Plasmocitoma extramedular de canal auditivo externo: caso clínico / Extramedullary plasmacytoma of external auditory canal: a case report

Resumen El plasmocitoma extramedular es una neoplasia de células plasmáticas poco frecuente, que se ubica en 80% a 90% de los casos en la cabeza o cuello. Esta neoplasia representa menos del 1% de toda la patología maligna de cabeza y cuello. Dada la poca frecuencia de la patología y la escasez de casos publicados, esta entidad presenta una gran dificultad clínica y terapéutica. El diagnóstico se basa en el análisis histológico con inmunohistoquímica de la muestra obtenida, y el tratamiento varía según la ubicación, donde se puede realizar radioterapia o cirugía. En este artículo presentamos el caso de una paciente de 56 años, con antecedentes de otorrea de larga data en oído derecho, al examen físico presentaba un tumor que obstruía todo el conducto auditivo externo. Se realizó exéresis tumoral y la biopsia evidenció un plasmocitoma.

Abstract Extramedullary plasmacytoma is a rare plasma cell neoplasm, affecting 80% to 90% of the head or neck. This neoplasm represents less than 1% of all malignant head and neck pathology. Given the infrequency of the pathology and the scarcity of published cases, this entity presents great clinical and therapeutic difficulty. Diagnosis is based on histology and immunohistochemistry and treatment varies depending on the location, where radiation therapy or surgery can be performed. In this article, we present the case of a 56-year-old patient with a history of long-standing otorrhea in the right ear. Physical examination presented a tumor that obstructed the entire external auditory canal. Tumor excision was performed, and the biopsy revealed a plasmacytoma.

Recurrence of Cholesteatoma: A Retrospective Study Including 1006 Patients for More than 33 Years

Abstract Introduction Cholesteatomas are benign tumors consisting of skin, and growing inside a retraction pocket in the tympanic membrane. Cholesteatomas can occupy the entirety of the middle ear, and are known for their osteolytic capabilities. Surgery is the only curative treatment for cholesteatomas. Objective To describe the risk of recurrence after first-time surgically-treated middle- ear cholesteatoma (STMEC1) on the island of Funen from 1983 to 2015. Methods Cases of STMEC1 were identified in the Danish National Hospital Register. The medical records were reviewed. Time-to-event analyses were applied. The ears were followed from STMEC1 to a secondary cholesteatoma, emigration, death, or end of follow-up. Results Records from 1,006 patients with STMEC1 were reviewed. A total of 54 patients were submitted to surgery on both ears. The total sample consisted of 1,060 ears with STMEC1; 300 were children's (< 16 years) ears, and 760 were adult's ears. The total observation time was of 12,049 years. The overall estimated proportion with recurrence 5 years after surgery was of 37% in children and of 15% in adults. The older the child was at the first surgery, the risk decreased by 7% per year. In children, canal wall up (CWU) mastoidectomy without obliteration was associated with a hazard ratio for recurrence of 1.9 (95% confidence interval [95%CI]: 1.2-3.0) compared with CWU with obliteration. Conclusion Compared with adults, children were had 2.6 times more risk of recurrence. Procedures performed without mastoidectomy had the lowest risk of recurrence. In children, obliteration was associated with a significantly lower risk of recurrence. However, patients were not randomized regarding the surgical approach; thus, the association between approach and risk of recurrence was likely influenced by confounding factors.

Retalho retroauricular ilhado para reconstrução parcial de orelha: relato de casos / Retroauricular island flap for partial ear reconstruction: case reports

Defeitos parciais de orelha podem ser tratados de diversas formas, dentre elas o fechamento primário, cicatrização por segunda intenção ou retalhos. Diversas opções técnicas foram descritas para a sua reconstrução de modo a manter o contorno natural da orelha, sem sacrificar tecido sadio ou alterar sua estética e função. Apresentamos neste artigo dois casos atendidos no Instituto do Câncer do Hospital de Base de São José do Rio Preto de reconstrução de defeitos condrocutâneos de orelha após ressecção de carcinoma basocelular em região central da orelha, com a confecção de retalho retroauricular ilhado transposto através de uma janela cartilaginosa e com o pedículo desepidermizado. Área doadora com fechamento primário. Tal procedimento constitui técnica segura, pois a região retroauricular é ricamente vascularizada, é de fácil execução, em único estágio e com resultado estético e funcional satisfatório.

