Challenges in diagnosing ceruminous adenocarcinoma

• Published in: BMJ case reports Vol. 14; no. 5; p. e241069
• Main Authors: Abelardo, Edgardo, Ng, Selwyn, Pope, Laysan, Prabhu, Vinod
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 06.05.2021; BMJ Publishing Group
• Subjects: Adenocarcinoma - diagnostic imaging; Biopsy; Cancer; Case reports; Ears & hearing; Head & neck cancer; Histology; Humans; Images In; Medical diagnosis; Neck; Nose; Pharynx; Tumors; Ulcers; head and neck cancer; ear; nose and throat/otolaryngology
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-241069

CA poses a challenge to pathologists as this is a rare tumour, with one large centre reporting only 0.00025% of all the surgical specimens, and 2.4%–5% of all ear canal malignancies.1 2 Histologically, the lesion was a highly infiltrative basaloid tumour with cribiform, tubular and cord-like infiltrative patterns with perineural invasion (figure 2A–C). CA has non-specific symptoms including otalgia, discharge, ear fullness, vertigo, tinnitus, hearing loss, ear bleeding, ear canal polyp and facial palsy, which could initially suggest a simple benign inflammatory condition.3 4 Considering this patient is diabetic with disproportionate otalgia, necrotising otitis externa was initially entertained. Perineural invasion is common and recurrence is as high as 90% if parotid gland was initially involved.1 Even with negative margins following resection, recurrence and distance metastasis occur.6 On average, patients with CA had a mean time from initial presentation to death of 4.7 years.1 Learning points A wax-producing gland in the ear canal can give rise to a neoplastic process, which can be benign or malignant.