Basal cell carcinoma - external auditory canal

Case contributed by Bahman Rasuli
Diagnosis certain


Hearing loss and otorrhea.

Patient Data

Age: 45 years
Gender: Female

There is a 29 x 33 x 41 mm heterogeneous enhancing infiltrated solid mass with a necrotic component located at the left external auditory canal and middle ear with extension to:

  • tragus base (external extension)
  • audits ad antrum causing to fluid signal at mastoid air cells (posterosuperior extension)
  • stylomastoid foramen (inferior extension)
  • tympanic, mastoid and stylomastoid part of the facial nerve 
  • destruction of middle ear ossicles and tympanic membrane secondary to infiltration of epitympanum and mesotympanum
  • infiltration of hypotympanum and sinus tympani and fascial recess (inferior extension) and extension to the opening of the Eustachian canal
  • close contact with the posterior wall of temporomandibular joint

Intracranial extension is not seen.

Inner ear and geniculate ganglion are intact.

High signal foci in T2 and flair sequences at subcortical and periventricular white matter of both cerebral hemispheres depict microvascular ischemic events.

Case Discussion

The mass of the external auditory canal was resected and surgical pathology revealed:

  • Mastoid foramen mass, excision: Invasive basal cell carcinoma with focal squamoid differentiation including parotid gland tissue and around bony trabeculae. Perineural invasion is present.
  • Tympanic bone lesion, biopsy: Invasive basal cell carcinoma invading around mature bony trabeculae.
  • Left ear canal medial part skin lesion: Invasive basal cell carcinoma with focal squamoid differentiation
  • Designated as ear auditory canal tumor, excision: Invasive basal cell carcinoma with focal squamoid differentiation invading parotid gland tissue.

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