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Clinical Challenge
January 2016

An Unusual Outcome After Mastoidectomy

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Ankara University Medical School, Ankara, Turkey
  • 2Department of Pathology, Ankara University Medical School, Ankara, Turkey
JAMA Otolaryngol Head Neck Surg. 2016;142(1):93-94. doi:10.1001/jamaoto.2015.2798

An elderly man was evaluated for long-standing discharge and hearing loss in the left ear and mild dizziness. Biopsy of the soft tissue at the external ear canal (EEC) showed granulation tissue. He did not have facial weakness. He was obese and had congestive heart failure and hypertension. Findings from the otolaryngologic examination were otherwise unremarkable. Advanced-stage mixed conductive and sensorineural hearing loss in the left ear were noted. Computed tomography (CT) showed a soft-tissue mass in the mastoid and middle ear cavity extending to the EEC with no significant erosion of ossicles (Figure, A). During modified radical mastoidectomy, the mastoid cavity was found to be full of edematous, fragile soft tissue with mucoid secretions. The incus was intact but dislocated. Histopathological examination revealed a polypoid lesion showing typical papillary architecture with central fibrovascular cores and dilated glandular structures, lined by a bland-looking single layer of high columnar/cuboidal epithelial cells (Figure, B). No mitotic activity or necrosis was detected. The richly vascularized fibrotic stroma consisted of cholesterol clefts, foamy macrophages, lymphocytes, and eosinophils, reminiscent of inflammatory granulation tissue (Figure, C). The epithelial cells were positive for cytokeratin-7 (CK7) (Figure, D), CK19, epithelial membrane antigen, and glial fibrillary acidic protein. Ki-67 immunostain showed a proliferation index of less than 1%.

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