Partial ear defects can be treated in several ways, including primary closure, healing by secondary intention, or flaps. Several surgical options have been described for reconstruction in order to maintain the natural contour of the ear, without sacrificing healthy tissues or changing the aesthetics and function. In this article, we present two cases of reconstruction of chondrocutaneous defects of the ear after resection of basal cell carcinoma in the central region of the ear, with the production of a retroauricular island flap transposed through a cartilaginous window with the de-epidermized pedicle. The donor area healed following a primary closure. This procedure can be performed in a single stage, yields satisfactory aesthetic and functional results, and is safe because the retroauricular region is richly vascularized.

Retalho pré-auricular tunelizado insular de base superior para reconstrução de defeitos auriculares / Superiorly-based, preauricular tunneled insular flap for reconstruction of auricular defects

O complexo auricular representa sede frequente de lesões, especialmente de origem tumoral ou resultante de eventos traumáticos. Diversas são as opções cirúrgicas para restaurar a integridade anatômica da orelha. Relatamos o caso de um paciente que apresentou lesões tumorais em mais de uma ocasião na face anterior da orelha esquerda e que precisou de intervenção cirúrgica para a correção do defeito gerado pela excisão tumoral. Como procedimento proposto, planejamos e executamos um retalho insular de base superior, que por meio de um túnel criado na projeção da fossa triangular foi rodado para a fossa escafoide, reparando-a em um único tempo cirúrgico, apresentando resultados estético e funcional satisfatórios ao paciente.

The auricular complex is commonly affected by tumors or traumatic events. Several surgical options are available for restoration of ear anatomy. We report the case of a patient who presented with tumor lesions on more than one occasion in the anterior left ear and required surgical intervention to correct the defect generated by excision. As a proposed procedure, we designed and executed a superiorly-based insular flap that was rotated to the scaphoid fossa through a tunnel created in the projection of the triangular fossa; this was performed in a single stage, and the patient was satisfied with the aesthetic and functional results.

Reconstrução da hélice da orelha sem triângulo de compensação / Ear's helix reconstruction without the compensation triangle

Os cânceres da pele na região da cabeça e do pescoço correspondem a 70-75% dos tumores cutâneos malignos, e, destes, 80% são do tipo carcinoma basocelular. O pavilhão auricular é a localização dos tumores cutâneos malignos em percentual que varia de três a 6% dos casos. Relatamos técnica alternativa para reconstrução da hélice após exérese de tumores sem a utilização do triângulo de compensação clássico, de modo a proporcionar cicatriz na dobra da hélice, com melhor resultado estético, sem retrações inestéticas ou cicatrizes transversais à hélice.

Skin cancers in the head and neck region account for 70-75% of malignant cutaneous tumors, of which 80% are basal cell carcinomas. Between 3-6% of malignant cutaneous tumors occur in the auricular pavilion. The authors of the present paper report an alternative technique for reconstructing the ear helix after excision of tumors, without the use of the classic compensation triangle. This method allows that the scar be located in the helical sulcus, resulting in a better aesthetic result, without unaesthetic retractions or scars located transversely to the helix.

Resonancia magnética con secuencia HASTE de carcinoma epidermoide del hueso temporal / HASTE magnetic resonance imaging of a squamous cell temporal bone carcinoma

El carcinoma epidermoide del hueso temporal es una neoplasia derivada de células epidérmicas del estrato espinoso, y que dado su baja incidencia, y presentación clínica similar a un cuadro de otitis media crónica colesteatomatosa, su diagnóstico es habitualmente tardío. El estudio del carcinoma epidermoide del hueso temporal se realiza con tomografía computarizada, la que evidencia erosión ósea. Sin embargo, existen distintos diagnósticos diferenciales, tanto malignos como benignos, que pueden provocar hallazgos similares en la tomografía computarizada. La resonancia magnética (RM) es un método de exploración de gran valor complementario para el estudio del carcinoma de oído medio. La RM con secuencia de difusión HASTE ha surgido como herramienta de estudio en patología de hueso temporal, tales como colesteatomas y teratomas de oído medio, pese a esto, no existen reportes en la literatura de la presentación imagenológica del carcinoma epidermoide de hueso temporal utilizando este método. En este artículo se presenta un caso clínico de una paciente con carcinoma epidermoide de oído medio, cuyo estudio preoperatorio incluyó RM-HASTE. Aun cuando se requiere un mayor número de casos para establecer el patrón imagenológico, se concluye que esta técnica es de utilidad para diferenciar este tumor de otitis media crónica colesteatomatosa.

