Large Fibroepithelial Polyp Initially Misdiagnosed as Hemangioma of the Middle Ear Extending Through External Auditory Meatus.

Abstract

Fibro epithelial polyps arising in the middle ear or external auditory canal are exceptionally rare and can be misdiagnosed due to the shared characteristics of benign lesions of the ear. A 43-year-old female with no prior history presented with right-sided otalgia, otorrhea, and hearing loss. At the time of presentation, patient was noted to have an erythematous tympanic membrane, which later developed into an pedunculated lesion on follow up. Imaging showed the lesion involved the Eustachian tube, middle ear and ossicular chain, and tympanic membrane and extended beyond the external auditory meatus. Hematoxylin and eosin staining and immunohistochemistry stains were negative for hemangiomas, nerve sheath neoplasms, myxoid sarcomas, and supported the final diagnosis of fibroepithelial polyp. The patient underwent surgical excision via a canal wall up tympanomastoidectomy including a facial recess approach with nointra-operative or post-operative complications. Throughout the workup of this case, three distinct pathologic diagnoses were reported for this tumor which highlights the shared pathologic characteristics among benign lesions of the temporal bone. However, all possible diagnoses were in keeping with the final diagnosis of fibroepithelial polyp. This case exhibits an unusually large and rare fibroepithelial polyp of the middle ear and temporal bone. This emphasizes the similarities of clinical and pathologic presentations of benign lesions of the middle ear and temporal bone and the importance of sending complete samples for pathologic diagnosis.