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Primary tumours of the external auditory canal. Our experience in 34
patients.Acta
Otorrinolaringol Esp. 2007 Jan;58(1):20-4.
OBJECTIVES:
Malignant neoplasms of the external auditory canal (EAC) and middle
ear are rare but have a poor prognosis. The aim of this study is to
identify the variables associated with worse prognosis. PATIENTS AND
METHOD: Thirty-four patients were treated in our department between
1990 and 2006 for EAC and middle ear tumours. The patients were staged
according to the 1990 Pittsburgh classification. In most cases,
surgery was followed by post-operative radiotherapy. RESULTS: The
overall disease-free survival was 49 % after 5 years. It reached 87 %
in stages I and II, whereas the survival for stages III and IV was 21
% (P=.001). Pre-operative facial nerve paralysis (P=.03), lymph node
metastasis (P=.01) and dural extension (P=.02) were associated with
decreased survival rates. CONCLUSIONS: In carcinomas of the EAC and
middle ear, lymph node involvement, facial nerve palsy, and dural
extension were associated with a poorer outcome. For tumours in
advanced stages, new therapeutic protocols should be evaluated.
Carcinoma of the
external auditory canal and middle ear: therapeutic strategy and
follow up.Laryngorhinootologie.
2004 Dec;83(12):818-23.
BACKGROUND:
Carcinomas of the external auditory canal (EAC) and the middle ear are
rare and considered to have a poor prognosis. The recommended
therapeutic strategy consists of surgical excision and postoperative
radiotherapy. However, there are different opinions about the extend
of the primary operation. PATIENTS AND METHODS: A series of 21
patients with carcinoma of the EAC and middle ear were treated at the
ENT-Department of the Hospital Fulda from 1985 to 2003. Their records
and radiologic findings were reviewed retrospectively with particular
reference to tumor type and size, its relation to surrounding tissues,
surgical procedures and radiation techniques. The tumors were staged
according to the modified Pittburgh staging system for temporal bone
carcinomas. The average follow-up time was 6.2 years (range 0.2 -
18.75). RESULTS: 17 patients suffered from carcinoma of the EAC, 4
carcinomas were primarily located in the middle ear. There were 15
squamous cell carcinomas, 3 adenoidcystic carcinomas, 2
adenocarcinomas and one mucoepidermoid carcinoma. 12 patients came
primarily to our institution and were staged as follows: pT1 (n = 2),
pT3 (n = 2), pT4 (n = 8). 8 patients showed up with recurrent or
residual tumors (all of T3 or T4 stage). One patient could not be
classified. In 5 cases the tumor was inoperable. These patients
underwent combined chemoradiation therapy. All other 16 patients were
operated and most of them received adjuvant radiation therapy. In the
group of patients who were primarily operated overall 5-year survival
rate was 100 %. In contrast, patients who's recurrent or residual
tumors were resected had a 5-year survival rate of only 33 %. Patients
who received combined chemoradiation therapy showed a 2-year survival
rate of 75 %. CONCLUSION: Carcinoma of the EAC and middle ear should
be treated primarily by a lateral or subtotal temporal bone resection
stage dependent combined with a parotidectomy as well as a neck
dissection. Local resection of the EAC is not sufficient, not even in
T1 tumors. As from stage T2, in cases of recurrent tumor removal and
questionable free margins as well as in cases with lymph node
metastases an adjuvant radiation therapy should be added. The most
important survival factor is removal of the primary tumor with
histologically clear margins.
Malignant tumours of the external auditory canal and of the middle
ear.Acta
Otorrinolaringol Esp. 2004 Dec;55(10):470-4.
OBJECTIVES: To
review our experience and results in the treatment of a low incidence
pathology such as the malignant ear tumors. METHODS: The study
reviewed 36 patients with malignant tumors of the EAC and middle ear
treated between 1977 and 2000 in our hospital, excluding cancer of the
pinna, metastatic tumours and sarcomas. It was used the staging system
proposed by the M.D. Anderson. RESULTS: The most common histological
type in our series is the squamous cell carcinoma, and the otorrhea
and pain are the primary symptoms in 100% of patients. Surgery
combined with radiotherapy obtained a 41% 5-year survival rate.
CONCLUSIONS: The staging system is an important prognostic factor and
it is important an early diagnosis to achieve a better therapeutical
result.
Avoiding
misdiagnosis in ceruminous gland tumours. Auris
Nasus Larynx. 2003 Aug;30(3) : 287-90.
Ceruminous
gland tumours are infrequent lesions of the external auditory canal (EAC).
Controversy still exists about nomenclature, classification, tissue of
origin, and accurate diagnosis of these tumours. We present three
cases of ceruminous gland tumours, including benign eccrine cylindroma,
ceruminous adenoma, and adenoid cystic carcinoma. Superficial biopsy
led to an initial erroneous diagnosis of adenocarcinoma in the latter.
