|
Expansion of an ceruminous adenoma into the middle ear.
Laryngorhinootologie. 2006
Jun;85(6):444-7.
A 37-year-old
female presented for surgery with central perforation of the eardrum
with granulation. Mastoidectomy had been performed 18 years ago
following chronic mastoiditis. As the clinical picture now suggested a
suspected cholesteatoma, radiological imaging was performed. The CT
scan revealed specification of the mastoid and the tympanic cavity. In
addition, MRI scan showed signal enhancement in the same areas.
However, the suspected cholesteatoma could not be confirmed
intraoperatively. Pathohistology revealed a ceruminal gland adenoma.
They are a rare phenomenon and should be distinguished from middle ear
adenomas, pleomorph ceruminal gland adenomas, ceruminal gland
adenocarcinomas and cylindromas of the ceruminal glands. Owing to a
high recurrence rate, complete surgical removal is necessary. Despite
its rare occurrence, a ceruminal gland adenoma must be taken into
consideration in the differential diagnosis of individual
cholesteatoma cases.
Ceruminous
adenomas: a clinicopathologic study of 41 cases with a review of the
literature.:
Am J Surg
Pathol. 2004 Mar;28(3):308-18.
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.
Ceruminous
gland adenoma of the external auditory canal: a case report.Otolaryngol
Pol. 2003;57(5):755-9.
Ceruminous
adenoma (ceruminoma) of the external auditory meatus is a rare
neoplasm with benign clinical behavior. This tumor is mainly composed
of the ceruminous gland cells (modified apocrine sweat glands). These
glands are localized deep in the skin mostly in the cartilaginous part
of the external auditory meatus. The most often symptom of the
ceruminous adenoma of external auditory meatus is the unilateral
conductive hearing loss. Occasionally symptoms of this tumor (pain,
otorrhoea) can result from an otitis externa secondary to meatus
obstruction. Ceruminous adenoma should be radical excised with
adequate margins of the normal tissues. The prognosis of these tumors
is good. The difficulties of nomenclature, histological structure of
the auditory external meatus ceruminoma, as well as symptomatology,
treatment and clinical behavior are discussed on the basis of the
literature. A case of histologically confirmed ceruminoma (ceruminous
adenoma) of the external auditory meatus in a surgically treated 53
years old men is presented.
Ultrastructural morphology of a middle ear ceruminoma.ORL
J Otorhinolaryngol Relat Spec. 2002
Sep-Oct;64(5):358-63.
The
ultrastructural morphology of a ceruminous gland adenoma in the middle
ear was examined electron microscopically. The epithelial tumor cells
displayed apocrine caps, microvilli, cell junctions, secretory
granules, vacuoles, lipid droplets and siderosomes, which are the
characteristic ultrastructural features of apocrine glands. Concentric
membranous bodies of the endoplasmic reticulum, phagocytic activity of
the tumor cells, intracytoplasmic lumina, ciliated cells and also
spiny collagen in the tumor stroma could be seen. The myoepithelial
cells are an important tumor marker in the differential diagnosis
between ceruminomas and adenomas of the middle ear. The ectopic origin
in the modified apocrine ceruminous glands, the specific localization,
the clinical features and the extremely rare occurrence of the
ceruminoma makes this tumor a unique neoplastic entity.
Ceruminoma
revisited. Am
J Otol. 1987 Nov;8(6):485-8.
Ceruminoma is a
catch-all term that has caused much confusion both in the literature
and in clinical practice in regard to the specific histologic
diagnosis and proper treatment for tumors arising from the ceruminous
glands of the external ear canal. The term ceruminoma has been used in
the past to refer to both benign and malignant lesions. To clarify the
terminology and better determine appropriate treatment, two cases of
benign adenoma of the ceruminous glands along with their
histopathologic findings will be presented. The specific
characterization of the individual types of ceruminous gland neoplasms,
their clinical manifestations, histopathology, and recommended
treatment will then be discussed. Finally, suggestions for the
appropriate nomenclature for these rare tumors will be reviewed.
|