Squamous cell carcinoma of the temporal bone (SCC) is a malignancy originated from epidermis spinous cells. Its low incidence and similar presentation to cholesteatomas, contributes to its late diagnosis. The most widely used study for this tumor is computed tomography (CT), which mainly evidences erosion of the temporal bone. There are several other diagnoses, malignant and benign, that could provoke similar findings at the CT. Magnetic resonance imaging (MRI) is a method of great value to study SCC. MRI with HASTE diffusion sequence has recently emerged as an important tool in the study of temporal bone pathologies, such as cholesteatoma and middle ear teratoma, despite this, there are no reports in the literature of the imaging presentation of SCC using this method. This article presents a clinical case of a patient with SCC, in whose preoperative study was performed HASTE-MRI. Although a larger number of cases are required to establish an imaging pattern, it is concluded that this technique is useful to differentiate this tumor from middle ear cholesteatomas.

Meningioma extradural de oído medio: reporte de un caso y revisión de la literatura / Extradural meningioma of middle ear: reporting a case and literature review

Los meningiomas son los tumores no gliales más comunes del sistema nervioso central constituyendo el 24%-30% de los tumores intracraneales y el 25% de los tumores de médula espinal. Se originan de células de la aracnoides y en general presentan un comportamiento benigno. Existe un subtipo llamado meningioma extracraneal primario o extradural que es poco frecuente y afecta principalmente el área de cabeza y cuello. Debido a su baja prevalencia y síntomas poco característicos son a menudo diagnosticados por fortuna, siendo la inmunohistoquímica fundamental. Se presenta el caso de una mujer adulta con una lesión tumoral en oído medio diagnosticada inicialmente mediante una biopsia incisional como un granuloma de colesterol. Luego del tratamiento quirúrgico y estudio de inmunohistoquímica se concluye el diagnóstico definitivo de meningioma extradural de oído medio. Se analiza la literatura al respecto y se discute sobre su epidemiología, clínica, estudio y manejo.

Meningiomas are the most common non-glial tumors of the central nervous system constituting 24-30% of intracranial tumors and 25% of spinal cord tumors. They originate from arachnoid cells and generally exhibit benign behavior. The subtype primary extracranial meningioma or extradural meningioma that is uncommon and affects the head and neck area. Due to their low prevalence and uncharacteristic symptoms are often diagnosed by fortune, being the immunohistochemistry fundamental. We present the case of an adult woman with a tumor lesion in the middle ear initially diagnosed by an incisional biopsy such as a cholesterol granuloma. After the surgical treatment and immunohistochemical study, the definitive diagnosis of extradural meningioma of the middle ear is concluded. The literature on this subject is analyzed and its epidemiology, clinical practice, study and management are discussed.

Post-auricular full thickness skin graft by M-plasty technique: an alternative to classical elliptical technique

Benign lesions over the auricular region are not uncommon. Most lesions require an excisional biopsy for its histopathological confirmation. If excised, the resultant would be a small to medium sized soft tissue defect, exposing the cartilaginous portion of the ear. Options for reconstruction include a full-thickness skin graft, local flap cover or a wedge composite excision to retain the aesthetic appearance of the auricle. Local flap cover or wedge composite resection are not without demerits. If a full thickness graft is needed, the donor area is usually the post auricular region. We present a modified elliptical incision M-plasty technique to minimize the tissue loss in donor post auricular area when harvesting full thickness skin graft. Although the traditional elliptical incision is used by majority of surgeons to harvest full thickness skin graft from the post-auricular region, the M-plasty technique used in our case is a modification of the traditional elliptical incision which preserves tissue that allows the surgeon to close the wound with less tension and short scar

