Three cases of middle ear and mastoid neoplasms are reported as "adenomatous tumors" since in their search of the literature the authors did not find any previously described lesions with a similar histologic appearance and benign biologic behavior. Microscopically, all three tumors are similarly composed of solid cords and nests of closely-packed small cells having an epithelial appearance. Two distinct cell types are present: cuboidal cells, arranged in a rudimentary gland-like pattern, and angular cells forming irregular nests with no distinct pattern. All three tumors developed in patients in their 20's, over a period of months with minimal symptoms; yet in all of the lesions the tympanic membrane was intact at the time of initial examination. None of the neoplasms was diagnosed preoperatively, and, once removed, all three tumors were pathologic enigmas and therapeutic problems in view of the initial and subsequent consultant pathologic opinions; nevertheless, total local excision with preservation of the tympanic membrane would appear to be safe treatment in these cases. The term "adenomatous tumor" is applied to these three neoplasms because: 1. a true glandular epithelial origin warranting the term adenoma or adenocarcinoma cannot be proven; and 2. the biologic behavior and prognosis is not necessarily reflected by the histologic appearance. A more specific term reflecting the origin and behavior of these tumors does not appear possible without the study of further cases.
The one time revolutionary allergic approach to the management of many previously considered surgical problems in rhinology is an accepted fact in our specialty. Now, a similar plan of allergic therapy aimed not only at treating symptoms, but also at the fundamental cause of several acute and chronic disorders of the external, middle and internal ear is evolving.Allergic disease is most often found in such tissues as the skin and the mucous membranes of the respiratory and gastro-intestinal tracts since they are the principal contacts of the human organism with the substances of the environment. The embryological derivatives of those tissues are similarly but less frequently affected by the allergic reaction. The salivary glands, the pancreas and the nasal accessory sinuses are examples. The middle ear and eustachian tube lined by respiratory mucosa, and the membranous labyrinth in the internal ear derived from an infolding of the fetal ectoderm, are pertinent examples.Although the concept that allergic diseases do occur in the ear is not new, the general acceptance and recognition by the otologist of the frequency of allergic states in the ear is not as yet an accomplished fact. Several reasons exist for the failure to recognize allergic ear disease, as well as other allergic disorders. The most important reason is the lack of one accepted conclusive test to prove allergy. The finding of increased eosinophiles in secretions or tissues is strong presumptive evidence of an allergic reaction, but it is not conclusive evidence. Skin tests as a diagnostic measure can often be misleading and disappointing. The most reliable proof of an allergic etiology is the therapeutic test, but even this is not completely conclusive due to the tendency to spontaneous remissions in allergic conditions, particularly in acute ones. The long standing chronic diseases which are resistant to all other forms of treatment and which respond to allergic management should be considered as allergic in origin.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.