middle ear squamous cell carcinoma

Middle ear squamous cell carcinoma (SCC) is a rare type of cancer that affects the middle ear, which is located behind the eardrum and contains three small bones called ossicles.

Characteristics:

• Soft tissue density lesions centered around the middle tympanum, exhibiting increased density, with external auditory canal involvement [1]
• Damage and absorption in the mastoid area, ossicles, and facial nerve canal [1]

Symptoms:

• Firm, red nodules and sores on skin of the ear with a scaly crust are among the most common visible signs of squamous cell carcinoma [3]
• Patients may also notice pain, sudden hearing loss, hemorrhage, and facial palsy [5]

Incidence:

• Estimated incidence of SCCA of the ear is between one and six people per million in the population [14]
• Primary middle ear squamous cell carcinoma is a rare neoplasm seen in less than 1 in 10,000 patients presenting with otologic disease [12]

Histopathology:

• Resembles squamous cell carcinomas at other sites, well to poorly differentiated Infiltrative malignant cells with keratinization, intercellular bridges [11]
• Microscopic (histologic) description of primary middle ear squamous cell carcinoma is similar to that of squamous cell carcinomas at other sites [11]

Age and Gender:

• Most often seen in 50- to 60-year-old men [12]

Middle ear squamous cell carcinoma can cause various symptoms, which are often related to the ear canal and surrounding areas. Here are some common signs and symptoms:

• Otorrhea: Bloody or foul-smelling discharge from the ear is a primary symptom of middle ear cancer [8].
• Otalgia: Pain in the ear, which can be sharp or dull, is another common symptom [7][8].
• Hearing loss: Middle ear squamous cell carcinoma can cause hearing loss, either temporary or permanent [7][9].
• Facial weakness: In some cases, middle ear cancer can cause facial weakness or numbness on one side of the face [7][9].
• Discharge and bleeding: Bloody discharge from the inner ear is a common symptom of middle ear cancer [9].

It's essential to note that these symptoms can also be caused by other conditions, so if you're experiencing any unusual symptoms, it's crucial to consult with a healthcare professional for proper diagnosis and treatment.

References: [7] - Ear cancers can cause symptoms such as pain, bleeding or drainage from the ear, hearing loss, and facial weakness. [8] - Otorrhea is the primary symptom, and otalgia, hearing loss, and bleeding may be frequent as well. [9] - Bloody discharge from the inner ear is the most common symptom for middle ear cancer, but other symptoms include: Inability to move the face on one side.

To diagnose middle ear squamous cell carcinoma, several diagnostic tests can be performed.

Imaging Studies

• A CT scan or MRI scan may be done to clearly identify the location of the growth and to determine if it has spread or not [3]. This information will be used to stage the disease.
• These imaging studies can help doctors determine the extent of the cancer and whether it has spread to other parts of the ear or head and neck region.

Biopsy

• A biopsy is a procedure where a small sample of tissue is taken from the abnormal area of the ear [6]. This is the only way to confirm a diagnosis of cancer.
• The biopsy sample will be examined under a microscope by a pathologist to determine if cancer cells are present.

Other Tests

• Patients suspected of possible ear cancer may undergo ear exams with a microscope, hearing tests, and a biopsy of any suspicious abnormal growths [8]. Imaging studies, such as CT or MRI scans, may also be performed.
• Routine preoperative testing may include CBCs, electrolyte level tests, renal function tests, liver function tests, and coagulation studies [9].

It's worth noting that the diagnosis of middle ear squamous cell carcinoma can be complex and requires a multidisciplinary approach. A team of specialists, including otolaryngologists, radiologists, and pathologists, may work together to determine the best course of action for each patient.

References: [3] - A CT scan or MRI scan may be done to clearly identify the location of the growth and to determine if it has spread or not. [6] - A biopsy is a procedure where a small sample of tissue is taken from the abnormal area of the ear. [8] - Patients suspected of possible ear cancer undergo ear exams with a microscope, hearing tests, and a biopsy of any suspicious abnormal growths. [9] - Routine preoperative testing includes CBCs, electrolyte level tests, renal function tests, liver function tests, and coagulation studies.

Differential Diagnosis of Middle Ear Squamous Cell Carcinoma

Middle ear squamous cell carcinoma (SCCME) is a rare and aggressive form of cancer that can be challenging to diagnose. When clinicians encounter symptoms or signs suggestive of SCCME, it's essential to consider a differential diagnosis to rule out other potential causes.

Possible Differential Diagnoses:

• Cholesteatoma: A non-cancerous growth in the middle ear that can cause similar symptoms to SCCME.
• Direct invasion from nasopharynx, skin, or external auditory canal: Tumors originating from adjacent structures can invade the middle ear and mimic SCCME.
• Middle ear adenocarcinoma: A rare type of cancer that can present with similar symptoms to SCCME.
• Carcinoid of the middle ear: A slow-growing tumor that can cause similar symptoms to SCCME.

Key Diagnostic Features:

To differentiate SCCME from other conditions, clinicians should look for the following features:

• Epithelial maturation: A lack of epithelial maturation is a hallmark of SCCME.
• Pleomorphism and mitoses: Significant pleomorphism and numerous atypical mitoses are characteristic of SCCME.
• Individual cell keratinization and keratin pearls: The presence of individual cell keratinization and keratin pearls is indicative of SCCME.

References:

• [3] Middle ear and inner ear tumors - malignant Squamous cell carcinoma. Author: Nat Pernick, M.D.
• [13] Squamous cell carcinoma is always a component of the histologic differential diagnosis when epithelium is involved.
• [14] Primary squamous cell carcinomas (SCCs) of the middle ear and temporal bone are rare and usually keratinizing by morphology.

These conditions should be considered in the differential diagnosis of middle ear SCCME, and a thorough diagnostic workup, including imaging studies and histopathological examination, is essential to confirm the diagnosis.