Primary papillary adenocarcinoma confined to the middle ear and mastoid

Primary adenocarcinoma is a rare tumor of the middle oar and temporal bone; its most frequent symptoms are hearing loss, otalgia, and facial paralysis . Otoscopic examination of a 27-year-old man revealed purulent discharge in the ear canal, diffuse edema, and hypertrophy of the right tympanic membra ne. He presented with a grade III (House-Brachman) facial paralysis and rig ht conductive hearing loss with a history of aural discharge for 6 months, otalgia, and facial weakness for 2 days. Computed tomography of the tempora l bone showed an opacity filling the tympanic cavity, antrum, and aditus. T ympanotomy revealed diffuse edema of the middle ear mucosa, and granulation tissue was encountered during mastoidectomy filling the antrum and periant ral cells and eroding the fallopian canal at the lever of the oval window. After the histopathological examination revealed papillary adenocarcinoma, a subtotal temporal bone resection, facial nerve segmenter resection, and e nd-to-end anastomosis of the facial with the hypoglossal nerves were perfor med. The importance of histopathological examination in all cases of chroni c otitis media with granulation tissue is stressed.