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Pathology of Ceruminous Adenoma (Ceruminoma) of the External Ear

Dr Sampurna Roy MD          

 

                                                                                                                      

 

Ceruminous adenoma (ceruminoma) of the external auditory meatus is a rare neoplasm with benign clinical behavior.

Visit: Ceruminous Adenocarcinoma of External Ear

This tumour is mainly composed of the ceruminous gland cells (modified apocrine sweat glands).

These glands are localized deep in the skin mostly in the cartilaginous part of the external auditory meatus.

Clinically, the patients present with a painless mass.

The most common symptom of the ceruminous adenoma of external auditory meatus is the unilateral conductive hearing loss.

Occasionally symptoms of this tumour (pain, otorrhoea) can result from an otitis externa secondary to meatus obstruction.

Gross feature: Circumscribed polypoid masses, range in size from 0.4 to 2 cm in greatest dimension.

Microscopic features:  Histologically, the tumours demonstrate glands and small cysts lined by a tubuloglandular proliferation of inner ceruminous cells -(cerumen-secreting epithelium with decapitation secretion) and outer spindled myoepithelial cells with hyperchromatic nuclei.

The inner cells are cuboidal or columnar cells with eosinophilic cytoplasm and apical snouts and contain yellow-brown granular cerumen pigment.

A hyalinized stroma created an infiltrative pattern of growth and surface involvement was seen in some cases.

Cerumen pigment, CK7, and p63 can help to distinguish this tumour from other neoplasms that occur in the region.

Literature review revealed that in one case the tumour cells were positive for CK, S-100 protein, Glut-1, HIF-1α, PI3K and p-Akt.

Ceruminous adenoma should be radical excised with adequate margins of the normal tissues.

Complete surgical excision results in an excellent long-term clinical outcome:

Differential Diagnosis: The differential diagnosis of ceruminous adenoma includes ceruminous adenocarcinoma, neuroendocrine adenoma of the middle ear, parotid pleomorphic adenoma, meningioma and paraganglioma.

Ceruminal adenocarcinoma is characterized by more infiltrative pattern , perineural invasion, irregular gland formation, pleomorphism with prominent nucleoli, increased mitotic figures including atypical mitotic figures, tumour necrosis.

Usually no ceruminous granules are noted.

Further reading:

Polygonal cells with ceroid granules and myoepithelial cells in fine needle aspiration cytology of ceruminous adenoma.

Expression of Glut-1, HIF-1α, PI3K and p-Akt in a case of ceruminous adenoma.

Expansion of an ceruminous adenoma into the middle ear].

Ceruminous adenomas: a clinicopathologic study of 41 cases with a review of the literature.

Ceruminous gland adenoma of the external auditory canal: a case report.

Ultrastructural morphology of a middle ear ceruminoma.

Ceruminoma revisited.

 

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

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