Malignant tumors originating from the middle ear are rare. The literature identifies chronic inflammation and Human Papillomavirus (HPV) infection as the most common risk factors. A CT scan to assess bony invasion and an MRI to evaluate soft tissue involvement, depth of invasion, and perineural invasion, followed by a biopsy, are indispensable for diagnosis and treatment. There is no standard treatment for squamous cell carcinoma of the middle ear, however, most reported cases are treated with surgical resection followed by postoperative radiotherapy. Given the challenges of achieving complete surgical excision, radiotherapy plays a crucial role in controlling middle ear cancers, as demonstrated in our case. We present a case of squamous cell carcinoma of the middle ear in a 63-year-old female with a history of chronic suppurative otitis media. The patient underwent a right subtotal petrosectomy without lymph node dissection followed by concurrent chemoradiotherapy. At the one-year follow visit, no recurrence or metastasis was detected.
References
[1]
Sandison, A. (2022) Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumours: Tumours of the Ear. HeadandNeckPathology, 16, 76-86. https://doi.org/10.1007/s12105-022-01450-9
[2]
Todorovic, E., Truong, T., Eskander, A., Lin, V., Swanson, D., Dickson, B.C., et al. (2020) Middle Ear and Temporal Bone Nonkeratinizing Squamous Cell Carcinomas with DEK-AFF2 Fusion: An Emerging Entity. AmericanJournalofSurgicalPathology, 44, 1244-1250. https://doi.org/10.1097/pas.0000000000001498
[3]
Gidley, P.W., Roberts, D.B. and Sturgis, E.M. (2010) Squamous Cell Carcinoma of the Temporal Bone. TheLaryngoscope, 120, 1144-1151. https://doi.org/10.1002/lary.20937
[4]
Shu, M., Lee, J., Yang, C. and Wu, K. (2012) Squamous Cell Carcinoma of the Middle Ear. Ear, Nose&ThroatJournal, 91, 14. https://doi.org/10.1177/014556131209100104
[5]
Zhang, F. and Sha, Y. (2013) Computed Tomography and Magnetic Resonance Imaging Findings for Primary Middle-Ear Carcinoma. TheJournalofLaryngology&Otology, 127, 578-583. https://doi.org/10.1017/s0022215113000923
[6]
Allanson, B.M., Low, T., Clark, J.R. and Gupta, R. (2018) Squamous Cell Carcinoma of the External Auditory Canal and Temporal Bone: An Update. HeadandNeckPathology, 12, 407-418. https://doi.org/10.1007/s12105-018-0908-4
[7]
Cristalli, G., Venuti, A., Giudici, F., Paolini, F., Ferreli, F., Mercante, G., et al. (2021) HPV Infection in Middle Ear Squamous Cell Carcinoma: Prevalence, Genotyping and Prognostic Impact. JournalofClinicalMedicine, 10, Article No. 738. https://doi.org/10.3390/jcm10040738
[8]
Correia-Rodrigues, P., Ramalho, S., Montalvão, P. and Magalhães, M. (2020) External Auditory Canal Carcinoma: Clinical Characteristics and Long-Term Treatment Outcomes. EuropeanArchivesofOto-Rhino-Laryngology, 277, 2709-2720. https://doi.org/10.1007/s00405-020-06019-2
[9]
Beauvillain de Montreuil, C. and Jourdain, A. (2012) Tumeurs malignes de l’oreille. EMC—Oto-Rhino-Laryngologie, 7, 1-17. https://doi.org/10.1016/s0246-0351(12)46985-9
[10]
Katre, M.I., Chintale, S.G., Deshmukh, S.D., Keche, P.N. and Dhanajkar, P.S. (2021) Study of Clinicopathological Presentation and Management of Malignant Tumours of the Ear and Temporal Bone at Tertiary Care Cancer Hospital. IndianJournalofOtolaryngologyandHead&NeckSurgery, 74, 3662-3670. https://doi.org/10.1007/s12070-020-02346-2
[11]
Gillespie, M.B., Francis, H.W., Chee, N. and Eisele, D.W. (2001) Squamous Cell Carcinoma of the Temporal Bone: A Radiographic-Pathologic Correlation. ArchivesofOtolaryngology—Head & Neck Surgery, 127, 803-807.
