Cavernous Hemangioma of the External Auditory Canal in Patients Older than 60 Years: A Rare Tumor

Abstract

A 62-year-old woman visited our otorhinolaryngology clinic with symptoms of aural fullness in right ear that began several months prior. On physical examination, a soft, pinkish, cystic mass was observed in the right external auditory canal (EAC) and it almost occluded the canal. Facial computed tomography revealed a 1.3 Â 1.0 cm poorly enhanced, posteriorly based, soft tissue density mass (Figure 1). Surgical excision was planned under the suspicion of vascular tumor.In microscopic surgery under local anesthesia, the mass was excised completely via a retroauricular approach. The retroauricular approach was performed due to large size of the mass. The mass was not in contact with the tympanic membrane, so the tympanic membrane was intact. After excision, the skin defect was minimal.After surgery, symptom of aural fullness in the right EAC improved. One year after surgery, there had been no tumor recurrence. Histopathologic findings revealed cavernous hemangioma, which consisted of thick-walled vessels. The vascular channels were covered with keratinized stratified squamous epithelium (Figure 2).

Capillary hemangioma in the external auditory canal

“…In 1982, Mulliken and Glowacki presented a classification of vascular tumors into two categories, hemangiomas and vascular malformations [ 2 , 4–6 ]. Hemangioma is a common vascular tumor that has an increased number of vessels filled with blood [ 4 , 6 ].…”

“…In 1982, Mulliken and Glowacki presented a classification of vascular tumors into two categories, hemangiomas and vascular malformations [ 2 , 4–6 ]. Hemangioma is a common vascular tumor that has an increased number of vessels filled with blood [ 4 , 6 ]. In contrast, a vascular malformation such as arteriovenous malformation is composed of vascular channels with flat mature endothelium [ 5 ].…”

“…The incidence of hemangioma is 1–2.6% at birth and 10% in 1-year-old children. Half of hemangiomas regress spontaneously within 5 years old and the rest usually regress by 10–12 years old [ 1 , 4 ].…”

“…Histopathologically, hemangioma is classified into capillary hemangioma, cavernous hemangioma and mixed hemangioma. Cavernous hemangiomas are composed of large cavernous vascular spaces and present after the sixth decade of life [ 2 , 4 ]. In contrast, capillary hemangiomas have capillary-like channels with surrounding fibrous stroma that result from endothelial proliferation [ 2 , 3 , 6 ].…”

“…It is the most common soft tissue tumor in children and >60% of hemangiomas occur in the head and neck region. However, these tumors are rare in the external auditory canal (EAC) [ 4 ]. In spite of its rarity, hemangioma in the EAC can be associated with symptoms, which can bring a patient to the clinic.…”