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Taverna C, Pollastri F, Pecci R, Giannoni B, Fattorini C, Santucci M, Mueller SK, Stoehr R, Franchi A, Agaimy A. Papillary-cystic neoplasms of the middle ear are distinct from endolymphatic sac tumours. Histopathology 2020; 79:306-314. [PMID: 32940914 DOI: 10.1111/his.14250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/24/2020] [Accepted: 09/09/2020] [Indexed: 12/21/2022]
Abstract
AIMS Papillary neoplasms of the middle and inner ear are rare and poorly characterised. The current World Health Organization classification divides them into two major subtypes: aggressive papillary tumours (APTs) and endolymphatic sac tumours (ELSTs). The aim of this article is to present two papillary neoplasms of the middle ear that do not fit into either the classic APT category or the classic ELST category, and compare them with three ELSTs. METHODS AND RESULTS The patients were a 48-year-old female and a 59-year-old male without a history of other neoplasms. Histology showed papillary-cystic growth of predominantly oncocytic (Case 1) or mucinous (Case 2) cells surrounded by a p63-positive basal layer. The overall histology was reminiscent of oncocytic sinonasal papilloma (Case 1) and pancreatobiliary or salivary intraductal papillary mucinous neoplasms (Case 2). Ovarian-type stroma, invasion and malignant features were absent. Immunohistochemistry revealed expression of cytokeratin (CK) 7, but not carbonic anhydrase IX (CAIX) or paired box gene 8 (PAX8) (except for very focal PAX8 expression in Case 1). The TST15 gene panel and HRAS sequencing revealed no pathogenic mutations in BRAF, KRAS, EGFR, AKT1, or HRAS. The TruSight RNA fusion panel revealed an MKRN1-BRAF fusion in Case 1. No fusion was detected in Case 2. The three ELSTs showed classic features of the entity, expressed CK7, epithelial membrane antigen, PAX8, and CAIX, and lacked a basal cell layer. CONCLUSION These novel cases suggest that papillary tumours of the ear represent a heterogeneous spectrum of distinct neoplasms unified by a prominent papillary-cystic pattern rather than a single entity. Future studies should clarify whether the MKRN1-BRAF fusion is a defining recurrent driver event, especially in those cases reported as sinonasal-type middle ear papillomas.
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Affiliation(s)
- Cecilia Taverna
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany.,Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Federica Pollastri
- Audiology Unit, Head and Neck Oncological and Robotic Surgery, Department of Oncological and Robotic Surgery, AOU Careggi, Florence, Italy
| | - Rudi Pecci
- Audiology Unit, Head and Neck Oncological and Robotic Surgery, Department of Oncological and Robotic Surgery, AOU Careggi, Florence, Italy
| | - Beatrice Giannoni
- Audiology Unit, Head and Neck Oncological and Robotic Surgery, Department of Oncological and Robotic Surgery, AOU Careggi, Florence, Italy
| | - Caterina Fattorini
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Marco Santucci
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Sarina K Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Robert Stoehr
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Alessandro Franchi
- Department of Translational Research, University of Pisa, School of Medicine, Pisa, Italy
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
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Idiopathic, Infectious and Reactive Lesions of the Ear and Temporal Bone. Head Neck Pathol 2018; 12:328-349. [PMID: 30069844 PMCID: PMC6081288 DOI: 10.1007/s12105-018-0952-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/13/2018] [Indexed: 12/13/2022]
Abstract
A number of infectious, inflammatory and idiopathic lesions develop within otologic tissues that may share similar clinical and/or microscopic features. This review first provides a working classification for otitis externa, and then otitis media and includes two recently described entities, eosinophilic otitis media and otitis media with ANCA-associated vasculitis. Next, the microscopic findings of a spectrum of otopathologic conditions are described, including post-inflammatory conditions such as tympanosclerosis and aural polyps, an overview of animate aural foreign body as well as iatrogenic aural foreign body reactions. Finally, a review of fungal disease affecting the ear with a brief synopsis of Candida auris, a recently described and virulent organism, is presented.
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