ABSTRACT
Salivary gland choristoma is defined as the architecturally normal salivary gland tissues found in abnormal locations. Middle ear salivary gland choristoma usually presents with conductive hearing loss. We present a case of middle ear mass with conductive hearing loss in a 6-year-old boy. A reddish mass was incidentally found behind the normal tympanic membrane. Magnetic resonance image showed the markedly enhancing lesion which was in accordance with glomus tympanicum. Preoperative angiography was performed, but supplying artery and mass was not identified. Surgical exploration was made and the mass was dissected easily without profuse bleeding. Final diagnosis was salivary gland choristoma by histopathology. We discuss the clinical features and management of middle ear salivary choristoma with the review of literature.
Subject(s)
Child , Humans , Male , Angiography , Arteries , Choristoma , Diagnosis , Ear, Middle , Glomus Tympanicum , Hearing Loss, Conductive , Hemorrhage , Salivary Glands , Tympanic MembraneABSTRACT
Jugulotympanic paragangliomas (JTPs) known as glomus tumors, are neoplasms of variable invasiveness that arise from the paraganglia situated around the jugular bulb or middle ear. We now report a rare case of JTP in an 18-year-old male. Preoperative diagnoses through external auditory canal biopsy and radiologic examination both failed. Even using a frozen section, an informative finding was not obtained because mostly granulation tissue was present along with associated squeezing artifacts. On permanent histologic examination, small cell nests between many ectatic small vessels and fibrotic stroma were seen, and those cells were positive for CD56, synaptophysin and chromogranin. Because JTPs are rare and have rather different histologic findings - higher vascularity, smaller and less uniform tumor cells than other paragangliomas - they are easy to misdiagnose. However, remembering those differences may help the physician avoid missing JTPs.
Subject(s)
Adolescent , Humans , Male , Artifacts , Biopsy , Ear Canal , Ear, Middle , Frozen Sections , Glomus Jugulare , Glomus Tumor , Glomus Tympanicum , Granulation Tissue , Paraganglioma , Paraganglioma, Extra-Adrenal , SynaptophysinABSTRACT
Jugulotympanic paragangliomas (JTPs) known as glomus tumors, are neoplasms of variable invasiveness that arise from the paraganglia situated around the jugular bulb or middle ear. We now report a rare case of JTP in an 18-year-old male. Preoperative diagnoses through external auditory canal biopsy and radiologic examination both failed. Even using a frozen section, an informative finding was not obtained because mostly granulation tissue was present along with associated squeezing artifacts. On permanent histologic examination, small cell nests between many ectatic small vessels and fibrotic stroma were seen, and those cells were positive for CD56, synaptophysin and chromogranin. Because JTPs are rare and have rather different histologic findings - higher vascularity, smaller and less uniform tumor cells than other paragangliomas - they are easy to misdiagnose. However, remembering those differences may help the physician avoid missing JTPs.
Subject(s)
Adolescent , Humans , Male , Artifacts , Biopsy , Ear Canal , Ear, Middle , Frozen Sections , Glomus Jugulare , Glomus Tumor , Glomus Tympanicum , Granulation Tissue , Paraganglioma , Paraganglioma, Extra-Adrenal , SynaptophysinABSTRACT
Los parangangliomas son tumores altamente vascularizados que se originan de células provenientes de la cresta neural. El tratamiento de elección es la resección quirúrgica completa, lo cual se ve dificultado por su abundante irrigación y por su estrecha relación anatómica con importantes estructuras vásculo-nerviosas. En el presente estudio se revisa retrospectivamenete la experiencia del Departamento de Otorrinolaringología de Clínica Las Condes en el manejo quirúrgico de estas neoplasias. Entre los años 1998 y 2003 se trataron 5 pacientes portadores de paragangliomas de cabeza y cuello: un glomus yugular (GY), 2 glomus carotídeo (GC) y 2 glomus timpánicos (GT). El estudio imagenológico consistió en tomografía computarizada (TC) para todos los casos, complementada con resonancia nuclear magnética (RNM) y/o angiografía en algunos pacientes. El abordaje quirúrgico fue el indicado para cada lesión: timpanotomía retroauricular (GT), cervicotomía (GC) y abordaje infratemporal tipo A de Fisch (GY). En todos se logró una resección tumoral completa, sin presentarse complicaciones perioperatorias de consideración ni recurrencias hasta la fecha. Contando con un adecuado estudio imagenológico y una cuidadosa planificación quirúrgica, la resección de los paragangliomas de cabeza y cuello puede realizarse con un bajo índice de complicaciones, reservando la radioterapia como alternativa terapéutica únicamente en aquellos casos inoperables.
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Head and Neck Neoplasms/surgery , Head and Neck Neoplasms/pathology , Carotid Body Tumor/surgery , Carotid Body Tumor/pathology , Neoplasm Staging , Follow-Up Studies , Glomus Tympanicum/pathology , Head and Neck Neoplasms/diagnosis , Carotid Body Tumor/classification , Glomus Jugulare Tumor/classification , Vertigo/etiologyABSTRACT
The therapeutic options for glomus tumor management are either palliative (ie, radiation, embolization or a combination) or definitive (ie, surgery or combinations of surgery-radiation, radiation-surgery or embolization-surgery). Of these, surgical excision is the standard treatment modality for glomus tympanicum tumors. As glomus tympanicum tumor has highly vascular nature, profuse hemorrhage may be intermittently induced during its removal. Preoperative embolization is used frequently to reduce intraoperative bleeding. We report a case of glomus tympanicum tumor which was removed completely with the help of direct inject of HistoacrylR into the mass during the operation. This method allows almost bloodless ablation of the entire tumor.
Subject(s)
Enbucrilate , Glomus Tumor , Glomus Tympanicum Tumor , Glomus Tympanicum , HemorrhageABSTRACT
Glomus tympanicum has to be considered to differentiate the etiology of middle ear mass with pulsatile tinnitus. MRI helps to differentiate the mass. Angiography helps to identify its feeding vessels and to embolize to reduce bleeding on operation. When the mass is not focally localized, tympanotomy combinded with mastoidectomy approach via posterior auricular incision is helpful to remove the mass completely.