted due to the necessary incus removal. Histologically, a very low proliferative, highly differentiated neuroendocrine neoplasia was detected. In future a second look surgical procedure with hearing restoration and tumor control is planned.

Conclusions:

The adenoma of the middle ear, also referred to as middle ear carcinoma or neuroendocrine adenoma of the middle ear, is a rare form of tumor that is predominantly classified as benign, but can also metastasize and cause recurrences. The middle ear adenoma must be differentiated from adenocarcinoma regarding its morphological, immunohistochemical and neuroendocrine properties.

Publication History

Publication Date:
23 April 2019 (online)