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American Cocker Spaniels (ACSs) develop aural ceruminous gland hyperplasia and ectasia more often than dogs of other breeds. Data on the cause and development of these breed characteristic histopathological changes are lacking. We performed video-otoscopic examinations and dermatological work-up on 28 ACSs, obtained aural biopsies from each dog and assessed the statistical associations between the presence of ceruminous gland hyperplasia and ectasia and disease history, clinical or microbiological findings and underlying cause of otitis externa (OE). Histological lesions of ceruminous gland hyperplasia and ectasia were observed in aural biopsies from 6/13 clinically healthy ears and 13/15 ears with OE from 19/28 examined dogs. Nine of 28 dogs had histologically normal ceruminous glands (odds ratio [OR] 6.2, 95% confidence interval [CI] 1.1-36.6). Bacterial growth in microbiological culture of aural exudate (OR 14.1, 95% CI 2.1-95.3) was associated with ceruminous glandular changes, whereas previous history of OE, cutaneous findings or underlying allergies were not. Pedigree analysis and a genome-wide association study (GWAS) were performed on 18 affected and eight unaffected dogs based on histopathological diagnosis. While the GWAS indicated a tentative, but not statistically significant, association of ceruminous gland hyperplasia and ectasia with chromosome 31, a larger cohort is needed to confirm this preliminary result. Based on our results, ceruminous gland hyperplasia and ectasia may also precede clinical signs of OE in ACSs and a genetic aetiological component is likely Further studies with larger cohorts are warranted to verify our preliminary results. (C) 2021 The Authors. Published by Elsevier Ltd.

Ceruminous gland adenocarcinomas are uncommon malignant neoplasms arising from the ceruminal glands of the external ear canal. They include three variants: ceruminous adenocarcinoma (not otherwise specified, NOS), ceruminous adenoid cystic carcinoma, and ceruminous mucoepidermoid carcinoma. The clinicopathological details of these neoplasms have been described; however, due to their scarcity, their cytological features in humans have not been documented before. The objective of this study was to investigate the cytological, histological, and immunocytochemical features of a ceruminous gland adenocarcinoma with pleural effusion. We performed effusion cytology on a 57-year-old man who was diagnosed with ceruminous adenocarcinoma (NOS) 8 months earlier and found pleural metastases. The cytology revealed features similar to those seen via tissue pathology, such as irregular glandular architecture with dual cell populations and a solid pattern of tumour cells. Although ceruminous adenocarcinoma (NOS) is rare, recognising its cytology is important to eliminate it as a differential diagnosis.

Ceruminous adenocarcinoma is a malignant subtype of ceruminoma. Ceruminous gland tumors of the external auditory canal (EAC are rare neoplasm, and less than 150 cases have been reported to date. These tumors encompass a wide variety of histological presentations with different malignant potential. A 51-year-old woman presented with one month history of a right side otalgia. Physical examination showed an irregular surface elevation on the anterior portion of the right EAC and a normal tympanic membrane. Histologic examination revealed adenoid cystic carcinoma. After radiation therapy, lateral temporal bone resection, total parotidectomy and split thickness skin graft were performed. The diagnosis was confirmed as a ceruminous adenocarcinoma. At the last follow-up at 10 months, there was no evidence of recurrence. Ceruminous adenocarcinoma of the EAC is a rare malignant neoplasm and as definitive diagnosis is sometimes not provided until surgery, a biopsy must be performed in every EAC lesion. Combined radical surgery and radiation is the mainstay of therapy. (Korean J Otolaryngol 2004;47:1311-4)

Given the limited source of human external auditory canal (EAC) skin, animal experiments remain an important approach for studying functional EAC reconstruction. However, differences between humans and animals in terms of the general EAC structure, histological characteristics of EAC skin, and cell markers of its specific glands in cartilaginous EAC skin remain unknown. We compared the characteristics of the EAC between humans and large animals, as a basis for appropriate animal model selection. Temporal bone computed tomography was used to compare the EACs of humans, goats, pigs, and dogs. EAC skin samples were harvested and their histological characteristics evaluated. The skin's ultrastructure and the histological structure of specific glands and cell markers related to cell phenotype and function were further identified. The EAC structure in goats was similar to that in humans in terms of diameter, length, and cartilaginous segment ratio of the EAC, while that of pigs and dogs differed markedly. Furthermore, histological evaluation showed that there were abundant ceruminous and sebaceous glands in the goat's cartilaginous skin, while dogs and pigs showed notably fewer of these glands in cartilaginous skin than humans. Nevertheless, ceruminous glands in all species studied showed similar expression of cell biomarkers and secretion function. Goats might have advantages in terms of surgery and reconstruction of the functional EAC skin compared to dogs and pigs and can be a useful candidate for ceruminous gland cell sources.

