Background
The ear is affected by manY different pathologic processes which overlap with many different organ systems. It is divided into the external, middle, and inner ear. The external ear contains the auricle and external auditory meatus leading to the tympanic membrane (ear drum). The middle ear includes the tympanic membrane, the ossicles (malleus, incus, and stapes), eustachian tube, epitympanic recess, and the mastoid cavity. The inner ear leads to the brain with the auditory nerve (cranial nerve VIII).
- Cholesteatoma
- Low-grade adenocarcinoma of probable endolymphatic sac origin
(Aggressive Papillary Tumor of Temporal Bone and Endolymphatic Sac)- Middle ear adenoma
- Relapsing Polychondritis
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HISTOPATHOLOGY CHARACTERIZATION CERUMINOUS ADENOMA Ceruminous Adenomas: A Clinicopathologic Study of 41 Cases With a Review of the Literature
Thompson, Lester D. R MD*; Nelson, Brenda L DDS, LCDR, DC, USNR*; Barnes, E Leon MD†
From the *Departments of Endocrine-Otorhinolaryngic-Head & Neck Pathology, Armed Forces Institute of Pathology, Washington, DC; and †Department of Pathology, Presbyterian University Hospital, Pittsburgh, PA.
The American Journal of Surgical Pathology : Volume 28(3) March 2004 pp 308-318 Abstract quote Background: Ceruminous gland neoplasms are rare neoplasms. To date, a large clinicopathologic study of benign ceruminous gland neoplasms has not been reported.
Design: Forty-one cases of ceruminous gland adenomas diagnosed between 1970 and 2000 were retrieved from the files of the Armed Forces Institute of Pathology. Histologic features were reviewed, immunohistochemical analysis was performed (n = 21), and patient follow-up was obtained (n = 40).
Results: The patients included 22 men and 19 women, 24 to 85 years of age (mean, 54.2 years). Patients presented clinically with a painless mass of the outer half of the external auditory canal (n = 33) or with hearing changes (n = 11). Symptoms were present for an average of 16.3 months. The polypoid masses affected the external auditory canal only and ranged in size from 0.4 to 2 cm in greatest dimension (mean, 1.1 cm). Histologically, the tumors demonstrated glands and small cysts lined by a tubuloglandular proliferation of inner ceruminous cells (cerumen-secreting epithelium with decapitation secretion) subtended by a spindled to cuboidal myoepithelial layer. A hyalinized stroma created an infiltrative pattern of growth; surface involvement (n = 8) was seen. Tumors were divided into ceruminous adenoma (n = 36), ceruminous pleomorphic adenoma (n = 4), and syringocystadenoma papilliferum (n = 1) types. The luminal cells were strongly and diffusely immunoreactive with CK7, while the basal cells were highlighted with CK5/6, S-100 protein, and p63. CD117 highlighted the luminal cells preferentially. The proliferation markers revealed a low index. Adenocarcinoma and middle ear adenoma are the principal differential consideration. Surgical excision was used in all patients. Four patients developed a recurrence due to incomplete excision. All patients were without evidence of disease at the last follow-up: alive (n = 28, mean 16.3 years) or dead (n = 12, mean 11.8 years).
Conclusion: Ceruminous gland adenomas are the most common external auditory canal tumors. They demonstrate a dual cell population of basal myoepithelial-type cells and luminal ceruminous (ceruminal) cells. Cerumen pigment, CK7, and p63 can help to distinguish this tumor from other neoplasms that occur in the region. Complete surgical excision results in an excellent long-term clinical outcome.
Tumors arising from the ceruminal glands of the external ear canal can present a diagnostic dilemma because of their varied clinical and histologic manifestations. While well described in cats and dogs, tumors of this type are rare in humans and therefore are seldom seen by general surgical pathologists.4,8,27 Further adding to the confusion for pathologists and clinicians alike is the variable nomenclature used to describe tumors of ceruminal gland origin ( Table 1 ). These terms in general do not suggest a specific diagnosis, clinical behavior, treatment alternatives, or long-term clinical outcome. Likewise, many reports in the literature, when critically reviewed, are examples of neuroendocrine adenoma of the middle ear (middle ear adenoma), endolymphatic sac tumors (Heffner tumor), paraganglioma, or most likely represent parotid gland neoplasms that have extended into the external auditory canal.5,7,10,13,16,17,20,22,25,29,33-38 Many cases are not illustrated or incompletely described histologically, further preventing a critical review. Limited mostly to case reports and small series ( Table 2 ), the English literature is devoid of a large comprehensive evaluation of ceruminous adenomas with respect to their histomorphology, immunohistochemical reactivity, treatment outcomes, and clinical behavior. We undertook this study in an attempt to identify the histologic and immunohistochemical features that can be used to separate benign from malignant ceruminous tumors and to determine the best nomenclature to yield a meaningful clinical management impact.
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Sternberg S. Diagnostic Surgical Pathology. Third Edition. Lipincott Williams and Wilkins 1999.
Weedon D. Weedon's Skin Pathology. Churchill Livingstone. 1997.
Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.
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Last Updated 3/15/2004
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