A Case of Primary Non-Hodgkin’s Lymphoma of the External Auditory Canal

Lymphomas represent the second most frequent malignant tumor (incidence 2.5%) in the head and neck region. Non-Hodgkin lymphomas (NHLs) present with cervical lymph node involvement, but in 40% extranodal site could be primary involved: nasopharynx, the lacrimal sac, the temporal bone, or the others areas. NHLs of the ear are rarely reported. In this report, we described a patient with primary NHL of the external ear canal who was successfully treated with surgical excision and chemotherapy. 1. Introduction Lymphomas represent the second most frequent malignant tumor (incidence 2.5%) in the head and neck region [1, 2]. Non Hodgkin lymphomas (NHLs) present with cervical lymph node involvement, but in 40% extranodal site could be primary involved: nasopharynx, the lacrimal sac, the temporal bone, or the other areas [3]. NHL of the ear are rarely reported. Ogawa et al. found only eighteen reported cases of primary temporal bone lymphoma in the English and Japanese literature, including the cases of primary lymphoma of the middle ear [4]. These tumors of the temporal bone are typically associated with facial nerve paralysis and hearing loss, and few cases have a soft mass in the external auditory canal too [5, 6]. Even more rarely, primary NHLs arise from the external auditory canal (EAC) and fill it [7, 8]. Only eight cases of lymphoreticular tumors of the EAC are described in the international literature [2, 7, 9–12]. Thus, the histological and clinical features of primary EAC lymphoma have not been extensively characterized. In this report, we described patient with primary NHL of the EAC who was successfully treated with surgical excision and chemotherapy. A review of the literature regarding EAC lymphoma also is provided to describe the characteristics and management options for this uncommon manifestation of the NHL. 2. Case Report D.G.E., a 46-year-old man, came to our attention in March 2009 for a left hearing loss started 3 weeks before. The patient referred only to aural fullness and he did not report any other symptoms like earache or effusion. Otomicroscopy revealed a polypus occluding the left EAC. The tympanic membrane was not visible. Pure tone audiometry showed a left conductive hearing loss and a normal hearing threshold at right (Figure 1). This peculiar clinical picture could be referred to a middle ear otitis with granulation tissue in external ear, but the absence of aural fullness, othorrea was atypical for this diagnosis. Figure 1: Left conductive hearing loss. Therefore, a petrous bone computed tomography (CT) was performed. The CT