PMC4090429_01
(a) Pure tone audiogram at presentation. (b) Pure tone audiogram 2 years following PORP.
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A pure tone audiogram (Figure 1) showed normal hearing in the right ear, with a high frequency sensorineural loss in the left. No signs of persistence or recurrence were found, and a partial ossicular reconstruction prosthesis (PORP) was performed with good results (see Figure 1(b)).
Computer tomogram at presentation.
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Temporal bone computer tomography showed a right sided middle ear soft tissue mass with possible erosion of the ossicles (Figure 2).
Intraoperative findings.
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Intraoperatively (Figure 3), the whole middle ear was filled with the soft tissue mass apart from a small area superiorly/anteriorly.
(a) Histological finding (overview), neuroendocrine adenoma (hematoxylin-eosin stain). (b) Histological finding (magnification), neuroendocrine adenoma (hematoxylin-eosin stain). (c) Histological finding (magnification), neuroendocrine differentiation (synaptophysin stain).
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Pathological examination revealed a glandular and neuroendocrine tumor with areas of pleomorphic nuclei (Figures 4(a) and 4(b)). Immunohistochemically, the cells excessively expressed a marker protein for neuroendocrine cells (synaptophysin, Figure 4(c)) and partially chromogranin A.