Ceruminous glands are modified apocrine glands located in the external auditory canal (EAC). Neoplastic lesions arising from these glands are rare in humans and constitute a major differential diagnosis for glandular neoplasms of the EAC. Due to anatomic restrictions, benign and malignant neoplasms present with similar symptoms and to some extent even comparable radiologic features, particularly when the tumors are localized. Biopsies are frequently limited by small size, fragmentation and improper anatomic and architectural orientation, thereby hampering our ability to appreciate the relationship of peripheral edges of the tumor to the surrounding tissue. Benign and malignant tumors may also have overlapping histomorphologic features, which further magnifies the challenges in accurate diagnosis and management strategies. This article summarizes the salient clinical, radiologic and histologic features of common ceruminous gland tumors, in addition to discussing features that can aid in differentiating ceruminous tumors from other EAC tumors and to distinguish benign from malignant entities.

The tumors derived of the ceruminous gland in the external auditory canal are rare. Here, we report a case of a ceruminous adenoma (apocrine adenoma) with refractory chronic inflammation in the external auditory canal. A 46-year-old man presented with otorrhea, itching, and a foreign body sensation in his right ear. A soft reddish protruding lesion was revealed at the posterosuperior portion of the entry to the right external auditory canal by otoscopy. The skin lesion was endaurally resected; histopathology showed luminal structures in the middle to deep layer of the epidermis and inflammatory granulation below pseudoepitheliomatous hyperplasia. The walls of the luminal structures consisted of inner luminal secretory cells featuring apical decapitation secretion and outer myoepithelial cells. The patient was diagnosed with an apocrine adenoma. Three years after surgery, there has been no evidence of recurrence. Complete resection, including the deep layer of the epidermis, is necessary.

