Crain Nikhil, Nelson Brenda L, Barnes E Leon, Thompson Lester D R
Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, 5601 De Soto Avenue, Woodland Hills, CA 91367-6701, USA.
Head Neck Pathol. 2009 Mar;3(1):1-17. doi: 10.1007/s12105-008-0095-9. Epub 2008 Dec 3.
Ceruminal gland carcinomas are rare neoplasms confined to the skin lining the cartilaginous part of the external auditory canal.
Retrospective.
The patients included 11 men and 6 women, aged 33-82 years (mean, 59.5 years). Patients presented clinically with a mass of the outer half of the external auditory canal (n = 14), hearing changes (n = 5), drainage (n = 4), or paralysis of the facial nerve (n = 3). The polypoid masses ranged in size from 0.5 to 3 cm in greatest dimension (mean, 1.8 cm). Histologically, the tumors demonstrated a solid to cystic pattern, composed of an infiltrating glandular to cribriform arrangement of epithelial cells. Histologic features included a dual cell population (although not the dominant histology), increased cellularity, moderate to severe nuclear pleomorphism, irregular nucleoli, increased mitotic figures (mean, 3/10 HPF), including atypical forms, and tumor necrosis (n = 2). Tumors were divided into three types of adenocarcinoma based on pattern of growth and cell type (ceruminous, NOS [n = 12], adenoid cystic [n = 4], mucoepidermoid [n = 1]). CK7 and CD117 highlighted the luminal cells, while S1-00 protein showed a predilection for the basal cells of ceruminous and adenoid cystic carcinomas. Metastatic adenocarcinoma or direct extension from salivary gland neoplasms are the principle differential considerations. Surgical resection was used in all patients with radiation used in four patients. Eleven patients were alive or had died of unrelated causes without evidence of disease (mean, 11.2 years); six patients had died with disease (mean, 4.9 years), all of whom had developed local recurrence.
Ceruminous-type carcinomas, with the exception of ceruminous mucoepidermoid carcinoma, all demonstrated a dual cell population of basal myoepithelial-type cells and luminal apocrine cells. The specific histologic sub-type does not influence the long-term patient outcome.
耵聍腺癌是一种罕见的肿瘤，局限于外耳道软骨部的皮肤。
回顾性研究。
患者包括11名男性和6名女性，年龄33 - 82岁（平均59.5岁）。患者临床上表现为外耳道外半段肿物（n = 14）、听力改变（n = 5）、耳漏（n = 4）或面神经麻痹（n = 3）。息肉样肿物最大直径为0.5至3 cm（平均1.8 cm）。组织学上，肿瘤呈实性至囊性结构，由上皮细胞浸润性腺管样至筛状排列组成。组织学特征包括双细胞群（尽管不是主要组织学类型）、细胞增多、中度至重度核多形性、不规则核仁、有丝分裂象增加（平均3/10高倍视野），包括非典型形式，以及肿瘤坏死（n = 2）。根据生长模式和细胞类型，肿瘤分为三种腺癌类型（耵聍腺癌，未特指 [n = 12]、腺样囊性癌 [n = 4]、黏液表皮样癌 [n = 1]）。CK7和CD117突出显示管腔细胞，而S1 - 00蛋白在耵聍腺癌和腺样囊性癌的基底细胞中表达较多。主要的鉴别诊断考虑为转移性腺癌或涎腺肿瘤的直接蔓延。所有患者均采用手术切除，4例患者加用放疗。11例患者存活或死于无关原因且无疾病证据（平均11.2年）；6例患者死于疾病（平均4.9年），所有这些患者均发生了局部复发。
除黏液表皮样耵聍癌外，耵聍型癌均表现为基底肌上皮样细胞和管腔顶泌汗腺细胞的双细胞群。特定的组织学亚型不影响患者的长期预后。
