PMC5569943_01
Axial CT scan. Showing soft tissue mass in the right external auditory canal with widening and occlusion of right ear canal (blue arrow) and small middle ear soft tissue opacity (green arrow).
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fig1
There was also soft tissue seen in the sinus tympani (Figures 1-3).
Coronal CT scans. (a) Soft tissue mass in the right external auditory canal (green arrow) extending into Prussak's space (blue arrow). (b) Minimal erosion of the scutum (blue arrow).
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fig2
There was also soft tissue seen in the sinus tympani (Figures 1-3).
Limited coronal CT scan of right ear revealing a lesion in the area of the second genu of the facial nerve (blue arrow).
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fig3
There was also soft tissue seen in the sinus tympani (Figures 1-3).
PMC5569943_02
Intraoperative images. (a) Showing lesion filling ear canal and extending out onto the squamous temporal bone (black arrow). (b) Showing disease on the facial nerve (blue arrow). (c) Postremoval of posterior canal wall, showing ossicles and disease on the facial nerve (black arrow).
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fig4
The perineural lesion was removed from the facial recess and sinus tympani completely (Figure 4).
Hematoxylin and eosin stain (H&E stain). (a) Ear canal ganglioneuroma (10x). Showing (arrow) surface squamous epithelium of the external auditory canal and the ganglioneuroma beneath the surface. (b) High power (40x) showing ganglion cells (blue arrow) without rim of satellite cells among Schwannian stroma (black arrow). (c) (10x) Epitympanum showing ganglion cells (arrow).
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fig5
There are no neuroblasts seen in the current specimen, which was submitted entirely (Figure 5).
PMC5569943_03
(a) Neurofilaments protein immunostain, showing bundles of axons (arrow). (b) Synaptophysin immunostain, showing cytoplasm of ganglion cells (blue arrow) and also axons (black arrow). (c) Neuronal nuclear immunostain, showing the ganglion cells cytoplasm and nuclei (arrow).
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fig6
Immunohistochemistry staining used neurofilaments protein immunostain (showing bundles of axons), synaptophysin immunostain (showing cytoplasm of ganglion cells and also axons), and neuronal nuclear immunostain (showing the ganglion cells' cytoplasm and nuclei) (Figure 6).