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| {{Infobox medical condition (new) | | {{Short description|A benign tumor of the ceruminous glands in the ear}} |
| | name = <!--{{PAGENAME}} by default--> | |
| | synonym = '''Adenoma of the ceruminous gland''' and '''ceruminoma'''<ref name="Mills">{{cite journal
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| |title='Ceruminoma'--a defunct diagnosis
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| |vauthors=Mills RG, Douglas-Jones T, Williams RG |journal=J Laryngol Otol
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| |date=Mar 1995
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| |volume=109
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| |issue=3
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| |pages=180–8
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| |pmid=7745330
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| |doi=10.1017/s0022215100129652
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| }}</ref>
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| A '''ceruminous adenoma''' is a benign glandular neoplasm which arises from the [[ceruminous glands]] located within the external auditory canal. These glands are found within the outer one third to one half of the external auditory canal, more common along the posterior surface; therefore, the tumor develops within a very specific location.<ref name="Thompson">{{cite journal | |
| |title=Ceruminous adenomas: a clinicopathologic study of 41 cases with a review of the literature
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| |vauthors=Thompson LD, Nelson BL, Barnes EL |journal=Am J Surg Pathol
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| |date=Mar 2004
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| |volume=28
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| |issue=3
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| |pages=308–18
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| |pmid=15104293
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| |doi=10.1097/00000478-200403000-00003
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| }}</ref><ref name="Durko">{{cite journal
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| |title=[Glandular neoplasms of the external auditory canal--clinical and morphologic observations]
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| |vauthors=Durko T, Danilewicz M, Pajor A |journal=Otolaryngol Pol.
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| |year=2003
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| |month=
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| |volume=57
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| |issue=1
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| |pages=51–7
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| |pmid=12741144
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| }}</ref><ref name="Hicks">{{cite journal
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| |title=Tumors arising from the glandular structures of the external auditory canal
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| |author=Hicks GW
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| |journal=Laryngoscope
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| |date=Mar 1983
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| |volume=93
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| |issue=3
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| |pages=326–40
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| |pmid=6300574
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| |doi=10.1288/00005537-198303000-00016
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| }}</ref> | |
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| == Signs and symptoms ==
| | '''Ceruminous adenoma''' is a rare, benign neoplasm that arises from the [[ceruminous glands]] located in the external [[auditory canal]]. These glands are specialized [[apocrine glands]] responsible for the production of [[earwax]], or cerumen. Ceruminous adenomas are considered to be non-cancerous and are typically slow-growing. |
| Ceruminous adenoma are rare tumors, accounting for less than 1% of all external ear tumors. The patients will present with a mass, perhaps associated pain, and may have changes in hearing (usually a sensorineural or a conductive hearing loss). Some patients have tinnitus. Nerve paralysis is very uncommon.<ref name="Thompson"/> | |
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| == Pathology findings == | | ==Pathophysiology== |
| [[File:Ear Ceruminous Adenoma H & E LDRT.tif|thumb|[[Hematoxylin and eosin]] stained slides shows a biphasic glandular proliferation with inner apocrine cells and basal myoepithelial cells, separated by fibrous connective tissue stroma.]]
