European Annals of Otorhinolaryngology, Head and Neck diseases 132 (2015) 243

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Letter to the Editor Meningioma of the external auditory canal Méningiome du conduit auditif externe A 45-year-old female patient consulted her otolaryngologist for bilateral hearing loss. Physical examination showed a normal otoscopy in the right ear and external auditory canal stenosis in the left ear hindering observation of the tympanic membrane. The Rinne test was negative bilaterally and the Weber test deviated to the left. Audiometry revealed bilateral severe mixed hearing loss and temporal bone CT found a probable osteoma in the left ear (Fig. 1). The patient underwent surgery for excision of the external auditory canal lesion. Histopathology revealed meningothelial cells and grade I meningioma. Meningioma is one of the most frequent primary tumors of the central nervous system [1]. Primary meningioma of the ear or temporal bone is rare, at less than 1% of all meningiomas [2] and 2% of primary tumors of the ear and temporal bone [2]. They are more frequent in women than in men [1]. Symptoms are

nonspecific [2], depending on tumor location; radiological features are also nonspecific [2]. The most common histological variants are meningothelial, fibroblastic, syncytial and transitional [1]. It is believed that several mechanisms underlie extracranial meningiomas [2,3]: accumulation of arachnoid cells in the sheaths of the cranial and spinal nerves and vessels from which the cranial nerves migrate through the foramina and suture lines; cell group migration to extracranial areas during embryogenesis; cerebral hypertension or trauma, displacing groups of arachnoid cells; direct origin from undifferentiated or multipotent cells, such as fibroblasts. These hypotheses may explain the various extracranial meningioma locations described in the literature [3,4]. In conclusion, meningiomas of the ear and temporal bone are rare tumors with nonspecific clinical and imaging features; accurate diagnosis therefore requires histological evaluation. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. References [1] Thompson L, Bouffard J, Sandberg G, et al. Primary ear and temporal bone meningiomas: a clinicopathologic study of 36 cases with a review of the literature. Mod Pathol 2003;16(3):236–45. [2] Petrulionis M, Valeviviene N, Paulauskiene I. Primary extracranial meningioma of the sinonasal tract. Acta Radiol 2005;46(4):415–8. [3] Tomaru U, Hasegawa T, Hasegawa F, et al. Primary extracranial meningioma of the foot: a case report. Jpn J Clin Oncol 2000;30(7):313–7. [4] Tuncay I, Güler U, Vural C, et al. Primary extracranial meningioma of the lower limb. Eklem Hastalıkları ve Cerrahisi 2011;22(2):114–7.

A. Ribeiro ∗ G. Lopes A. Leonardo M. Rodrigues e Rodrigues ENT, Hospital Pedro Hispano, Matosinhos, Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Portugal ∗ Corresponding author. E-mail address: [email protected] (A. Ribeiro)

Fig. 1. CT scan (axial slice): mass in the left external auditory canal – probable osteoma.

http://dx.doi.org/10.1016/j.anorl.2015.03.004 1879-7296/© 2015 Elsevier Masson SAS. All rights reserved.