Middle ear carcinoid: An indolent tumor with metastatic potential

Background. Neuroendocrine tumors of the head and neck region may present p roblems in diagnosis. Middle ear carcinoid is a rare, recently recognized t umor, which to date has not been reported to metastasize. Methods. We report the case of a 64-year-old man with a g-year history of r ecurrent middle ear neoplasm and ipsilateral cervical lymphadenopathy. A mi croscopic parathyroid tumor was also identified. The approach to the diagno sis of this unusual combination is presented. Results. The patient had a neuroendocrine tumor metastatic to multiple unil ateral cervical lymph nodes, which was morphologically identical to his rec urrent middle ear neoplasm. The neoplasm had the morphologic, immunohistoch emical, and ultrastructural features of a carcinoid tumor. Conclusions. This case illustrates that middle ear carcinoids may metastasi ze. We suggest that immunohistochemical studies be performed on all biopsy specimens from neoplasms of the middle ear, as distinction from the more co mmon paraganglioma may be difficult on morphologic grounds alone. (C) 1999 John Wiley & Sons, Inc.