Pleomorphic Adenoma of Ceruminal Glands


A benign neoplasm of the skin with a structure similar to that of pleomorphic adenoma of salivary glands is also occasionally seen in the external auditory meatus. Cartilage, myoepithelial and adenomatous structures are features of this neoplasm.


Syringocystadenoma papilliferum is seen in children or young adults usually on the scalp or face. Occasionally it occurs in the ear canal. The histological appearance of the neoplasm is that of an invagination from the surface epithelium forming a cyst-like structure. Projecting into the lumen are papillae lined with bilayered glandular epithelium, which may show decapitation secretion typical of apocrine (ceruminal) glands.

Because of the difficulty of classifying a solitary benign neoplasm composed of woven bone and fibrous tissue into one or other of the classical groups - monostotic fibrous dysplasia or ossifying fibroma - the designation benign fibro-osseous lesion (fibrous dysplasia) may be used in most circumstances without loss of accuracy. Lesions of this type are found in the temporal bone often presenting deep to the external ear [65, 80]. On other sides, this lumping is less appropriate, as discussed in Chap. 4.

The main clinical features are progressive loss of hearing, conductive in most, sensorineural, which can be profound, in some and enlargement of the temporal bone with progressive bony occlusion of the external auditory meatus. Facial nerve palsy is present in some patients due to involvement of the facial nerve by the pathological process.

The gross appearance of benign fibro-osseous lesions is one of yellowish-white resilient tissue, which occasionally includes small cysts filled with an amber-coloured fluid. The transition to normal bone is sharp. Microscopically, irregular trabeculae of woven bone are embedded in a connective tissue stroma. The constriction of the ear canal may cause an epidermoid cyst lateral to the tympanic membrane, referred to in some publications as "cholesteatoma" [65].

Although fibrous dysplasia has been on rare occasions associated with malignant disease such as osteo-genic sarcoma, fibrosarcoma, chondrosarcoma and giant cell tumour, the temporal bone is not one of the sites where this change has been described.

Osteoma and exostosis are two types of benign bony enlargement of the deeper bony portion of the external auditory canal. Osteoma is a spherical mass arising from the region of the tympanosquamous or tympanomas-toid suture line by a distinct bony pedicle. Symptoms are usually those of ear canal obstruction. Microscopically, the osteoma is composed of lamellar bone and may show outer cortical and inner cancellous trabeculated areas, the latter with marrow spaces. There may be a thin layer of woven bone on the surfaces of the lamellar bone. The osteoma is covered in the normal squamous epithelium of the ear canal (Fig. 8.5).

Exostosis is a broad-based lesion, which is often bilateral and symmetrical. It is usually situated deeper in the ear canal than osteomas. In the bony portion of the normal external auditory meatus there are no adnexal structures, and the subcutaneous tissue and

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