Author(s)
Erin K. Haser MD
Melanie A. Lang-Orsini MB
Jonathon S. Sillman MD
Affiliation(s)
Tufts Medical Center
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to discuss the pathologic entity of middle ear adenoma and its controversial nomenclature, understand its rare metastatic potential, and differentiate it from glomus tympanicum. Objectives: Adenomatous tumors of the middle ear are rare tumors described under varying names based on their neuroendocrine features and rare metastases. These tumors may actually represent a spectrum of a pathologic entity. There are rare reports of regional metastases with even fewer distant metastases. This case series serves to describe four patients with middle ear adenoma, including a case of distant visceral metastasis, as well as describe its differentiation from glomus tympanicum on pathology. Study Design: Case series with retrospective chart review. Methods: We report a series of four cases of middle ear adenoma in patients age 40-80 years old. Results: All four cases involve recurrent middle ear adenoma. One case is a 67 year old man presenting with a recurrent mass involving the right cerebellopontine angle (CPA), jugular foramen, and hypoglossal foramen as well as a concurrent large liver lesion. The patient underwent resection of the CPA mass and percutaneous liver biopsy, and pathology with immunohistochemical staining for neuroendocrine markers confirmed metastasis. Another case involves a woman with history of presumed glomus tympanicum later diagnosed with middle ear adenoma of the hypotymapnum. The patients' clinical course, diagnosis, and pathology are presented. Conclusions: The nature of middle ear adenomas ( carcinoid ) has been a controversial topic. These cases exemplify the tendency for recurrence when surgical resection is incomplete, the potential for intracranial extension, and rare distant metastatic potential. These neuroendocrine differentiated tumors may represent a spectrum of pathology with varying metastatic potential rather than a benign entity and should be differentiated from glomus tympanicum on pathology.