Metastasizing Middle Ear Carcinoid: An Unusual Case Report, With Focus on Ultrastructural and Immunohistochemical Findings

Background: There are only 4 unequivocal cases of metastasizing middle ear carcinoid previously reported. Objective: To present a case of metastasizing middle ear carcinoid, to review previously reported cases, and to discuss the clinical nature of this tumor, which is similar to "orthotopic" carcinoids bearing definite metastatic potential. Study Design: Case report. Patient, Intervention, Results: We present a 72-year-old woman who developed ipsilateral parotid gland and cervical lymph node metastases 8 and 11 months after surgical removal of a primary middle ear lesion. She subsequently required 2 revision procedures and radiotherapy for local recurrences. Her case was complicated by nonsurgically induced permanent facial nerve paralysis, the cause of which remains obscure. At the end of the 8-year follow-up, the patient was alive with locally, recurrent tumor eroding the cranial base and invading the posterior intracranial fossa but with no signs of metastases. Main Outcome Measures: Light microscopy and immunohistochemical analysis. Conclusion: Considering the reported high rate of recurrence and their consequent metastases, a middle ear carcinoid should be classified as a neuroendocrine low-grade carcinoma.