Case report and review of the literature about the primary Schneider papilloma of the temporal bone with involvement of the skull base
23 April 2019 (online)
Inverted papilloma is lesion which occurs predominantly in the nasal cavity and paranasal sinuses. The primary origin of this tumor in the middle ear is extremely rare with fewer than 21 cases described in the literature.
A 45-year-old patient presented in our Klinik with 3 years of progressive hearing loss and a feeling of pressure in the right ear with otorrhea. The clinical examination showed a pus secretion and a pulse-synchronous fluid movement. Tonal audiometry showed right-sided conductive hearing loss. MRI revealed a tissue formation in the tympanic cavity with an extension in the middle cranial fossa. DVT showed soft tissue formation in the left temporal bone filling the mastoid cavities and cavum tympani. Mastoidectomy antrotomy and duraplasty were performed. Histological diagnosis was Schneider papilloma of the middle ear. After 2 months, the tumor had spread transdurally towards the outer ear canal and toward the middle fossa. Complete tumor resection was performed by a transtemporal, access and subtotal petrosectomy. Postoperatively there was no evidence of recurrence.
The origin of the inverted papilloma of the middle ear is unknown. In fact, our case is the 22nd case described. In the literature, the average age is 48.8 years in 10 male and 11 female patients. In only 6 cases there was a malignant transformation. The recurrence rate was 59.25%. The first choice of therapy is surgery that tries to achieve a complete resection. Our experience has shown that performing a subtotal petrosectomy is the best way to ensure a lower risk of recurrence. In this way, the entire mucous membrane is removed. In addition, a long-term follow-up with MRI is mandatory to detect a possible recurrence or malignant transformation over time.