Staged retroauricular flap for helical reconstruction after Mohs micrographic surgery

Abstract Staged retroauricular flap is a great option for full-thickness defects along the helical rim and antihelix. Donor site consists of the posterior ear, postauricular sulcus and mastoid area. The advantages of this flap include hidden donor scar, donor tissue similarity and rich vascularity. We present a case of collision tumor on the left helix treated with Mohs micrographic surgery and the resulting full-thickness defect repaired with a staged retroauricular flap. This flap is an effective technique for full-thickness helical defect repair with relatively little operative morbidity. High esthetic and functional results may be obtained restoring the ear size and shape.

Total earlobe reconstruction with a superiorly based preauricular flap

Abstract: An 86-year-old woman was referred for treatment of a lentigo maligna melanoma on the left earlobe, confirmed by cutaneous biopsy. The resulting surgical defect involved the earlobe's full thickness. The authors outline a simple method for reconstructing the entire lobe in one stage, without grafts, whilst offering a pleasant appearance. Earlobe deformity may be congenital or, more often, acquired due to trauma, burns or surgery. Ear lobules are an important reference point for facial symmetry and they serve decorative purposes like wearing earrings. Losing them represents an obvious aesthetic abnormality. Several methods developed to reconstruct this deformity have presented various advantages and disadvantages.

Carcinoma espinocelular del oído externo con extensión parotídea: a propósito de un caso / Squamous cell carcinoma of the external ear with parotid extension: case report

El pabellón auricular y el conducto auditivo externo constituyen una región anatómica que puede ser asiento de múltiples patologías, entre ellas procesos inflamatorios, infecciosos y neoplásicos, tanto benignos como malignos. Con respecto a los tumores, los diversos tipos suelen presentarse con síntomas y signos similares y en general es difícil inferir la variedad histológica del tumor a través del examen físico, por lo cual es necesario el estudio histopatológico para determinar el diagnóstico. La mayoría de los tumores del oído externo son carcinomas; entre ellos se destacan el carcinoma basocelular, el más frecuente, y el carcinoma espinocelular. Menos frecuentemente se encuentran otros tipos de tumores como los melanomas, adenocarcinomas, carcinomas de glándulas ceruminosas, carcinomas mucoepidermoides, sarcomas, procesos linfoproliferativos, etc. Suelen ocurrir en la edad media y avanzada (50-70 años) y con mayor periodicidad en el sexo masculino. En el presente trabajo se describe un caso clínico de carcinoma espinocelular del oído externo, tratado exitosamente mediante cirugía y radioterapia, así como también se describen las características clínicas de esta enfermedad, con especial atención al compromiso del oído externo por ella.

The pinna and the ear canal are an anatomical region that can be affected by many diseases, including inflammatory, infectious and benign and malignant neoplastic processes. With regard to tumors, various types usually present with similar symptoms and usually is very difficult to know the histological type through physical examination, so histopathological examination is necessary in order to determine the diagnosis. Most tumors are carcinomas; they can be basal cell carcinoma (more frequently), or squamous carcinoma. Less frequently are other types of tumors such as melanomas, adenocarcinomas, ceruminous glands carcinomas, mucoepidermoid carcinomas, sarcomas, lymphoproliferative disorders, etc. They usually present in middle and advanced age people (50-70 years) and are more frequently in men. In this article we present a case of squamous cell carcinoma of the external ear with extention to parotid gland, successfully treated with surgery and radiotherapy, as well as we describe the clinical characteristics of this disease, with special attention to the compromise of the external ear. (AU)

Adenoma carcinoide de oído medio / Middle ear carcinoid adenoma

Las neoplasias primarias de oído medio son poco frecuentes y más aún lo es el adenoma de oído medio. Se plantea que el tumor se origina de células pluripotenciales endodérmicas indiferenciadas que están presentes en la mucosa. El adenoma carcinoide está compuesto por dos tipos de células: exocrinas y neuroendocrinas, estas últimas son capaces de liberar granulaciones y neuropéptidos que se detectan en la inmunohistoquímica. La mayoría se presentan con síntomas vagos de la esfera otológica, siendo raras las manifestaciones sistémicas de síndrome carcinoide. No existe examen físico característico ni patrón imagenológico. Se debe hacer diagnóstico diferencial con colesteatoma y otros tumores de oído medio. El diagnóstico definitivo es anatomopatológico y el tratamiento de elección es quirúrgico dado el potencial destructivo local. Se presentan en este artículo dos casos de adenoma carcinoide de oído medio.

