J Korean Soc Radiol.  2013 Sep;69(3):187-191. 10.3348/jksr.2013.69.3.187.

CT and Magnetic Resonance Imaging Features of Middle Ear Adenoma of Neuroendocrine Differentiation: A Case Report

• Lee SK
• Choe MS

• KMID: 2208799
• DOI: http://doi.org/10.3348/jksr.2013.69.3.187

Abstract

Middle ear adenoma is a rare benign epithelial tumor. We report the CT and magnetic resonance imaging findings of a case of middle ear adenoma of neuroendocrine differentiation in a 36-year-old man. On high-resolution CT, the mass was found to fill the middle ear, in which the ossicles were embedded, but not destroyed, with outward bulging of the intact tympanic membrane. On MRI, the mass, which was intensely enhanced on 3-dimensional (3D) gadolinium (Gd)-enhanced spoiled gradient-recalled (SPGR) sequence, involved the middle ear, aditus ad antrum and a portion of mastoid antrum. Histological and immunohistochemical findings of the specimen obtained by surgical excisions were consistent with middle ear adenoma of neuroendocrine differentiation. Middle ear adenoma of neuroendocrine differentiation should be included in the differential diagnosis of an intensely enhancing mass filling the middle ear/mastoid antrum without ossicular destructions. The extent of the mass can be excellently assessed with 3D Gd-enhanced SPGR sequence.

MeSH Terms

Adenoma
Adult
Diagnosis, Differential
Ear, Middle
Gadolinium
Humans
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Mastoid
Tomography, X-Ray Computed
Tympanic Membrane
Gadolinium

Figure

• 

  Fig. 1 CT, MRI, and pathologic features of middle ear adenoma of neuroendocrine differentiation in a 36-year-old man. A, B. Axial high-resolution CT images show a soft tissue mass filling the middle ear (arrows), in which the ossicles (arrowheads) are embedded, but not destroyed. Also noted are outward bulging of the intact tympanic membrane (open arrow) and complete opacification of the mastoid antrum and air cells (asterisks). C. Coronal high-resolution CT reveals the mass occupying entire middle ear (arrows). The incus and stapes (arrowheads) are embedded within the mass, but not destroyed. D, E. Axial fast spin echo T2-weighted (D) and 3-dimensional (3D) spoiled gradient-recalled (SPGR) (E) sequences reveal the mass (arrows), isointense to the gray matter, filling the entire middle ear cavity, aditus ad antrum, and a portion of the mastoid antrum. In contrast, the fluid retention in the mastoid antrum and air cells (asterisks) is hyperintense on both sequences. Note that the hypointense malleus and incus (arrowhead) are embedded within the mass. F. Axial gadolinium (Gd)-enhanced 3D SPGR sequence demonstrates homogeneous and intense enhancement of the mass (arrows) involving the entire middle ear cavity, aditus ad antrum, and a portion of the mastoid antrum. Fluid retention in the mastoid antrum and air cells (asterisks) shows varying signal intensities and the ossicles (arrowhead) are hypointense. G. Coronal Gd-enhanced 3D SPGR sequence shows intact incus (arrowhead) embedded within the enhancing middle ear mass (arrows). H. Histologically, the tumor demonstrates a trabecular growth pattern. The tumor cells are cuboidal, and nuclei are round and uniform (hematoxylin-eosin, × 400).

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