PMC8294997_01
Preoperative (a-c) and postoperative (d-f) clinical findings. (a) Preoperative otoendoscopic examination revealed a pinkish mass-like lesion (black arrow) behind the anterior portion of the tympanic membrane. Middle ear effusion is observed (white arrow) despite previous ventilation tube insertion (black arrow head). (b) Axial view of temporal bone computed tomography (TBCT) demonstrated soft tissue density obstructing the bony portion of the Eustachian tube (black arrow) and mastoiditis (white arrows). (c) Pure tone audiometry showed conductive hearing loss with an air-bone gap of 37 dB in the left side. (d) Postoperative otoendoscopic examination revealed normal tympanic membrane. (e) Axial view of TBCT demonstrated a clean mastoid cavity (white arrow) and no residual mass in the bony portion of the Eustachian tube (black arrow). (f) Pure tone audiometry showed that the air-bone gap was reduced to 5 dB in the left side.
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fig1
On the otoendoscopic examination, a pinkish mass was seen through the anterosuperior quadrant of the tympanic membrane without discharge (Figure 1(a)). A nonenhanced temporal bone computed tomography (TBCT) demonstrated soft tissue density obstructing the bony portion of the Eustachian tube and opacification in the middle ear and mastoid cavity with an intact bony labyrinth (Figure 1(b)). A pure tone audiometry (PTA) revealed the left-side mixed hearing loss with a large air-bone gap (Figure 1(c)). One year after surgery, the left tympanic membrane appeared normal (Figure 1(d)), TBCT revealed no residual mass in the tympanic cavity (Figure 1(e)), and conductive hearing loss was much improved (Figure 1(f)).
(a) A nonencapsulated, polypoid, pinkish mass (black arrow) and gray-colored mass with fibrotic consistency (white arrow) were seen in the anterior part of the tympanic cavity. Black arrow heads, malleus handle; blue arrow, tympanomeatal flap. (b) Tubular tumor cell structures with intervening bands of tumor stroma are observed, hematoxylin-eosin X100. (c) Immunohistochemical staining for cytokeratin 7 was positive in luminal cells, X100.
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fig2
A retroauricular canal wall-up tympanomastoidectomy was performed, and a polypoid mass filling the anterior part of the tympanic cavity was revealed (Figure 2(a)) and completely removed. Histological examination revealed a nonencapsulated mass composed of glandular structures lined by two layers of epithelium originating from the ceruminous gland, which was consistent with ceruminous gland adenoma (Figure 2(b)). Luminal cells were positive for cytokeratin 7 (Figure 2(c)).