Medical Excellence- Issue 1

Conclusion Neuroendocrine tumour of the middle ear is a rare presenta- tion. When present surgical excision is the treatment of choice. Diagnosis should be confirmed by immunohistochemistry post- operatively. The role of chemo-radiation in the treatment of neu- roendocrine tumour of the middle ear is controversial. Compliance with Ethical Standards Conflict of interest  All the authors declares that they have no conflict of interest. Ethical Approval  All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed Consent  Informed consent was obtained from all individual par- ticipants included in the study. References 1. Bapat U, Mackinnon N, Spencer MG (2005) Carcinoid tumour of the larynx. Eur Arch Otorhinolaryngol 262:194–197. 2. Ferlito A, Devaney KO, Rinaldo A (2006) Neuroendocrine neoplasm of the larynx: advances in identification, understanding and man- agement. Oral Oncol 42:770–788. 3. Tabuchi K, Aoyagi Y, Uemaetomari I, Tobita T, Wada T, Inadome Y, Noguchi M, Hara A (2009) Carcinoid tumours of the middle ear. J Otolaryngol Neck Surg 38:E91–E94. Fig. 1: H&E stained sections ×10 showing tumour cells in solid islands and trabecular arrangement. Fig. 3: HRCT temporal bone showing low dense component in the left mastoid antrum, aditus and middle ear extending to the external auditory canal. Fig. 2: H&E stained sections ×40, tumour cells showing uniform round nuclei with salt and pepper chromatin and eosinophilic cytoplasm. presents with unilateral hearing loss, tinnitus and occa- sional ear discharge [ 6 ]. Unlike in this case, the tumour usually remains confined to the middle ear cavity. It is usually fragmented, soft, rubbery and white to gray-tan. The tumour can be sub-divided into TC, AC, smCC, combined smCC with non-small cell carcinoma and those with neurological origins (paraganglioma) accord- ing to 2005 WHO classification of head and neck tumours [ 7 – 10 ]. Immunohistochemistry shows tumour positive for Pan CK and Synapatophysin. Differential diagnosis includes paraganglioma, ceruminous adenoma, metastatic adenocarcinoma and meningioma [ 6 ]. Surgical excision of the tumour through modified radical mastoidectomy is the treatment of choice [ 11 ]. Recurrences can be seen (up to 15%), especially if the ossicular chain is not remove [ 6 ]. No sufficient data exist regarding the role of chemo-radiation in middle ear adenoma. Conventional radiotherapy was used earlier either alone or in combination with surgery and chemotherapy. However, their efficacy is yet to be proved [ 12 , 13 ]. In a review by Furuta et al. [ 14 ], it was proposed that radiation and chemotherapy can be per- formed as post-operative adjuvant therapy when a complete resection is difficult and surgery is ineffective. Conclusion Neuroendocrine tumour of the middle ear is a rare pre- sentation. When present surgical excision is the treatment of choice. Diagnosis should be confirmed by immunohis- tochemistry post-operatively. The role of chemo-radiation in the treatment of neuroendocrine tumour of the middle ear is controversial. Fig. 1 H&E stained sections 9 10 showing tumour cells in solid islands and trabecular arrangement Fig. 2 H&E stained sections 9 40, tumour cells showing uniform round nuclei with salt and pepper chromatin and eosinophilic cytoplasm Fig. 3 HRCT temporal bone showing low dense component in the left mastoid antrum, aditus and middle ear extending to the external auditory canal Indian J Otolaryngol Head Neck Surg exist regarding the role of chemo-radiation in middle ear adenoma. Conventional radiotherapy was used earlier either alone or in combination with surgery and chemotherapy. However, their efficacy is yet to be proved [ 12 , 13 ]. In a review by Furuta et al. [ 14 ], it was proposed that radiation and chemotherapy can be per- formed as post-operative adjuvant therapy when a complete resection is difficult and surgery is ineffective. Conclusion Neuroendocrine tumour of the middle ear is a rare pre- sentation. When present surgical excision is the treat e t of choice. Diagnosis should be confirmed by i munohis- tochemistry post-operatively. The role of chemo-radiation in the treatment of neuroendocrine tumour of the middle ear is controversial. stained sections 9 40, tumour cells showing uniform with salt and pepper chromatin and eosin philic temporal bone ense component toid antrum, dle ear extending l auditory canal Surg radical Recurr ossicul exist re adeno either chemot proved propos formed comple Concl Neuroe sentati of choi tochem in the ear is c Fig. 1 H&E stained s ctions 9 10 showing tumour cells in solid islands and trabecular arrangeme t Fig. 2 H&E stained sections 9 40, tumour cells showing uniform round nuclei with salt and pepper chromatin and eosinophilic cytoplasm Fig. 3 HRCT temporal bone showing low dense component in the l ft mastoid antrum, aditus and middle ear extending to the external auditory canal 123 Issue-1  |  19 MEDICAL EXCELLENCE