Adenoma versus Carcinoid Tumor of the Middle Ear: a Study of 48 Cases and Review of the Literature

Department of Endocrine and Otorhinolaryngic-Head and Neck Pathology, Armed Forces Institute of Pathology, Washington, D.C.
Modern Pathology (Impact Factor: 6.36). 06/2002; 15(5):543-55. DOI: 10.1038/modpathol.3880561
Source: PubMed

ABSTRACT Carcinoid tumors and adenomas of the middle ear are rare neoplasms of indeterminate relationship to one another. Indeed, the literature is devoid of a large comprehensive series that evaluates the clinical, histologic, and immunophenotypic features of these tumors and their potential relationship. Forty-eight cases of middle ear adenoma between 1970 and 1995 were identified in the files of the Armed Forces Institute of Pathology. All cases were evaluated for cytomorphology and architectural pattern, in addition to their reactivity with various immunohistochemical reagents. Clinical follow-up was also obtained. A comprehensive review of the literature was performed with an eye toward correlating any distinct differences or similarities between carcinoid tumors and adenomas of the middle ear. The patients included 21 women and 27 men, aged 20 to 80 years (mean, 45.0 y). Patients experienced hearing loss, mass, and/or pain for a mean duration of 1.7 years. The mean tumor size was 0.8 cm, with six tumors extending beyond the middle ear. Histologically, the tumors were moderately cellular and unencapsulated, arranged in glandular, trabecular, and solid patterns composed of small cells with "salt and pepper" nuclear chromatin distribution. The tumor cells were immunoreactive with keratin, keratin 7, chromogranin, and human pancreatic polypeptide. All patients had surgery. No patients died with their disease (mean follow-up, 15.7 y). Eight patients developed recurrences that were treated surgically and were without evidence of disease at last follow-up (mean, 15.1 y). Our study and the review of the literature showed adenomas and carcinoid tumors of the middle ear to be essentially indistinguishable benign tumors. Middle ear adenoma most correctly describes their morphologic features and clinical behavior, although neuroendocrine adenoma of the middle ear may be a more accurate designation.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Middle ear adenoma is a rare disease that is thought to originate in the middle ear mucosa. It occurs over a wide age range, has no gender predilection, and is not characterized by specific symptoms or findings. The most frequent complaints are unilateral hearing loss and ear fullness. We report a 48-year-old woman with middle ear adenoma who had a history of unilateral ear fullness and hearing loss on the left side. Middle ear adenoma was suspected following a biopsy performed under local anesthesia. To remove the tumor, the patient underwent a left postauricular canal wall-up tympanoplasty type IIIc. Microscopic examination and immunohistochemistry confirmed a middle ear adenoma. In this case, we diagnosed the lesion as middle ear adenoma with neuroendocrine differentiation on the basis of the pathological findings. The patient has shown no recurrence for almost 5 years, but since this adenoma showed neuroendocrine differentiation, long-term observation is required.
    Nagoya journal of medical science 08/2014; 76(3-4):355-60. · 0.80 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The present study aimed to analyze the diagnosis and treatment of 13 cases of pancreatic carcinoid tumors during a 56-year period at the Tianjin Medical University Cancer Institute and Hospital (Tianjin, China). The data from 13 cases, consisting of 5 males and 8 females (mean age, 50 years), were collected and analyzed. Hematoxylin-eosin and immunohistochemistry staining were performed to investigate the expression of neuron-specific enolase (NSE), cytokeratin (CK), chromogranin A (CgA) and synaptophysin (Syn) in the tumors. The affected patients suffered abdominal and/or back pain without typical carcinoid syndrome. Radical resection was performed in 10 cases and regional resection in one case. The remaining two patients exhbited remote metastasis, and so were treated with single and double bypass surgery (choledochojejunostomy and gastrojejunostomy/choledochojejunostomy, respectively). The expression of CK, Syn, CgA and NSE was positive in nine (69.23%), 10 (76.92%), five (38.46%) and eight (61.54%) cases, respectively. The median survival time was 26.6 months. In conclusion, in patients with pancreatic carcinoid tumors that exhibit no typical carcinoid syndrome, such as those in the present study, the diagnosis can be confirmed by pathological examination and surgery is the most effective treatment.
