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Ear Ceruminous Adenoma PATHOLOGYPATHOLOGY CLINIC CLINIC Ear ceruminous adenoma Lester D.R. Th ompson, MD Figure 1. An H&E-stained slide shows a ceruminous adenoma’s Figure 2. A high-power view shows the biphasic nature of the biphasic glandular proliferation. Th ere is a lack of encapsulation, neoplasm. Th e inner apocrine, secretory cells have a brightly with fi brosis separating the epithelial cells. Th e surface epithelium eosinophilic cytoplasm with small, yellow granules, subtended by is intact. a basal cell proliferation of smaller myoepithelial type cells with a high nuclear-to-cytoplasmic ratio. Ceruminous adenoma, also called ceruminoma, ce- excision associated with an increased risk of recur- ruminal adenoma, apocrine adenoma, or even cylin- rence. droma in the past (the latter three terms are discour- Most of these tumors are small (mean, 1.2 cm), large- aged) is a benign glandular neoplasm of ceruminous ly a function of the anatomic confi nes of the region. glands (modifi ed apocrine sweat glands) that arises Th ey are separated histologically into three types: (1) solely from the external auditory canal. By defi nition, ceruminous adenoma; (2) ceruminous pleomorphic this tumor type cannot involve the auricular cartilages, adenoma; and (3) ceruminous syringocystadenoma ear lobe, or other such external ear apparatus. papilliferum, although the latter two are exceedingly Ceruminous adenoma accounts for <1% of all exter- uncommon. Regardless of the type, these tumors tend nal ear tumors, usually aff ecting middle-aged (mean, to be well circumscribed but unencapsulated (fi gure 55 years) patients, without gender predilection. Pa- 1). Th ere is frequently a background of dense, sclerotic tients usually present with a mass that is most oft en fi brosis that may simulate invasion. Th e tumors are on the posterior wall of the outer one-third to outer moderately cellular, arranged in a mixture of glandu- one-half 0of the external auditory canal. Th ere may lar and cystic patterns, each comprised of a dual cell be associated pain, hearing loss (sensorineural and population (fi gure 2). conductive), tinnitus, or even paralysis of the nerves. Th e inner luminal secretory cells have apocrine de- Complete excision will be curative, with incomplete capitation secretions, or blebs, and abundant granular, From the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, Calif. 304 ■ www.entjournal.com ENT-Ear, Nose & Throat Journal ■ July 2011 MedNet Locator, Inc. PATHOLOGY CLINIC Quality Refurbished Medical Equipment “Over 25 Years” eosinophilic cytoplasm. Specifi cally, there are yellow- brown, ceroid, lipofuscin-like (cerumen) pigment granules within the cytoplasm of these luminal cells, which are surrounded by basal, myoepithelial cells lined up along the basement membrane. Th ere is usu- ally very limited pleomorphism and a lack of necrosis. Mitoses are inconspicuous. A ceruminous pleomorphic adenoma is identical to a salivary gland pleomorphic adenoma, thus showing Surgical Treatment Exam Chairs chondromyxoid matrix material juxtaposed to, and Microscopes Cabinets blended with, epithelium, with the added feature of ceruminous diff erentiation among the epithelial cells. MedNet Locator, Inc., a small family owned business, has been providing quality refurbished medical It is important to separate a primary external auditory equipment for over 25 years. Specializing in the sales canal tumor from a parotid salivary gland tumor with and service of ENT equipment for the otolaryngology local extension into the ear. Th e ceruminous papillary field, we also provide quality surgical microscopes for cystadenoma papilliferum has papillary projections all types of surgery. lined by cuboidal to columnar cells, a dense plasma- cytic infi ltrate, and cells with ceruminous diff erentia- Visit Our Web Site: www.mednetlocator.com Email: [email protected] tion. Phone: (800) 754-5070 or (662) 622-7033 Immunohistochemistry is not necessary for the diagnosis, but stains can be used to highlight the bi- phasic nature of the tumor cells. Th e luminal cells will entjournal.com/readerservice be positive for CK7, EMA, and pankeratin; the latter two are also positive in the basal cells. Additionally, the basal cells will stain with CK5/6, p63, and S-100 protein. Th is tumor type is unique to the external auditory canal. With the exception of ceruminous adenocar- cinoma, other neoplasms are rarely identifi ed in this location. Ceruminous adenocarcinoma has an infi ltra- tive and destructive growth pattern with pronounced Renew/Receive your cellular pleomorphism and prominent nucleoli. Mito- ses and necrosis can be seen. Ceroid pigmentation is COMPLIMENTARY absent. Ceruminous adenocarcinoma is also divided Subscription Today! into types, but it is the not otherwise specifi ed (NOS) MAY 2009 • VOL. 88, NO. 5 type rather than the adenoid cystic type that would give the most diffi culty in the diff erential diagnosis. ▲ Suggested Reading The role of angiography in managing patients with temporal bone fractures: Crain N, Nelson BL, Barnes EL, Th ompson LD. Ceruminous gland car- A retrospective study of 64 cases ▲▲▲ Patient history and CT fi ndings in cinomas: A clinicopathologic and immunophenotypic study of 17 predicting surgical outcomes for cases. Head Neck Pathol 2009;3(1):1-17. patients with rhinogenic headache Aggressive fi bromatosis of the oropharynx: A multidisciplinary Hicks GW. Tumors arising from the glandular structures of the external approach to a benign disease auditory canal. Laryngoscope 1983;93(3):326-40. Online Exclusive: Technique selection for orbital decompression: Combined endoscopic Mills RG, Douglas-Jones T, Williams RG. ‘Ceruminoma’—a defunct di- and transconjunctival versus combined endoscopic and transantral approach agnosis. J Laryngol Otol 1995;109(3):180-8. (includes video clip of a surgical procedure) Th ompson LD, Nelson BL, Barnes EL. Ceruminous adenomas: A clini- www.entjournal.com copathologic study of 41 cases with a review of the literature. Am J Surg Pathol 2004;28(3):308-18. SIMPLY visit www.submag.com/sub/ej Volume 90, Number 7 www.entjournal.com ■ 305.
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