| | Ceruminous adenomas originate from the ceruminous glands, which are modified sweat glands found in the skin of the external auditory canal. These tumors are composed of glandular structures that resemble normal ceruminous glands but exhibit a benign proliferation. The exact cause of ceruminous adenoma is not well understood, but it is believed to be related to the abnormal growth of glandular tissue. |
| The tumors are usually small, with a mean size of about 1.2 cm.<ref name="Thompson"/>
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| The tumors are separated into three histologic types based on the dominant findings:
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| * Ceruminous adenoma<ref name="Thompson"/>
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| * Ceruminous pleomorphic adenoma<ref name="Thompson"/><ref name="Markou">{{cite journal
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| |title=Primary pleomorphic adenoma of the external ear canal. Report of a case and literature review
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| |vauthors=Markou K, Karasmanis I, Vlachtsis K, Petridis D, Nikolaou A, Vital V |journal=Am J Otolaryngol
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| |date=March–April 2008
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| |volume=29
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| |issue=2
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| |pages=142–6
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| |pmid=18314029
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| |doi=10.1016/j.amjoto.2007.04.005
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| }}</ref>
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| * Ceruminous syringocystadenoma papilliferum<ref name="Thompson"/>
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| All of the tumors are unencapsulated, but are usually well defined or circumscribed. The overlying surface epithelium is not involved. The tumor shows a dual or biphasic appearance, with glandular or cystic spaces showing inner luminal secretory cells with abundant granular, eosinophilic cytoplasm subtended by basal, [[myoepithelial cell]]s at the periphery, adjacent to the [[basement membrane]]. The luminal cells will often have decapitation ([[apocrine]]) secretions and will also have yellow-brown, ceroid, [[lipofuscin]]-like (cerumen) pigment granules. There is no pleomorphic, limited [[mitosis|mitoses]], and no [[necrosis]].<ref name="Thompson"/>
| | ==Clinical Presentation== |
| | Patients with ceruminous adenoma may present with symptoms such as: |
| | * [[Hearing loss]] |
| | * [[Tinnitus]] |
| | * [[Otalgia]] (ear pain) |
| | * Aural fullness |
| | * Occasionally, [[otorrhea]] (ear discharge) |
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| [[Immunohistochemistry]] can be performed to confirm the biphasic nature of the tumor. All cells are positive with [[pancytokeratin]] and [[epithelial membrane antigen]]; only the luminal [[cell (biology)|cell]]s are positive with [[Keratin 7|CK7]]; only the basal cells are positive with [[CK5/6]], [[TP73L|p63]], [[S-100 protein|S100]] protein. [[CD117]] can be positive in either population. The cells are negative with [[chromogranin]], [[synaptophysin]] and [[Keratin 20|CK20]].<ref name="Thompson"/>
| | The tumor may be visible upon otoscopic examination as a mass in the external auditory canal. |
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| == Diagnosis == | | ==Diagnosis== |
| The major diagnosis from which to separate ceruminous adenoma is ceruminous adenocarcinoma, which shows an infiltrative growth, pleomorphism, mitoses, necrosis, and lacks ceroid pigment granules.<ref name="Crain">{{cite journal | | The diagnosis of ceruminous adenoma is typically made through a combination of clinical examination and imaging studies. [[Computed tomography]] (CT) or [[magnetic resonance imaging]] (MRI) may be used to assess the extent of the tumor. Definitive diagnosis is achieved through histopathological examination of a biopsy or excised tissue, which reveals characteristic glandular structures. |
| |title=Ceruminous gland carcinomas: a clinicopathologic and immunophenotypic study of 17 cases.
