Alberto Staffieri

Intracranial Invasion from Primary Adenocarcinoma Arising in the External and Middle Ear

Objective: Primary middle ear and external ear adenocarcinoma is extremely rare. Involvement of the antrum, mastoid, petrous bone and parotid gland has been described. Intracranial invasion has been rarely reported. Patient: The authors present a new case of primary adenocarcinoma of the middle ear, external canal, mastoid, petrous part of the temporal bone with intracranial invasion. Conclusions: Diagnostic (in particular differential diagnosis from endolymphatic sac tumours) and therapeutic problems are discussed. Computerized tomography is useful in detecting bone involvement beyond the external canal, giving a direct representation of the markedly destructive pathological process. Magnetic resonance has better soft tissue contrast, permitting more accurate evaluation of the cartilaginous portion of the external auditory canal, surrounding soft tissues, intracranial extension, and vascular encasement. The limited number of cases reported in the literature recommend radical surgery and postoperative radiotherapy on initial presentation.