Aspiration cytopathology of middle-ear neuroendocrine carcinoma

Primary neuroendocrine carcinoma (carcinoid tumor) is among the rarest of m iddle-ear (ME) neoplasms, with only a rare case of metastatic disease havin g been reported. Fine-needle aspiration biopsy (FNAB) was performed in a 51 -yr-old male with a two-decade history of multiple local recurrences from a right middle-ear neoplasm, with the most recent surgical excision 2 yr ago . He currently presented with an enlarged right parotid gland, and a right infratemporal mass. Aspirate smears showed a monotonous population of cytol ogically bland cells with a small to moderate amount of pale granular cytop lasm, round to oval nuclei, inconspicuous nucleoli, and finely granular chr omatin. Rare, isolated large cells were occasionally seen. Immunohistochemi cal staining of the cell block made from the aspirated material showed stro ng cytoplasmic positivity for chromogranin, synaptophysin, neuron-specific enolase (NSE), serotonin, and cytokeratin cocktail, and negative staining f or S100 protein. Review of tissue slides from the patient's prior middle-ea r tumor showed an identical immunoprofile and morphology, and led to a revi sion of the original diagnosis of paraganglioma. Middle-ear neuroendocrine carcinoma has a low but definite metastatic potential, which can be diagnos ed using FNAB if ancillary immunohistochemical studies are available. (C) 2 001 Wiley-Liss, Inc.