Primary Adenoid Cystic Carcinoma, Subtype of Ceruminous Adenocarcinoma in Right External Auditory Canal: a Case Report

Eka Putra Pratama, Susilawati, Wresnindyatsih
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Abstract

Background. Ceruminous adenocarcinoma is rare, accounting for less than 2,5% of all external auditory canal neoplasms. The tumours occur in the outer half of the external auditory canal, excluding direct extension from parotid gland. Adenoid cystic carcinoma is the most common subtypes. Adenoid cystic carcinoma needs to be distinguished from its primary origin from the salivary glands and extends to ear, because they share the same histopathology features and immunohistochemistry. Therefore, combinations of clinical features and radiology is needed to diagnose this tumour correctly.Case description. A female patient, 60 years old, admitted to RSMH Palembang with complaint ofyellow discharge coming out from ear. She also havehearing loss and pain since 6 months before admission to the hospital. One week later, the patient develops facial weakness with no mass on face. CT-Scan examination was performed, with the results showed that the mass in right external auditory canal and extends to the mastoid cavity, maxillary sinus wall and brain parenchym. Biopsy was performed in mastoid region and revealed tumour mass with cribriform pattern, few solid pattern, consists of bilayered neoplastic cells with inner luminal and outer abluminal cells. Immunostaining showed CK7 and CD117 positive in luminal cells, p63 positive in abluminal cells, S100 showed positivity in myoepithelial cells.Discussion and conclusion. Based on clinical symptoms, radiology, histopathology, and imunohistochemical staining, the mass in right mastoidis consistent with a ceruminous adenocarcinoma, adenoid cystic carcinoma subtypes, originated from external auditory canal.
右侧外耳道原发性腺样囊性癌,耵聍腺癌亚型1例
背景。耵聍腺癌是罕见的,占所有外耳道肿瘤的不到2.5%。肿瘤发生在外耳道的外半部,不包括从腮腺直接延伸出来的。腺样囊性癌是最常见的亚型。由于腺样囊性癌具有相同的组织病理学特征和免疫组织化学特征,因此需要将其与原发于唾液腺并延伸至耳部的腺样囊性癌区分开来。因此,需要结合临床特征和影像学来正确诊断该肿瘤。案例描述。一名女患者,60岁,因耳朵流出黄色分泌物而入住巨港皇家医院。入院前6个月,她也有听力损失和疼痛。一周后,患者出现面部无力,面部无肿块。行ct扫描检查,肿块位于右侧外耳道内,并向乳突腔、上颌窦壁及脑实质延伸。在乳突区行活检,肿瘤肿块呈筛状,少量实型,由内腔和外腔细胞组成的双层肿瘤细胞组成。免疫染色显示CK7和CD117在腔细胞中呈阳性,p63在腔细胞中呈阳性,S100在肌上皮细胞中呈阳性。讨论与结论。根据临床症状、影像学、组织病理学和免疫组织化学染色,右侧乳突肿块符合一种起源于外耳道的耵聍腺癌、腺样囊性癌亚型。
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