PMC7772049_01
Audiometric threshold before (a) and after (b) the surgical treatment. Red circles and lines: right ear air threshold, red triangles and lines: masked right ear air threshold, red triangles: right ear bone threshold, and blue crosses and lines: left ear air threshold.
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Measurement of her audiometric threshold showed that she had bilateral normal hearing levels (Figure 1(a)). Postoperative audiometric examination revealed the presence of good auditory residue in the operated ear (Figure 1(b)).
Axial magnetic resonance imaging (MRI) scans of the middle ear. (a) T1 fat-saturated MRI revealed tissue in the middle ear. (b) T1 diffusion-weighted imaging did not show a restriction of diffusion in the tissue, as is typical of cholesteatoma.
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Magnetic resonance imaging (MRI) of the ear did not reveal any signs of cholesteatoma (i.e., hyperintensity on diffusion-weighted imaging) in the right ear (Figure 2); therefore, we decided to proceed with an excisional biopsy to establish a diagnosis.
Neuroendocrine adenoma of the middle ear (encircled) during the first surgery; view from the ear canal.
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During the surgical procedure, the lesion appeared as a reddish mass with no capsule and had a parenchymatous consistency (Figure 3).
(a) Hematoxylin and eosin stain; the tumor was unencapsulated with an organoid growth pattern characterized by rounded nests and trabecular and glandular aggregates, with hyalinized fibrous stroma in the background (magnification x25). Cytologically, the tumor cells lacked nuclear pleomorphism and exhibited finely dispersed nuclear chromatin (magnification x100). (b) Immunohistochemistry results showed diffuse positivity for Cam 5.2.
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The results of intraoperative histological examination were suggestive of paraganglioma, whereas a definitive histological report highlighted both the presence of neuroendocrine markers (synaptophysin and partial expression of chromogranin A) and epithelial markers (cytokeratin 7 and Cam 5.3) (Figure 4).
(a) Axial T1 fat-saturated magnetic resonance imaging scan of the middle ear; blue arrow indicated the residual tumor in the middle ear before the canal-wall-down tympanoplasty. (b) Axial T1 fat-saturated magnetic resonance imaging scan of the middle ear after one year from the surgical procedure; the blue rectangle showed the absence of recurrence or persistence of the disease.
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The imaging showed some pathological residual tissue (Figure 5(a)). A new MRI was performed at one year postoperatively, and it showed the absence of recurrence or persistence of the disease (Figure 5(b)).