Primary neoplasms of the middle ear are rare and even more so is the middle ear adenoma. It is stated that the tumor originates from undifferentiated endodermal stem cells that are present in the mucosa. Carcinoid adenoma is compromised of two cell types; exocrine and neuroendocrine cells, the latter are able to release neuropeptides and granulations that can be detected in immunohistochemistry. Most cases present with vague symptoms of the otologic sphere, being less common the systemic manifestations of carcinoid syndrome. There is no physical examination or characteristic imaging pattern. Differential diagnosis must be done with cholesteatoma and other middle ear tumors. The definitive diagnosis is anatomopathological and the treatment of choice is surgery given the local destructive potencial. Two cases of middle ear carcinoid adenoma are presented in this article.

Earlobe reconstruction by the Gavello technique and bilobed flap / Reconstrução do lóbulo auricular pela técnica de Gavello e retalho bilobado

The earlobe is an anatomical structure that has a significant aesthetic role. Its surgical repair places a challenge due to the difficulty of obtaining a natural appearing and durable outcome. The authors present two options: the Gavello technique and the bilobed flap, after the excision of malign neoplasms of the earlobe. The Gavello technique makes use of a bilobed flap with an anterior base to mold the new earlobe. D'Hooghe's bilobed flap with a pre and post-auricular lobe allows the reconstruction of small earlobes. Both techniques, although old, acquire an important and current interest in earlobe reconstruction, by reason of the moderate degree of difficulty, the use of a single time surgical act and under local anesthesia, with a proper aesthetic result.

O lóbulo auricular é uma estrutura anatómica com uma importância estética significativa. O desafio inerente à sua reconstrução relaciona-se com a dificuldade em obter um resultado duradouro e cosmeticamente aceitável. Os autores apresentam duas opções: a técnica de Gavello e o retalho bilobado, após excisão de neoplasias malignas do lóbulo auricular. A técnica de Gavello, recorre a um retalho bilobado com base anterior, para constituir o novo lóbulo auricular. O retalho bilobado de D'Hooghe, com lobos pré e pós-auriculares, permite a reconstrução de defeitos de pequenas dimensões. As duas técnicas descritas, apesar de antigas, mantém-se actuais pela execução de grau de dificuldade média, em tempo cirúrgico único, sob anestesia local com a obtenção de resultados cosmeticamente aceitáveis.

Ear reconstruction after traumatic injuries / Reconstruções auriculares após lesões traumáticas

BACKGROUND: Congenital or traumatic ear deformities are difficult and complex issues in plastic surgery due to the increasing number of cases and high degree of difficulty involved in surgeries to restore facial harmony. The authors assessed the techniques used in ear reconstruction, their complications, and the degree of esthetic and functional satisfaction. METHODS: A retrospective cross-sectional study was performed, including cases of post-traumatic ear reconstruction in which costal cartilage graft was employed; the study took place at Hospital Geral de Goiânia Dr. Alberto Rassi and a private clinic from February 2005 to March 2010. Patient satisfaction with respect to esthetic and functional aspects was recorded during postoperative visits. RESULTS: Thirty-four cases were analyzed including 14 (41.1 percent) women and 20 (58.9 percent) men (range, 13-56 years). The average time for reconstruction after trauma was 6-8 months, and the average interval between surgeries was 6 months. Five patients had complications; only 1 required re-intervention due to posterior atrial contraction. Of all patients, 30 reported being satisfied with both the esthetic and functional results; 4 were dissatisfied, and 1 of them underwent subsequent retouching. CONCLUSIONS: Ear reconstruction after trauma is a complex issue in plastic surgery; however, with the standardization and systematization of techniques and a well-established learning curve, the results are very satisfactory; facial harmony can be restored with low complication rates.

