今日の臨床サポート

外耳・中耳腫瘍・グロームス腫瘍

著者: 角田篤信 順天堂大学 耳鼻咽喉・頭頸科

監修: 森山寛 東京慈恵会医科大学附属病院

著者校正/監修レビュー済:2022/02/16
患者向け説明資料

概要・推奨   

  1. 外耳道腫瘍、中耳腫瘍とも正確な視診が重要である。
  1. 外耳道悪性腫瘍は炎症性疾患との鑑別が困難なことがあり、組織診断が重要となる。
  1. 一方、血管性腫瘍や神経原性腫瘍では生検に伴う出血や神経障害が問題となる。
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、 著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※同効薬・小児・妊娠および授乳中の注意事項等は、海外の情報も掲載しており、日本の医療事情に適応しない場合があります。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適応の査定において保険適応及び保険適応外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適応の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
角田篤信 : 特に申告事項無し[2022年]
監修:森山寛 : 特に申告事項無し[2022年]

改訂のポイント:
  1. 定期レビューを行い、外耳道がん、グロームス腫瘍について追記した。

まとめ

疾患情報(疫学・病態)  
  1. 外耳腫瘍には耳介腫瘍と外耳道腫瘍があり、頻度としては前者が多い。
  1. 外耳、中耳腫瘍は外来で観察可能なものから頭蓋手術を要する病変までさまざまである。
  1. 外耳道腫瘍は骨腫、線維性骨異形成症など腫瘍類似疾患や疣贅、神経鞘腫などの良性疾患がみられる。
  1. 外耳道悪性腫瘍は百万人に数人のまれな腫瘍で扁平上皮癌が最も多い。
  1. 中耳腫瘍は神経鞘腫、グロームス腫瘍などがあり、内頸静脈孔への進展がしばしばみられる。
  1. 中耳悪性腫瘍はさらにまれであり、慢性中耳炎に合併する癌腫や横紋筋肉腫などがある。
問診・診察のポイント  
問診:
  1. 難聴・耳鳴・耳閉塞感の有無、特に拍動性耳鳴の有無と症状の変化・増悪

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文献 

Atsunobu Tsunoda, Takuro Sumi, Omi Terasaki, Seiji Kishimoto
Right dominance in the incidence of external auditory canal squamous cell carcinoma in the Japanese population: Does handedness affect carcinogenesis?
Laryngoscope Investig Otolaryngol. 2017 Feb;2(1):19-22. doi: 10.1002/lio2.43. Epub 2017 Jan 23.
Abstract/Text OBJECTIVES/HYPOTHESIS: To investigate the relationship between handedness and the incidence of squamous cell carcinoma in the external auditory canal (EACSCC).
MATERIALS AND METHODS: Sixty-eight cases of EACSCC were enrolled in this study, and their affected side was checked. Handedness and ear-picking habits were also investigated in 34 EACSCC cases. Handedness was judged based on self-categorization, and the relationship between handedness and the affected side was investigated.
RESULTS: Fifty-two cases occurred on the right side, and 16 cases occurred on the left side of patients with EACSCC. The incidence of laterality in EACSCC showed a statistically significant right dominance. Concerning handedness, 29 cases were right-handed, 4 cases were left-handed, and 1 case was ambidextrous. Twenty-seven out of the 29 right-handed cases and 1 ambidextrous case suffered from carcinoma on the right side, whereas 3 left-handed cases suffered from carcinoma on the left side. That is, most of the cases suffered from EACSCC on the same side as their handedness, and this tendency showed a statistically significant difference. Most of the patients with EACSCC experienced itching and habitual ear-picking in the affected side.
CONCLUSION: Mechanical stimulations to the EAC, such as ear picking, may plausibly cause EACSCC. In Japan, ear picking, also called "mimikaki," is a popular habit and an established unique culture. Because ear picking requires delicate handling and manipulation, this tends to occur on the same side as the handedness in the Japanese population. This is the first report about the relationship between handedness and carcinogenesis.
LEVEL OF EVIDENCE: N/A.

PMID 28894818
Kiyoto Shiga, Ken-Ichi Nibu, Yasushi Fujimoto, Takahiro Asakage, Akihiro Homma, Hiroki Mitani, Takenori Ogawa, Kenji Okami, Shigeyuki Murono, Shigeru Hirano, Tsutomu Ueda, Nobuhiro Hanai, Kiyoaki Tsukahara, Ichiro Ota, Seiichi Yoshimoto, Takeshi Shinozaki, Shigemichi Iwae, Katsunori Katagiri, Daisuke Saito, Naomi Kiyota, Makoto Tahara, Fumiaki Takahashi, Ryuichi Hayashi
Multi-institutional Survey of Squamous Cell Carcinoma of the External Auditory Canal in Japan.
Laryngoscope. 2021 Mar;131(3):E870-E874. doi: 10.1002/lary.28936. Epub 2020 Jul 30.
Abstract/Text OBJECTIVES: This study aimed to evaluate the efficacy of chemoradiotherapy (CRT) for patients with advanced cancer of the external auditory canal (EAC) by analyzing the outcome of the patients.
METHODS: This is a multi-institutional retrospective survey, and we reviewed the medical records of the subjects. A total of 181 patients with tumor (T)3 or T4 tumor in 17 institutions were enrolled. Further analysis was performed for 74 patients who underwent CRT under curative intent.
RESULTS: Overall 5-year survival rates of the patients who underwent CRT (n = 74) were 54.6%. Those of the patients who underwent CRT with modified TPF (docetaxel, cisplatin [CDDP], and 5-fluorouracil) regimen (n = 50) and CRT with CDDP regimens (n = 24) were 64.4% and 36.7%, respectively. Significant differences were observed between these two groups.
CONCLUSION: Given the tendency that head and neck surgeons prefer CRT for advanced larger cancer of the EAC, CRT for advanced EAC cancer using the modified TPF regimen showed good clinical outcomes.
LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E870-E874, 2021.

