PATHOLOGIC QUIZ CASE 1
Robert Naclerio, MD, Houston
A 31-year-old man lost the hearing in his right ear for two months. His hearing had been deteriorating gradually in his right ear until one week before his admission to the hospital, when he noticed a sudden decrease in hearing associated with an airplane flight. He experienced no vertigo, tinnitus, pain, or discharge and did not have a history of ear disease.Results of a physical examination showed a normal left ear. In the right ear there was a normal external auditory canal. However, a mass located anterior and posterior to the malleus was visualized through an intact tympanic membrane. An audiogram demonstrated a 20-dB conductive hearing loss in the right ear. A type B tympanogram was obtained.At exploration of the right middle ear, a white, fleshy mass was seen encompassing the incus and stapes. Histologic sections of the mass are