INTRODUÇÃO: As deformidades auriculares congênitas ou traumáticas representam um tema de expressividade e complexidade em cirurgia plástica, pelo aumento de casos e pelo alto grau de dificuldade observado nos procedimentos de reparação, necessários para a restauração da harmonia facial do indivíduo. Os autores avaliam a técnica utilizada nas reconstruções auriculares e suas complicações, bem como o grau de satisfação estética e funcional. MÉTODO: Foi realizado um estudo retrospectivo, transversal, analisando os casos de reconstrução de orelha pós-trauma, operados no Hospital Geral de Goiânia Dr. Alberto Rassi e em clínica particular, de fevereiro de 2005 a março de 2010, em que foi empregado enxerto de cartilage costal. O grau de satisfação dos pacientes foi aferido nas consultas de pós-operatório com relação aos aspectos estéticos e funcionais. RESULTADOS: Foram analisados 34 casos, sendo 14 (41,1 por cento) mulheres e 20 (58,9 por cento) homens, com faixa etária entre 13 e 56 anos. O tempo médio para a reconstrução após o trauma foi de cerca de seis meses a oito meses e de um ato cirúrgico para outro, de seis meses. Cinco pacientes apresentaram complicações, e apenas um deles necessitou reintervenção em decorrência de retração auricular posterior. Do total de pacientes avaliados, 30 se definiram como satisfeitos com o resultado tanto estético como funcional e os outros 4, como insatisfeitos, sendo um deles submetido a retoque posterior. CONCLUSÕES: A reconstrução auricular após trauma é um tema complex da cirurgia plástica, mas com a padronização e a sistematização de técnicas e uma curva de aprendizagem bem executada os resultados são muito satisfatórios, devolvendo harmonia facial ao indivíduo, com baixa taxa de complicações.

Metástasis de adenocarcinoma de recto al conducto auditivo externo: presentación de un caso y revisión de la literatura / Metastatic rectal adenocarcinoma to the external auditory canal: case report and literature review

Las metástasis de neoplasias primarias de diferentes localizaciones a cabeza y cuello son un hecho infrecuente. La localización más habitual de recepción de dichas metástasis es el hueso temporal, sitio que usualmente es afectado por neoplasias que se diseminan a los huesos en general. Sin embargo, las neoplasias al conducto auditivo externo son muy raras, habiéndose publicado pocos casos en la literatura . Presentamos el caso de un varón de 81 años con clínica de dolor, acúfenos y otorrea derecha. La otomicroscopía demostró una lesión polipoide en el conducto auditivo extemo derecho. La biopsia objetivó una proliferación de células epiteliales atípicas que formaban luces glandulares anómalas con positividad para citoqueratina 20 y antígeno carcinoembrionario. Se diagnosticó como metástasis de adenocarcinoma de probable origen colónico y posteriormente se conocieron antecedentes de colectomía 9 años antes por adenocarcinoma de recto-sigma. Las metástasis de adenocarcinoma de colon al conducto auditivo externo son un hecho infrecuente y de aparición tardía. Requieren un diagnóstico diferencial con metástasis de adenocarcinomas de otras localizaciones y, en menor medida debido a su baja frecuencia, con tumores primarios. Entre estos últimos, los que plantean mayores dificultades diagnósticas son los adenocarcinomas ceruminosos.

Metastasis to the head and neck region are unusual. The most common site of receiving those metastasis is the temporal bone, a site which is usually affected by tumors that spread to the bones. However, metástasis to the external auditory canal are infrequent. Only a few cases have been published in the literature. We report the case of a 81 year-old man with pain, tinnitus and right otorrhea. The otomicroscopy showed a polypoid lesion in the right ear canal. The biopsy showed an atypical proliferation of epitelial cells forming anomalous glands, which were positive for citoqueratine 20 and carcinoembryonic antigen. He was diagnosed with metastatic adenocarcinoma of colon-rectum nine years previously Metastasis of colon adenocarcinomas to the external auditory canal are infrequent. Require a defferential diagnosis with metastatic adenocarcinomas of others locations but is always necessary to rule outprimary tumors. Among these, the most challenging diagnostic is with ceruminous adenocarcinomas.