Ceruminous gland tumours: a reappraisal

Abstract

Ceruminous glands should no longer be regarded as purely apocrine glands, but as apoeccrine glands with both apocrine and eccrine modes of secretion. We present two cases of pleomorphic adenoma of ceruminous glands, among the rarest of such tumours. The use of such terms as ‘ceruminoma’ and ‘hidradenoma’ should finally be abandoned, and ‘ceruminous gland tumour’ used instead as a generic term. Classification should be based on Wetli's prototype (adenoma, pleomorphic adenoma, adenoid cystic carcinoma and adenocarcinoma), with the addition of benign eccrine cylindroma and syringocystadenoma papilliferum; the inclusion of mucoepidermoid carcinoma should await full validation. Wide local excision is necessary for all tumours, with only follow-up for histologically benign neoplasms. Malignant tumours need early aggressive surgery and radiotherapy. If marginal invasion cannot be assessed histologically, then adenoma and adenocarcinoma cannot be distinguished and we suggest that the tumour be reported as ‘of uncertain malignant potential’. Long-term studies are needed to confirm or refute the view that all ceruminous gland tumours are potentially malignant.

Recurrent Ceruminous Adenocarcinoma of the External Auditory Canal

“…Finally, erosion and ulceration may also suggest malignancy if present. CT scans are helpful in detecting bone erosion and disease extension as well as to exclude a primary parotid or middle ear tumor [5]. Our patient's CT scan did not reveal any bony erosion.…”

“…Pain is a characteristic symptom suggesting malignancy [1,5,7]. Hearing loss and secondary otitis externa may be present according to the site and extension of the mass.…”

“…Our patient's CT scan did not reveal any bony erosion. Moreover, histologic confirmation of tumor invasion is sometimes crucial as the tumor may be cytologically indistinct from ceruminous adenoma [5]. An adequate specimen is required to demonstrate infiltration into bone, cartilage, blood vessels or perineurally, and the features are best demonstrated at the periphery of the lesion [1].…”

Ceruminous Adenocarcinoma of External Auditory Canal: A Case Report

“…CT is helpful in detecting bone erosion and destruction as well as tumor extension [10]. The main treatment is surgery.…”

“…The main treatment is surgery. Most authors recommend aggressive surgery that may be followed by radiotherapy [4,10] . As a surgical procedure, Hicks suggested initial wide en bloc surgical resection.…”