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| |vauthors=Crain N, Nelson BL, Barnes EL, Thompson LD |journal=Head Neck Pathol
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| |date=Mar 2009
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| |volume=3
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| |issue=1
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| |pages=1–17
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| |pmid=20596983
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| |doi=10.1007/s12105-008-0095-9
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| |pmc=2807538
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| }}</ref> Other tumors which need to be excluded include a neuroendocrine adenoma of the middle ear (middle ear adenoma),<ref name="Torske">{{cite journal
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| |title=Adenoma versus carcinoid tumor of the middle ear: a study of 48 cases and review of the literature
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| |vauthors=Torske KR, Thompson LD |journal=Mod Pathol
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| |date=May 2002
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| |volume=15
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| |issue=5
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| |pages=543–55
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| |pmid=12011260
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| |doi=10.1038/modpathol.3880561
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| }}</ref> paraganglioma, and endolymphatic sac tumor.<ref name="Thompson"/><ref name="Lassaletta">{{cite journal
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| |title=Avoiding misdiagnosis in ceruminous gland tumours
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| |vauthors=Lassaletta L, Patrón M, Olóriz J, Pérez R, Gavilán J |journal=Auris Nasus Larynx
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| |date=Aug 2003
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| |volume=30
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| |issue=3
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| |pages=287–90
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| |pmid=12927294
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| |doi=10.1016/S0385-8146(03)00055-5
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| }}</ref>
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| ==Management== | | ==Treatment== |
| The tumors are usually removed in small pieces due to the anatomic confines of the area.<ref name="Thompson"/> | | The primary treatment for ceruminous adenoma is surgical excision. Complete removal of the tumor is usually curative, and recurrence is rare. Surgery is typically performed under local or general anesthesia, depending on the size and location of the tumor. |
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| == Prognosis == | | ==Prognosis== |
| Patients treated with complete surgical excision can expect an excellent long term outcome without any problems. Recurrences may be seen in tumors which are incompletely excised.<ref name="Thompson"/>
| | The prognosis for patients with ceruminous adenoma is excellent, as these tumors are benign and do not metastasize. Recurrence after complete surgical excision is uncommon. |
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| == Epidemiology == | | ==Related pages== |
| While there is a wide age range at clinical presentation (12–85 years), most patients come to clinical attention at 55 years (mean). There is no gender difference.<ref name="Thompson"/>
| | * [[Ceruminous gland]] |
| | | * [[Earwax]] |
| == References ==
| | * [[Auditory system]] |
| {{reflist|30em}}
| | * [[Benign tumor]] |
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| == Further reading ==
| |
| {{cite book |author1=Lester D. R. Thompson |author2=Bruce M Wenig |title=Diagnostic Pathology: Head and Neck: Published by Amirsys |publisher=Lippincott Williams & Wilkins |location=Hagerstown, MD |year=2011 |pages=7:42–45 |isbn=1-931884-61-7 |oclc= |doi= |accessdate=}}
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| {{Tumors of skin appendages}}
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| [[Category:Benign neoplasms]] | | [[Category:Benign neoplasms]] |
| {{dictionary-stub1}}
| | [[Category:Otorhinolaryngology]] |
| == Ceruminous_adenoma ==
| | [[Category:Rare diseases]] |
| <gallery>
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| File:Ear_Ceruminous_Adenoma_H_&_E_LDRT.tif|Ear Ceruminous Adenoma H & E LDRT
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| </gallery>
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A benign tumor of the ceruminous glands in the ear
Ceruminous adenoma is a rare, benign neoplasm that arises from the ceruminous glands located in the external auditory canal. These glands are specialized apocrine glands responsible for the production of earwax, or cerumen. Ceruminous adenomas are considered to be non-cancerous and are typically slow-growing.
Pathophysiology
Ceruminous adenomas originate from the ceruminous glands, which are modified sweat glands found in the skin of the external auditory canal. These tumors are composed of glandular structures that resemble normal ceruminous glands but exhibit a benign proliferation. The exact cause of ceruminous adenoma is not well understood, but it is believed to be related to the abnormal growth of glandular tissue.
Clinical Presentation
Patients with ceruminous adenoma may present with symptoms such as:
The tumor may be visible upon otoscopic examination as a mass in the external auditory canal.
Diagnosis
The diagnosis of ceruminous adenoma is typically made through a combination of clinical examination and imaging studies. Computed tomography (CT) or magnetic resonance imaging (MRI) may be used to assess the extent of the tumor. Definitive diagnosis is achieved through histopathological examination of a biopsy or excised tissue, which reveals characteristic glandular structures.
Treatment
The primary treatment for ceruminous adenoma is surgical excision. Complete removal of the tumor is usually curative, and recurrence is rare. Surgery is typically performed under local or general anesthesia, depending on the size and location of the tumor.
Prognosis
The prognosis for patients with ceruminous adenoma is excellent, as these tumors are benign and do not metastasize. Recurrence after complete surgical excision is uncommon.
Related pages