All cases were positive for cytokeratin and S-100 protein, supporting
a ceruminous gland origin. The benign eccrine cylindroma should be
included in the ceruminous gland tumour classification. A wide
excisional biopsy should be performed in every EAC lesion. The terms 'ceruminoma'
and 'cylindroma' should be avoided.
Cancer of the
external auditory canal.Arch
Otolaryngol Head Neck Surg. 2002 Jul;128
(7): 834-7.
OBJECTIVE: To
evaluate the outcome of surgery for cancer of the external auditory
canal and relate this to the Pittsburgh staging system used both on
squamous cell carcinoma and non-squamous cell carcinoma. DESIGN:
Retrospective case series of all patients who had surgery between 1979
and 2000. Median follow-up was 47 months (range, 2-148 months). Data
on age, sex, symptoms, TNM status, histopathological diagnosis,
surgery, adjunctive therapy, sequelae, recurrence, and status at
follow-up were obtained. SETTING: An ear, nose, and throat department
in an ambulatory and hospitalized care center. PATIENTS: Ten women and
10 men with previously untreated primary cancer. Median age at
diagnosis was 67 years (range, 31-87 years). Survival data included 18
patients with at least 2 years of follow-up or recurrence.
INTERVENTION: Local canal resection or partial temporal bone
resection. MAIN OUTCOME MEASURE: Recurrence rate. RESULTS: Half of the
patients had squamous cell carcinoma. Thirteen of the patients had
stage I tumor (65%), 2 had stage II (10%), 2 had stage III (10%), and
3 had stage IV tumor (15%). Twelve patients were cured. All patients
with stage I or II cancers were cured except 1 with adenoid cystic
carcinoma. No patients with stage III or IV cancer were cured. All
recurrences developed in patients with incompletely resected tumors.
CONCLUSIONS: The outcome was related to the stage of disease,
suggesting that the Pittsburgh staging system is useful also in
patients with non-squamous cell carcinoma. Patients with early cancer
benefited from a less aggressive surgical approach, while survival was
poor in patients with advanced cancer with incompletely resected
tumors despite adjuvant radiotherapy.
Tumor of ceruminous gland
with intracranial invasion: case report.Arq
Neuropsiquiatr. 2000 Jun;58(2A):324-9.
Ceruminous
glands are modified apocrine glands, confined to the skin lining of
the cartilaginous part of the external auditory meatus. Tumors arising
from these glands are rare. Controversy exists regarding the term "ceruminoma".
Actually this neoplasia should be classified as adenoma,
adenocarcinoma, adenoid cystic carcinoma and pleomorphic ceruminous
adenoma. We report a 39-year-old woman first seen at Santa Casa of
Belo Horizonte, in 1998, presenting with headache, nausea, vertigo,
hearing loss and tinnitus on the right for the past two years. CT scan
showed a tumor eroding cartilaginous and bony limits with intracranial
invasion. She was submitted to multidisciplinary treatment with
surgery followed by radiotherapy (6000 cG). Histology showed a
ceruminous adenoid cystic carcinoma. The patient manifested a right
peripheral facial palsy and had no recovery of the previous deficits.
After one year from surgery she is clinically stable.
Prognostic factors in carcinoma of the external auditory canal.Arch
Otolaryngol Head Neck Surg. 1997 Jul;123(7):720-4.
BACKGROUND:
Carcinomas of the external auditory canal are rare neoplasms (< 1% of
all head and neck malignant neoplasms). OBJECTIVE: To evaluate the
prognostic factors in 79 patients treated in a single institution.
PATIENTS AND METHODS: The disease was staged as follows: 34 patients
with stage T1 to T2 tumors; 43 patients with stage T3 to T4 tumors; 2
patients with stage TX tumors; 68 patients with stage N0 tumors; and
11 patients with stage N1 tumors. The initial treatment was surgery in
59 patients and radiotherapy in 9 patients. Eleven patients were not
considered candidates for treatment. RESULTS: To date, 29 patients
have experienced local recurrences and 2, neck metastases. The 5-year
survival rates were 65% for patients who underwent surgery, 29% for
patients who underwent radiotherapy, and 63% for patients who
underwent a combination of surgery and radiotherapy. Univariate
survival analysis showed statistical difference according to tumor
type (P = .003), bone involvement (P = .002), and tumor stage (P <
.001). CONCLUSION: Every effort must be undertaken to make an early
diagnosis and perform radical surgical resection of squamous cell
carcinomas in the external auditory canal. This study validates the
staging system used for squamous cell carcinoma of the ear treated
with surgery.
Twenty-one cases of malignant tumor of the external auditory canal or
middle ear.Nippon
Jibiinkoka Gakkai Kaiho. 1996 May;99(5):645-52.
