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Pathology of Meningioma of the Middle Ear

Dr Sampurna Roy MD

 

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Primary extracranial meningiomas have been documented in the ear, skin, orbit, parapharyngeal space, parotid gland, mediastinum, and rarely the paranasal sinuses.

Site: The tumours affected the middle ear ,external auditory canal or a combination of temporal bone and middle ear.

Meningiomas arising in or presenting as middle ear lesions are relatively uncommon.

The great majority of tumours that arise in the internal auditory canal are schwannomas of the eighth cranial nerve (acoustic neuromas). Meningiomas constitute the second largest group of posterior fossa tumors.   

Vestibular Schwannoma of the Ear

Meningiomas arise from arachnoid villae, the apparatus responsible for cerebrospinal fluid absorption, in proximity to a major vein or dural sinus in most cases. These structures are present in many places in the temporal bone.

Arachnoid villae are present along neural foramena at the base of the skull. They have been observed histologically in the internal auditory canal and are the probable site of origin of meningiomas in this location.

Meningiomas of the jugular foramen manifest the same signs and symptoms as glomus jugulare tumours. They arise from arachnoid cells lining the jugular bulb and grow slowly, infiltrating the temporal bone and posterior fossa.

These lesions, however, are more clinically treacherous than glomus tumours.

Meningiomas infiltrate surrounding bone and nerve tissue and require wide margins of resection to prevent recurrence.

Primary meningioma most commonly occurs in the middle ear cleft.

Clinical presentation: Patients often complain of vestibulocochlear nerve disturbance at presentation. Patients clinically present with hearing changes, otitis, pain, and/or dizziness/vertigo.

Gross appearance: The tumours ranged in size from 0.5 to 4.5 cm in greatest dimension. Gross features are those of granular or gritty mass.

Microscopic features:  Histologically, the tumours demonstrated features similar to those of intracranial meningiomas, including meningothelial, psammomatous, fibroblastic and atypical meningioma.

An associated cholesteatoma may identified in some cases.

The most common form of meningioma in the middle ear is of meningothelial type.

Immunohistochemical studies confirm the diagnosis of meningioma with positive reactions for epithelial membrane antigen and vimentin.

The differential diagnosis includes paraganglioma , schwannoma , carcinoma, melanoma, and middle ear adenoma.

 

Further reading:

Temporal bone secretory meningioma presenting as a middle ear mass.

Cerebellopontine angle meningioma resulting in middle-ear polyp.

Meningioma of the internal auditory canal: a case report.

Meningiomas of the cerebellopontine angle with extension into the internal auditory canal.

Meningiomas of the internal auditory canal.

Meningioma of the internal auditory canal: case report.

Primary ear and temporal bone meningiomas: a clinicopathologic study of 36 cases with a review of the literature.

Meningioma in the internal auditory canal.

Middle ear meningiomas.

Temporal meningiomas presenting as chronic otitis media. 

Meningiomas of the jugular foramen.

Meningioma of the internal auditory canal.

Primary tumors of the external and middle ear. II. A clinicopathologic study of 14 paragangliomas and three meningiomas.

Meningiomas of the middle ear.

 

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Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

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