PMC6286763_01
2008 high-resolution multidetector computed tomography (MDCT) (axial views) showing nonosteolytic nodular tissue mass in the hypotympanum alongside the promontory.
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fig1
The well-defined soft tissue mass density observed on the CT scan close to the ossicles but without any bone erosion did not support a diagnosis of cholesteatoma (cf.  Figure 1).
(a) Hematoxylin-eosin (HE) stain: the pattern of growth is trabecular or glandular. The tumor cells are uniform and cuboidal with a moderately abundant acidophilic cytoplasm. Mitoses are rare and necrosis absent. (b) Immunostaining for synaptophysin. (c) Immunoreactivity: typical immunostaining for chromogranin.
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No necrosis or mitotic activity was identified (cf.  Figure 2(a)). Immunohistochemical staining was strongly positive for synaptophysin (cf.  Figure 2(b)), focally positive for chromogranin (cf.  Figure 2(c)) and neuron-specific enolase (NSE), reactive for epithelial membrane antigen (EMA) and cytokeratin (AE1/AE3) but was negative for S100 protein.
(a) 111In-pentetreotide scintigraphy from 2010 (MIP) intense activity in the right ME. (b) 111In-pentetreotide scintigraphy from 2010 (fused transverse SPECT/CT images and transverse SPECT images).
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fig3
Two years after the tumor resection, the patient presented an intense right otalgia and a neurosensorial hearing loss. 111Indium-pentetreotide scintigraphy showed an intense activity in the right ME (cf.  Figure 3), and the CT scan revealed a soft tissue density mass in the attic of the ME, which confirmed the MEANT recurrence (cf.  Figure 4).
High-resolution MDCT from 2010 (coronal and axial views): nodular tissue mass located in the mesotympanum covering the incus and the stapes without osteolysis, suspected of tumor recurrence.
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fig4
Two years after the tumor resection, the patient presented an intense right otalgia and a neurosensorial hearing loss. 111Indium-pentetreotide scintigraphy showed an intense activity in the right ME (cf.  Figure 3), and the CT scan revealed a soft tissue density mass in the attic of the ME, which confirmed the MEANT recurrence (cf.  Figure 4).