Adenoid Cystic Carcinoma of the External Auditory
Canal Rare Case Report
Department of Otolaryngology-Head and Neck Surgery, Aleppo University, Iraq
Submission: July 6, 2016; Published: July 14, 2016
*Corresponding author: Faisal Dibsi, Department of Otolaryngology-Head and Neck Surgery, Aleppo University, Syria, Aleppo City. Al Shahba Al
Jadideh Quarter Al Sanober Street No 92, Iraq, Tel: 963 21 2633022; +963 944488980; Email: [email protected]
How to cite this article: Faisal D. Adenoid Cystic Carcinoma of the External Auditory Canal “Rare Case Report. Glob J Oto. 2016; 1(4): 555567. DOI: 10.19080/GJO.2016.01.555567
Adenoid cystic carcinoma (ACC) of the external auditory canal (EAC) is extremely rare tumor. A wide excisional biopsy should be performed.
Its propensity for Perineural invasion and slow growing, but highly invasive cancer with a high local recurrence rate. Lymphatic spread to the
local lymph nodes is rare. It is not uncommon for distant metastasis, mainly to the lungs, to occur over the course of many years. Aggressive
surgical resection with adjuvant radiotherapy is the standard treatment for local disease control.
A 45 year old male (M.M.) applied 06.04.1999 with a tumor in the left external auditory canal. The pathology of wide excisional biopsy was
adenoid cystic carcinoma. The patient refused having a surgery. He had decided to go only for irradiation, which helped to stop the growth of the
tumor for years. In 05.02.2008 he applied with progressive growth of tumor, extending and diffusing, with bloody pus discharge from the meatus
and peripheral left facial palsy. The CT scan showed an involvement of the mandible. Otoscopy with photography showed the middle & lateral
wall of Inner ear involvement. The patient died after several months.
Keywords: Adenoid cystic carcinoma; Malignant tumors of the external auditory canal; Head and neck neoplasms; Salivary neoplasm; Cylindroma
Primary malignancies of the external auditory canal (EAC)
are extremely rare with more than 80% being squamous cell
carcinomas and adenoid cystic carcinoma (ACC) accounting for
approximately 5% [1,2] Adenoid cystic carcinoma (ACC) is a rare
epithelial tumor entity and comprises about 1% of all malignant
tumours of the oral and maxillofacial region . (ACC) first
described as ‘‘Cylindroma” by Billroth , is commonly classified
with the salivary gland tumors. (ACC) of the head and neck is
usually found in the salivary glands, oral cavity, palate, nasal
cavity, and nasopharynx .
Since 1894, there have been only 106 cases of (ACC)
involving the (EAC) reported the English literature . Although
it presents a widespread age distribution, peak incidence occurs
predominantly among women, between the 5th and 6th decades of
life . It is a slow growing but highly invasive cancer with a high
recurrence rate. Lymphatic spread to the local lymph nodes is rare
too. It is not uncommon for distant metastasis, mainly to the lungs,
to occur over the course of many years . The natural history of
(ACC) of the (EAC) is characterized by an indolent clinical course,
which usually leads to a late diagnosis .
Earlier diagnosis of these tumours is of utmost importance,
in view of the fact that delays in diagnosis may increases the risk
of distant metastasis . The long natural history of this tumor,
its propensity for Perineural invasion, and its tendency for local
recurrence are well known . The treatment goal includes
complete surgical extirpation and a clear margin because of the
high risk of repeat local recurrence. Aggressive surgical resection
with adjuvant radiotherapy is the standard treatment for local
disease control [6-8]. Because of the rarity of (ACC) of the (EAC),
most of the observations drawn from various reports lack detailed
comparisons of pathological findings and long-term outcome
We present our own case along with a review and discussion
of the literature to date.
During my practice Otolaryngology-Head & Neck Surgery
since 1966 until present time, I meet only this case.
In 06.04.1999 male patient M.M. 45 year old applied with a
tumor in the left external auditory meatus (Figure 1). He used to
work as an employee in the agricultural bank in the countryside
of Aleppo city-Syria. He had presented himself at my private clinic
while taking an excision biopsy. The pathology was Adenoid Cystic
Carcinoma (Figure 2). The patient refused having a surgery when
he knew that growth of tumor is very slow and takes many years.
He had decided to go only for the irradiation, which helped to stop
the growth of the tumor for a few years (Figure 3).
Patient used to visit clinic from time to time for flew up.
He suffered from ear bloody pus discharge and hearing loss. In
05.02.2008 he applied with a progressive growth in the pinna,
behind the pinna and tragus. He kept refusing the surgery and
used a herbal therapy. With a diffuse tumor that extended from
the entrance to the external auditory meatus in his left ear. These
tumors had also extended into front and behind of the pinna
with a bloody pus discharge from the meatus and peripheral left
facial palsy (Figure 4). The CT scan showed an involvement of
the mandible (Figure 5), and erases the temporal bone (Figure
6). Otoscopy and photography showed the middle & lateral wall
of Inner ear involvement (Figure 7). No lymphatic spread to the
local lymph nodes or to lungs found. The patient died after several