Difficulties in clinical staging of external ear canal carcinoma– a case report

Carcinoma of the external auditory canal (EAC) is known to be very rare with a rate of 1-6 per million people. It affects mostly people over the age of 50 regardless of gender. The most common type of carcinoma of EAC is squamous cell carcinoma (SCC). The aim of this paper is to present the case of a 56-year-old woman with carcinoma of EAC. She was admitted to otolaryngology clinic due to ear buzzing lasting for five months, periodic otorrhea and hearing deterioration in her right ear. In otoscopic examination a tumor in the right ear meatus was identified. It filled almost the entire canal. Biopsy confirmed the presence of squamous-cell cancer. Tumor advancement was diagnosed using computer tomography of the temporal bones, magnetic resonance imaging of the head and ultrasonography of the neck. Imaging examinations indicated T3 N0 stage. Doctors decided to perform lateral petrosectomy with elective neck dissection. During the operation, the results of histopathological examination of frozen specimens from marginal tissues revealed an invasion of the anterior wall of the ear canal, capsule of temporomandibular joint and parotid gland. The resection eventually included also parotid gland and temporo-mandibular joint with the caput of the mandible. After recuperation, the patient had complementary radiotherapy. The presented case shows that precise imaging is necessary before surgical treatment, but unfortunately the invasion of cancer may not be estimated properly. Based on literature, the best prognosis concerns wide resection with complementary radiotherapy, although the schedule of treatment is not determined.