Pathology Quiz Case 1: Diagnosis

Carcinoid tumor of the middle ear is a rare neoplasm. It was first reported in 1980 by Murphy et al,¹ who noted its histologic similarity to adenomatous tumor of the middle ear but defined it as a distinctly different entity. Since then, more recent comprehensive reviews of carcinoid tumors have advocated that the 2 entities be grouped as one.² Carcinoid tumors of the middle ear may present with a variety of symptoms. The single most common presenting complaint is hearing loss, usually conductive in nature. However, patients often present with other nonspecific complaints, such as aural fullness, tinnitus, pain, discharge, disequilibrium, facial nerve paralysis, and bleeding.³ Alternatively, the tumors can remain completely asymptomatic and be discovered incidentally during routine physical examination or during diagnostic radiographic studies performed for other reasons, as in the present case. On otoscopic examination, the tympanic membrane is generally intact but often bulges laterally. A middle ear mass may not always be identified, as the drum is often described as hyperemic or thickened. Of all patients described as having carcinoid tumors of the middle ear, to our knowledge only 1 demonstrated symptoms of the well-known “carcinoid syndrome” (flushing, sweating, wheezing, diarrhea, and abdominal pain).⁴