Between 1982 and
1994, 21 patients with malignant tumors of the external auditory canal
and middle ear were treated at the Department of Otolaryngology,
Niigata University. Eleven patients with tumors of the external
auditory canal and 10 tumors of the middle ear were registered. There
were 9 males and 12 females, and their ages ranged from 10 to 80 years
(median: 61). Otalgia, otorrhea or bloody otorrhea were the chief
complaints of most patients with external auditory canal of middle ear
tumors. Pathological examination revealed squamous cell carcinoma in
16 patients, adenoid cystic carcinoma in 3 patients, and basal cell
carcinoma and rhabdomyosarcoma in 1 patient each. External auditory
canal tumors were surgically excised, while radical mastoidectomy and
subsequent irradiation were performed for the middle ear tumors. The
five-year survival rate determined by the Kaplan-Meier method, was
77.8% for patients with external auditory canal tumors and 40% for
those with middle ear tumors.
Ceruminous gland
tumours: a reappraisal. J
Laryngol Otol. 1992 Aug; 106(8):727-32.
Ceruminous
glands should no longer be regarded as purely apocrine glands, but as
apoeccrine glands with both apocrine and eccrine modes of secretion.
We present two cases of pleomorphic adenoma of ceruminous glands,
among the rarest of such tumours. The use of such terms as 'ceruminoma'
and 'hidradenoma' should finally be abandoned, and 'ceruminous gland
tumour' used instead as a generic term. Classification should be based
on Wetli's prototype (adenoma, pleomorphic adenoma, adenoid cystic
carcinoma and adenocarcinoma), with the addition of benign eccrine
cylindroma and syringocystadenoma papilliferum; the inclusion of
mucoepidermoid carcinoma should await full validation. Wide local
excision is necessary for all tumours, with only follow-up for
histologically benign neoplasms. Malignant tumours need early
aggressive surgery and radiotherapy. If marginal invasion cannot be
assessed histologically, then adenoma and adenocarcinoma cannot be
distinguished and we suggest that the tumour be reported as 'of
uncertain malignant potential'. Long-term studies are needed to
confirm or refute the view that all ceruminous gland tumours are
potentially malignant.
Primary tumors of the external auditory canal.Acta
Otorrinolaringol Esp. 1992 Nov-Dec;43(6):439-42.
Primary tumors
of the external auditory canal (EAC) are rare, their etiology is
uncertain and their prognosis, dim. The most effective therapy
combines both surgery and radiotherapy. This study reviews the
literature and shows the results from 13 cases, treated between
1981-1991. This series proves a clear prevalence for the epidermoid
tumors (10 out of 13) and we call the attention on their poor
prognosis even in those tumors confined to EAC. The types of treatment
and their complications as well, were reviewed.
Malignant tumors of
the external ear.Ann
Plast Surg. 1988 Dec;21(6):550-4.
Although only a
few of the malignant tumors of the skin develop in the external ear,
they are more frequent than one would expect. These tumors recur and
develop metastases more often than tumors in other sites. Because of
this and because of surrounding vital structures, these tumors have a
poor prognosis. Surgical therapy, that is, wide excision, is better
than radiotherapy. Many methods for reconstruction of the external ear
have been published, and sometimes plastic protheses are acceptable.
From 1982 to 1986, 17 patients with malignant tumors of the external
ear were treated in our center. There were 15 men and 2 women. The
mean age was 73 years. There were 4 basal cell and 12 squamous cell
carcinomas, and 1 patient had malignant melanoma of the external ear.
Nine of these tumors were on the helix. During the follow-up period, 6
patients had local recurrent disease. In 7 patients, reexcision had to
be performed several times after incomplete excision. Six patients are
alive without any sign of the disease, and 3 patients died.
Malignancies of
the external ear canal and temporal bone: surgical techniques and
results.Laryngoscope.
1987 Feb;97(2):158-64.
A combined
therapy approach to malignancies of the external auditory canal and
middle ear has been developed. A technique of external canal resection
and gross tumor removal from the middle ear, parotid gland, and
superior cervical lymph nodes is followed by postoperative
full-therapy irradiation. This combined approach has been used in 30
patients with malignancies involving the external auditory canal and
temporal bone. The preoperative evaluation and surgical technique,
including the intraoperative decision-making process, is described.
Twenty-four patients had squamous cell carcinoma of the external
auditory canal, and two patients had basal cell carcinoma. There was
one patient each with adenocystic carcinoma, acinic cell carcinoma,
high grade mucoepidermoid carcinoma, and a giant cell tumor of bone.
This group of patients was broken down into three groups based on the
extent of disease as determined at surgery. Overall control of
disease, both locally and distant, for the 30 patients was 66%. There
were 12 patients with disease limited to the ear canal. These patients
had a 91% survival of this disease process. Seven patients were
determined to have limited extension beyond the ear canal. These were
treated with combined therapy with an overall control of disease of
72%. Eleven patients had extensive disease outside of middle ear into
the carotid jugular spine, stylomastoid foramen, and skull base, with
a survival rate of 45%. It is concluded that a step-wise removal of
all gross tumor, as opposed to an en bloc dissection of the temporal
bone and skull base, followed by full-therapy irradiation gives
equally as good, or even better, long-term survival for this
malignancy of the external auditory canal and middle ear.
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