Middle ear carcinoid with distant osseous metastasis

Abstract

Middle ear carcinoid is a rare entity with an indolent clinical course. Numerous reports have described local recurrence and metastasis to the cervical lymph nodes, although only one report of distant visceral metastasis exists in the literature. We describe the potential for osseous metastasis. A 52-year-old male with previous middle ear carcinoid (resected 10 years prior) presented with a neck mass. Subsequent workup revealed a suspicious lytic lesion of the iliac crest. Selective neck dissection and core biopsy of the iliac lesion were performed, which revealed concurrent histologically identical metastasis to both the cervical lymph nodes and iliac crest, morphologically indistinguishable from the previous middle ear carcinoid. This case presents the novel description of distant osseous metastasis of middle ear carcinoid.

Neuroendocrine Adenoma of the Middle Ear: A Rare Histopathological Diagnosis

“…Although considered a benign neoplasm, regional metastases have occurred in the cervical lymph nodes and parotid gland [ 22 – 25 ] and these regions should be assessed and neck dissection performed where required. Distant metastasis has also been described by Fundakowski et al [ 26 ] in the iliac crest and cervical lymph nodes. Gaafar et al had also previously described visceral hepatic metastasis.…”

‘Neuroendocrine’ middle ear adenomas: consistent expression of the transcription factor ISL1 further supports their neuroendocrine derivation

“…However, most recurrences were considered to represent growth of residual tumour after incomplete removal, and the frequency of true recurrence after complete gross excision was ≤4% . Regional node metastasis occurred in six patients and distant metastases in two patients . However, some authors have argued that metastasizing tumours are not MEA, on the basis of site of origin and the morphology of the primary tumour …”

“…occurred in six patients and distant metastases in two patients. 2,[27][28][29][30] However, some authors have argued that metastasizing tumours are not MEA, on the basis of site of origin and the morphology of the primary tumour. 31 The immunoprofile of neuroendocrine MEA (ISL1+/ PAX8À/CDX2À/TTF1À) is distinctive from that of ileal (CDX2+/ISL1À/PAX8À/TTF1À), pancreatic (ISL1+/PAX8+/CDX2À/TTF1À), rectal (ISL1+/PAX8+/ CDX2+/TTF1À) and bronchopulmonary (TTF1+/CD X2À/PAX8À/ISL1À) neuroendocrine tumours.…”

Middle Ear Adenoma Imitating Late Postoperative Complication

“…10 To date, only one case of distant metastasis has been reported. 11 Patients with MEAs commonly experience progressive unilateral conductive hearing loss, tinnitus, and a feeling of fullness in the ear. 5,12 Headache and vertigo are not typical.…”