And Sebaceous Types

A hamartoma is a focal overgrowth, in improper proportions, of tissues normally present in that part of the body. A choristoma is similar to hamartoma, except that the tissues of which it is composed are not normally present in the part of the body where it is found. Choristomas are occasionally seen in the middle ear. They are composed of one or other of three types of tissue: salivary gland, glial or sebaceous glandular tissue.

Salivary gland choristomas consist as a rule of mixed mucous and serous elements like the normal subman-dibular or sublingual gland, but unlike the parotid gland. The lesion typically consists of a lobulated mass of histologically normal salivary gland tissue in the middle ear attached posteriorly in the region of the oval window. Frequently, the mass is intimately associated with the facial nerve. There are usually absent or malformed ossicles [44].

Glial choristomas are composed largely of astrocyt-ic cells with large amounts of glial fibrils, the identity of which may be confirmed by immunohistochemical staining for glial acidic fibrillary protein. When such masses are identified in biopsy material from the middle


Adenoma is the commonest neoplasm of the middle ear. The epithelium of the middle ear has a propensity towards gland formation in otitis media (see above) and adenoma would seem to represent a benign neoplastic transformation of the epithelium along the same lines.

The neoplasm has been described as being white, yellow, grey or reddish brown at operation and unlike para-ganglioma is usually not vascular. It is usually situated in the middle ear cavity, sometimes extending into the mastoid. It seems to peel away from the walls of the surrounding middle ear with ease, although ossicles may sometimes be entrapped in the tumour mass and may even show destruction.

Adenoma is formed by closely apposed small glands with a "back to back" appearance (Fig. 8.13). In some places a solid or trabecular arrangement is present. Sheet-like, disorganised areas are seen in which the glandular pattern appears to be lost. This may be ar-tefactual and related to the effects of trauma used in taking the biopsy specimen on the delicate structure of the cells, but the appearance may erroneously lead one to suspect malignancy. The cells are regular, cuboidal or columnar and may enclose luminal secretion. A dis

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