[12]
Allanson, B.M., Low, T., Clark, J.R. and Gupta, R. (2018) Squamous Cell Carcinoma of the External Auditory Canal and Temporal Bone: An Update. HeadandNeckPathology, 12, 407-418. https://doi.org/10.1007/s12105-018-0908-4
[13]
Leong, S.C., Youssef, A. and Lesser, T.H. (2013) Squamous Cell Carcinoma of the Temporal Bone: Outcomes of Radical Surgery and Postoperative Radiotherapy. TheLaryngoscope, 123, 2442-2448. https://doi.org/10.1002/lary.24063
[14]
Snell, R.S. (2012) Clinical Anatomy by Regions. Lippincott Williams & Wilkins.
[15]
Cristalli, G., Manciocco, V., Pichi, B., Marucci, L., Arcangeli, G., Telera, S., et al. (2009) Treatment and Outcome of Advanced External Auditory Canal and Middle Ear Squamous Cell Carcinoma. JournalofCraniofacialSurgery, 20, 816-821. https://doi.org/10.1097/scs.0b013e3181a14b99
[16]
Gupta, R., Sandison, A., Wenig, B.M. and Thompson, L.D.R. (2018) Data Set for the Reporting of Ear and Temporal Bone Tumors: Explanations and Recommendations of the Guidelines from the International Collaboration on Cancer Reporting. ArchivesofPathology&LaboratoryMedicine, 143, 593-602. https://doi.org/10.5858/arpa.2018-0415-sa
[17]
Osu, N., Musha, A., Yumisaki, H., Okada, K., Kubo, N., Okano, N., et al. (2022) The Efficacy of Radiotherapy without Surgery for External Auditory Canal Squamous Cell Carcinoma. JournalofClinicalMedicine, 11, Article No. 5905. https://doi.org/10.3390/jcm11195905
[18]
Shinomiya, H., Uehara, N., Fujita, T., Yoshida, K., Imamura, Y., Teshima, M., et al. (2021) New Proposal to Revise the Classification for Squamous Cell Carcinoma of the External Auditory Canal and Middle Ear. TheJournalofLaryngology&Otology, 135, 297-303. https://doi.org/10.1017/s002221512100089x
[19]
Takenaka, Y., Cho, H., Nakahara, S., Yamamoto, Y., Yasui, T. and Inohara, H. (2014) Chemoradiation Therapy for Squamous Cell Carcinoma of the External Auditory Canal: A Meta‐Analysis. Head&Neck, 37, 1073-1080. https://doi.org/10.1002/hed.23698
[20]
Chen, W., Kuo, S., Chen, Y., Lu, S., Tsai, C., Chia-Hsien Cheng, J., et al. (2012) Postoperative Intensity-Modulated Radiotherapy for Squamous Cell Carcinoma of the External Auditory Canal and Middle Ear: Treatment Outcomes, Marginal Misses, and Perspective on Target Delineation. InternationalJournalofRadiationOncologyBiologyPhysics, 82, 1485-1493. https://doi.org/10.1016/j.ijrobp.2011.05.018
[21]
Ogawa, K., Nakamura, K., Hatano, K., Uno, T., Fuwa, N., Itami, J., et al. (2007) Treatment and Prognosis of Squamous Cell Carcinoma of the External Auditory Canal and Middle Ear: A Multi-Institutional Retrospective Review of 87 Patients. InternationalJournalofRadiationOncologyBiologyPhysics, 68, 1326-1334. https://doi.org/10.1016/j.ijrobp.2007.01.052
[22]
Choi, J., Kim, S., Koh, Y.W., Choi, E.C., Lee, C.G. and Keum, K.C. (2017) Tumor Stage-Related Role of Radiotherapy in Patients with an External Auditory Canal and Middle Ear Carcinoma. CancerResearchandTreatment, 49, 178-184. https://doi.org/10.4143/crt.2016.165
[23]
Theissing, J. (1978) Das Mittelohrkarzinom [The Cancer of the Middle Ear (Author’s Transl.)]. Laryngologie, Rhinologie, Otologie, 57, 85-90.
[24]
Korzeniowski, S. and Pszon, J. (1990) The Results of Radiotherapy of Cancer of the Middle Ear. InternationalJournalofRadiationOncologyBiologyPhysics, 18, 631-633. https://doi.org/10.1016/0360-3016(90)90071-q