|Year : 2014 | Volume
| Issue : 1 | Page : 57-58
Squamous cell carcinoma of the middle ear arising from CSOM: A case report
SR Davanageri1, HB Bannur1, AS Harugop2, GS Pilli1
1 Department of Pathology, Jawaharlal Nehru Medical Collage, Belgaum, Karnataka, India
2 Department of Ear, Nose, Throat, Jawaharlal Nehru Medical Collage, Belgaum, Karnataka, India
|Date of Web Publication||7-Feb-2014|
S R Davanageri
Department of Pathology, Jawaharlal Nehru Medical Collage, Belgaum - 590 010, Karnataka
Source of Support: None, Conflict of Interest: None
Squamous cell carcinoma occurring in a background of chronic suppurative otitis media (CSOM) is a rare complication. It runs an aggressive course. Hence early identification is significant to prevent disease progression and to improve the survival rate. Subjecting granulation tissue from middle ear for histopathologic examination is of importance to rule out associated malignant change.
Keywords: CSOM, middle ear, squamous cell carcinoma
|How to cite this article:|
Davanageri S R, Bannur H B, Harugop A S, Pilli G S. Squamous cell carcinoma of the middle ear arising from CSOM: A case report. J Sci Soc 2014;41:57-8
|How to cite this URL:|
Davanageri S R, Bannur H B, Harugop A S, Pilli G S. Squamous cell carcinoma of the middle ear arising from CSOM: A case report. J Sci Soc [serial online] 2014 [cited 2019 Sep 16];41:57-8. Available from: http://www.jscisociety.com/text.asp?2014/41/1/57/126760
| Introduction|| |
Middle ear cancer represents 5-10% of all ear neoplasms. Sqaumous cell carcinoma (SCC) constitutes majority of these neoplasms.  SCC arising from chronic suppurative otitis media (CSOM) is a rare complication with the reported incidence being 1/4000 cases.
It is important to detect these lesions very early, since they retain a poor prognosis despite the development of increasingly radical surgical procedures and advances in radiotherapy.  Herein, we report one such rare case of SCC arising in a background of CSOM.
| Case Report|| |
A 41-year-old male presented with complaints of painful ear discharge since six months, which was blood stained since one month. The ear discharge was initially only mucopurulent, later on became blood tinged and foul smelling. The pain was pulsatile in nature and is aggravated on lying down in left-lateral position. There was history of loss of weight for one month and the patient was a known alcoholic and tobacco-chewer.
On examination, high resolution CT scan of the temporal lobe on the left side showed evidence of a soft lesion involving the middle ear, hypotympanus and limbus extending to the external auditory canal. The lesion was seen to be involving the tensor tympanum muscle and facial nerve, inside the middle ear cavity. There was erosion of the tegmen tympani and posterior wall of the external auditory canal, resulting in punched-out lesions. Bilateral mastoid schuller's view showed sclerosis of mastoid air cells suggestive of bilateral sclerosing mastoiditis.
Clinical diagnosis of CSOM with suspicion of associated malignancy was made. The biopsy tissue sent as granulation tissue from the middle ear was received for histopathological examination, which revealed features suggestive of well differentiated SCC [Figure 1].
|Figure 1: Photomicrograph showing well-differentiated squamous cell carcinoma (H and E, × 100)|
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| Discussion|| |
Malignant transformation in middle ear cleft is an extremely rare phenomenon. The most likely neoplasm being SCC.  It accounts for 60-80% of the carcinomas of the temporal bone.  The classical hallmarks are otologic hemorrhage, intractable pain, sudden deafness, facial palsy and other symptoms of inner ear damage, which may not be evident in few cases.  The common age group of presentation is between 5 th -6 th decade. Middle ear cancer masquerades CSOM for at least 6 months before its diagnosis. The pre- existing CSOM with or without cholesteatoma further delays the diagnosis and poses several diagnostic and therapeutic challenges.  Our case had a similar presentation with a mucopurulent ear discharge initially suggestive of CSOM which later became blood tinged, giving rise to a suspicion of malignancy which was confirmed by histopathologic examination.
Even though CSOM and SCC co-exist, no definitive correlation has been proven. It is widely accepted that one of the most commonly identified predisposing factors in tumor development is chronic suppuration.  The other risk factors include exposure to radiation, viruses and chemical carcinogens like aflatoxin B.  Lodge et al. considered that malignancy developed from cellular metaplasia subsequent to infection. Conley raised the possibility that the biologic features that predispose to chronic recurring infections may be more responsible for the development of cancer than infection per se.  A recent report has suggested the association of human papilloma virus types 16 and 18 with SCC of the middle ear at both tissue and molecular levels, thus providing a good model to explain the pathogenesis of chronic inflammation related human malignancies. 
There are no clear-cut theories in the literature on the facilitation of the genesis of malignancy by CSOM or Cholesteatoma. Lodge et al. suggested that the chronic otitis might promote the development of a carcinoma in the middle ear in a manner analogous to the skin adjacent to draining sinuses resulting from chronic oseomyelitis. 
Middle ear SCC, though a rare entity should be considered with a high index of suspicion when there is refractory or excessively bleeding granulation. Histopathologic examination of all granules and polyps is of significance in early diagnosis and treatment.  SCC in the early stage is susceptible to be cured and in advanced stage, surgical resection with radiotherapy and chemotherapy could improve the survival. Recurrence and metastasis mainly occur in advanced stages and result in a poor survival.  The poor prognostic markers include facial nerve paralysis, positive tumor margins, dural involvement, regional lymph node involvement , multiple cranial involvement and severe pain. The 5 year survival remains 25-35%. 
This case is reported for the rare incidence of the occurrence of SCC in association with CSOM. Early identification of malignancy helps in preventing the progression of the disease, thereby initiating early treatment, and thus improving the survival rate. Histopathological examination of granulation tissue from the middle ear is of great importance, so as to rule out associated malignant change.
| References|| |
|1.||Kumar KS, Venugopal M, Rajan S. Middle ear malignancy masquerading as csom. Indian J Otolaryngol Head Neck Surg 2001;53:135-7. |
|2.||Vikram BK, Saimanohar S, Narayanaswamy GN. Is Squamous Cell Carcinoma of Middle Ear a Complication of Chronic Suppurative Otitis Media? Internet J Otolaryngol 2007;6:10. |
|3.||Lasisi O, Ogunleye A, Akang E. Squamous cell carcinoma of mastoid- A report of two cases. Ghana Med J 2005;39:28-32. |
|4.||Yin M, Ishikawa K, Honda K, Arakawa T, Harabuchi Y, Nagabashi T, et al. Analysis of 95 cases of squamous cell carcinoma of external and middle ear. Auris Nasus Larynx 2006;33:251-7. |