© 2020 The American Laryngological, Rhinological and Otological Society, Inc.
PMID 33216374
M Arriaga, H Curtin, H Takahashi, B E Hirsch, D B Kamerer
Staging proposal for external auditory meatus carcinoma based on preoperative clinical examination and computed tomography findings.
Ann Otol Rhinol Laryngol. 1990 Sep;99(9 Pt 1):714-21.
Abstract/Text An accepted staging system for squamous cell carcinoma of the external auditory meatus is currently lacking and would permit accurate comparison of treatment strategies and results for patients with this unusual neoplasm. In order to develop such a staging system we reviewed the prognostic variables and the accuracy of radiographic diagnosis in 39 patients undergoing temporal bone resection for squamous carcinoma of the external auditory meatus. Predictors of poor survival were extensive tumor involvement, facial nerve paralysis, middle ear involvement, and cervical or periparotid lymphadenopathy. In a comparison of 12 specific anatomic sites, computed tomography was found to be an accurate indicator of histopathologically proven tumor invasion. On the basis of this clinical radiographic-histopathologic analysis, we propose a TNM staging system for external auditory meatus carcinoma utilizing preoperative computed tomography and physical examination. This system fulfills the requirements of the American Joint Committee on Cancer that a staging system should provide a sound basis for therapeutic planning for cancer patients by describing the survival and resultant treatment of different patient groups in comparable form.

PMID 2396807
S A Moody, B E Hirsch, E N Myers
Squamous cell carcinoma of the external auditory canal: an evaluation of a staging system.
Am J Otol. 2000 Jul;21(4):582-8.
Abstract/Text OBJECTIVE: The study was conducted to review a staging system proposed by the University of Pittsburgh for temporal bone cancer and to evaluate survival status according to stage, treatment, and certain prognostic factors.
STUDY DESIGN: The study was a retrospective case review.
SETTING: The study was conducted at a tertiary care medical center and specialty hospital.
PATIENTS: Thirty-two patients with primary squamous cell carcinoma of the external auditory canal were studied.
INTERVENTION: All patients underwent surgery of the temporal bone. Radiotherapy was given depending on tumor stage and histopathologic findings.
MAIN OUTCOME MEASURES: The 2-year survival rates of patients undergoing surgical resection with or without adjuvant radiotherapy.
RESULTS: The 2-year survival rates for primary squamous cell carcinoma of the temporal bone were as follows: T1 lesions 100%, T2 80%, T3 50%, and T4 7%. Survival for T3 tumors was 75% with postoperative radiotherapy, compared with 0% with surgery alone.
CONCLUSIONS: The 2-year survival data directly correlated with the staging system. The use of adjuvant radiotherapy increased survival rate in patients with a T3 lesion.

PMID 10912706
Luc G T Morris, Saral Mehra, Jatin P Shah, Mark H Bilsky, Samuel H Selesnick, Dennis H Kraus
Predictors of survival and recurrence after temporal bone resection for cancer.
Head Neck. 2012 Sep;34(9):1231-9. doi: 10.1002/hed.21883. Epub 2011 Sep 23.
Abstract/Text BACKGROUND: The purpose of this study was to identify factors predictive of outcome in patients undergoing temporal bone resection (TBR) for head and neck cancer.
METHODS: This was a retrospective study of 72 patients undergoing TBR. Factors associated with survival and recurrence were identified on multivariable regression.
RESULTS: Most tumors were epithelial (81%), commonly (69%) involving critical structures. Cervical metastases were uncommon (6%). Squamous cell carcinoma (SCC) of the external auditory canal carried a high rate of parotid invasion (25%) and parotid nodal metastases (43%). The 5-year rate of overall survival (OS) was 62%; disease-specific survival (DSS), 70%; recurrence-free survival (RFS), 46%. Factors independently associated with outcome on multivariable analysis were margin status and extratemporal spread of disease to the parotid, mandible, or regional nodes. Recurrence was common (72%) in cT3-4 tumors.
CONCLUSIONS: Margin status and extratemporal disease spread are the strongest independent predictors of survival and recurrence. In SCC of the external auditory canal, high rates of parotid involvement support adjunctive parotidectomy. Risk of recurrence in T3-T4 tumors may support a role for adjuvant therapy.

Copyright © 2011 Wiley Periodicals, Inc.
PMID 21953902
U Fisch
Infratemporal fossa approach for glomus tumors of the temporal bone.
Ann Otol Rhinol Laryngol. 1982 Sep-Oct;91(5 Pt 1):474-9.
Abstract/Text The surgical experience with 74 glomus tumors of the temporal bone is presented. The article proposes new refinements in the classification of type C and D tumors and describes in detail the technique of blind sack closure of the external auditory auditory canal, double ligation of the sigmoid sinus and the use of a special infratemporal fossa retractor. The postoperative treatment and intraoperative management of the internal carotid artery, facial nerve and cranial nerves IX, X, XI and XII including the technique and results of a new type of V-VII anastomosis are discussed.

PMID 6291440

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