    Oncology letters 02/2015; 9(2):780-784. DOI:10.3892/ol.2014.2776 · 0.99 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Extracranial meningiomas of the sinonasal tract are rare tumors. These tumors are frequently misclassified, resulting in inappropriate clinical management. To date, there has been no comprehensive study to evaluate the clinicopathologic aspects of meningioma in these anatomic sites. Thirty cases of sinonasal tract meningiomas diagnosed between 1970 and 1992 were retrieved from the files of the Otorhinolaryngic Registry of the AFIP. Histologic features were reviewed, immunohistochemical studies were performed, patient follow up was obtained, and the results were statistically analyzed. The patients included 15 females and 15 males, aged 13 to 88 years (mean, 47.6 yrs). Patients presented clinically with a mass, epistaxis, sinusitis, pain, visual changes, or nasal obstruction, dependent on the anatomic site of involvement. Symptoms were present for an average of 31.1 months. The tumors affected the nasal cavity (n = 14), nasopharynx (n = 3), frontal sinus (n = 2), sphenoid sinus (n = 2), or a combination of the nasal cavity and ethmoid, frontal, sphenoid, and/or maxillary sinuses (n = 9). The tumors ranged in size from 1.0 to 8.0 cm in greatest dimension (mean, 3.5 cm). Radiographic studies demonstrated a central nervous system connection in six cases. The tumors often eroded the bones of the sinuses (n = 18) and involved the surrounding soft tissues, the orbit, and occasionally the base of the skull. Histologically, the tumors demonstrated features similar to intracranial meningiomas. The majority were of the meningothelial type (n = 23), although there were three atypical meningiomas. Immunohistochemical studies confirmed the diagnosis of meningioma with positive reactions for epithelial membrane antigen (EMA) and vimentin (all tested). The differential diagnosis includes paraganglioma, carcinoma, melanoma, psammomatoid ossifying fibroma, and angiofibroma. Surgical excision was used in all patients. Three patients died with recurrent disease (mean, 1.2 yrs), one was alive with recurrent disease (25.6 years), and the remaining 24 patients were alive or had died of unrelated causes (mean, 13.9 yrs) at the time of last follow up (two patients were lost to follow up). Extracranial sinonasal tract meningiomas are rare tumors which need to be considered in the differential diagnosis of sinonasal tumors. A whorled growth pattern and psammoma bodies, combined with positive EMA and vimentin immunohistochemical reactions, can confirm the diagnosis of meningioma. The overall prognosis is good, without a difference in outcome between benign and atypical meningiomas. Meningioma is a common intracranial neoplasm with a variety of histomorphologic growth patterns which are usually easily recognized. 7,30 However, primary extracranial (ectopic, extracalvarial) meningiomas of the nasal cavity, paranasal sinuses, and nasopharynx (hereinafter referred to collectively as the sinonasal tract) are rare. The literature is generally limited to isolated case reports 1,2,5,6,10–19,24,26,28–32,34–38,40–44,46–54,56,58–61,63,64,66,67 with a few reviews of the literature. 13,19,28,46 The largest study to date is of 12 cases reported by Perzin et al. 46 While a degree of controversy continues to exist around the exact origin of sinonasal tract meningiomas, 19,46 it seems generally accepted that primary extracranial meningiomas do occur. 14,19,28,46 Histologically, meningiomas of the sinonasal tract are identical to their intracranial counterparts, although diagnostic difficulties are frequently encountered in the differential diagnosis with carcinoma, melanoma, and olfactory neuroblastoma resulting from the rarity of meningiomas in this location. With these difficulties in mind, we thought it would be legitimate to undertake this study of 30 cases of sinonasal tract meningiomas to describe the clinical findings associated with these tumors, illustrate their pathologic features, document their immunophenotype, apply meningioma grading parameters, and analyze this data as it relates to patient outcome in a single comprehensive study. Our results are analyzed in comparison to a review of the English literature.
    American Journal of Surgical Pathology 01/2000; 24(5):640-650. DOI:10.1097/00000478-200005000-00002 · 4.59 Impact Factor

Full-text (2 Sources)

Available from
Jun 1, 2014