Some dogs with chronic otitis externa (OE) develop proliferation of the tissues surrounding the opening of the external ear canal, resulting in obstruction. Traditionally total ear canal ablation with bulla osteotomy (TECABO) has been recommended.To evaluate the efficacy of a novel treatment using carbon dioxide (COTwenty-six dogs were included, 16 with bilateral and 10 with unilateral disease (42 ears were treated). Dogs with nonpatent horizontal ear canal or macroscopic calcification of the ear canal were excluded. For histopathological evaluation, tissue samples were collected from 11 dogs (17 ears).Hyperplastic tissue around the canal opening and within the vertical ear canal was dissected and ablated using a COFollowing COCarbon dioxide laser surgery is an effective treatment of proliferative OE causing obstruction of the ear canal opening and vertical canal, and should be considered as an alternative to TECABO whenever possible.Des chiens avec otite externe chronique (OE) développent des proliférations des tissus entourant l’ouverture du conduit auriculaire externe résultant en une obstruction. Une ablation totale du conduit auriculaire avec ostéotomie (TECABO) est traditionnellement recommandée.Evaluer l’efficacité d’un nouveau traitement utilisant la chirurgie laser au dioxide de carbone (CO2) et décrire les données histopathologiques de l’OE obstructive et proliférative chronique.Vingt-six chiens ont été inclus, 16 avec atteinte bilatérale et 10 avec atteinte unilatérale (42 oreilles ont été traitées). Les chiens avec canal horizontal lésé ou calcification macroscopique du conduit auriculaire ont été exclus. Pour analyse histopathologique, des échantillons cutanés ont été prélevés sur 11 chiens (17 oreilles). MATÉRIELS ET METHODS: Le tissu hyperplasique bordant l’ouverture des conduits auriculaires et au niveau du conduit vertical a été disséqué et retiré à l’aide d’un laser au CO2. Les échantillons de biopsies ont été évalués pour l’hyperplasie des glandes cérumineuses et sébacées, hyperplasie épidermique, inflammation et fibrose. RÉSULTATS: A la suite de la chirurgie au laser à CO2, il y avait une évolution bonne à excellente avec résolution des proliférations pour 39 des 42 oreilles de 24 des 26 chiens. Un suivi était suffisant pour 21 chiens et trois chiens ont eu deux chirurgies. Deux chiens ont récidivé après une chirurgie et ont subi une TECABO. Deux chiens n’ont pas eu de récidive de prolifération tissulaire après chirurgie et ont eu une infection persistante et ont subi une TECABO. Les autres chiens ont été traités médicalement au long cours à la suite de la chirurgie. A l’histopathologie, huit oreilles avaient une réaction des glandes sébacées prédominante, trois avaient une réponse principalement des glandes cérumineuses et six avaient un patron glandulaire mixte. L’hyperplasie épidermique, l’inflammation et la fibrose variaient de moyennes à sévères.La chirurgie au laser Co2 est un traitement efficace de l’OE proliférative entrainant une obstruction du conduit auriculaire et du canal vertical et devrait être considéré en alternative à la TECABO lorsque possible.INTRODUCCIÓN: algunos perros con otitis externa crónica (OE) desarrollan proliferación de los tejidos que rodean la apertura del canal auditivo externo, lo que provoca una obstrucción. Tradicionalmente se ha recomendado la ablación total del canal auditivo con osteotomía de bulla (TECABO). OBJETIVOS: Evaluar la eficacia de un tratamiento novedoso mediante la cirugía con láser de dióxido de carbono (CO2) y describir las características histopatológicas de la OE crónica proliferativa y obstructiva. ANIMALES: Se incluyeron veintiséis perros, 16 con enfermedad bilateral y 10 con enfermedad unilateral (se trataron 42 orejas). Se excluyeron los perros con conducto auditivo horizontal no patente o con calcificación macroscópica del conducto auditivo. Para la evaluación histopatológica, se recolectaron muestras de tejido de 11 perros (17 orejas). MÉTODOS Y MATERIALES: el tejido hiperplásico alrededor de la abertura del canal y dentro del canal auditivo vertical se diseccionó y extirpó con un láser de CO2. Las muestras de biopsia se evaluaron prestando atención a la hiperplasia de las glándulas sebáceas y ceruminosas, hiperplasia epidérmica, inflamación y fibrosis. RESULTADOS: después de la cirugía con láser de CO2 hubo un resultado bueno o excelente con una resolución sustancial de los cambios proliferativos en 39 de 42 oídos de 24 de 26 perros. Una cirugía fue suficiente en 21 perros y tres perros tuvieron dos cirugías. Dos perros tuvieron recidiva de tejido proliferativo después de una cirugía y se sometieron a TECABO. Dos perros no tuvieron recidiva del tejido proliferativo después de la cirugía, pero tuvieron una infección luminal persistente y se sometieron a TECABO. El resto de los perros fue tratado médicamente de manera efectiva a largo plazo después de la cirugía. Histológicamente, ocho oídos tuvieron una respuesta predominantemente de las glándulas sebáceas, tres tuvieron una respuesta predominantemente ceruminosa y seis tuvieron un patrón glandular mixto. La hiperplasia epidérmica, la inflamación y la fibrosis variaron de leves a graves. CONCLUSIONES Y RELEVANCIA CLÍNICA: La cirugía con láser de CO2 es un tratamiento eficaz de la OE proliferativa que causa obstrucción de la apertura del canal auditivo y del canal vertical, y debe considerarse como una alternativa a TECABO siempre que sea posible.Einige Hunde mit einer chronischen Otitis Externa (OE) entwickeln eine Proliferation der Gewebe, die die Öffnung des äußeren Gehörgangs umgeben, was in einer Obstruktion endet. Traditionellerweise wurde dann eine totale Ohrkanalablation mit einer Bulla Osteotomie (TECABO) empfohlen.Eine Evaluierung der Wirksamkeit einer neuen Behandlung mittels Carbondioxid (Co2) Laser Chirurgie und die Beschreibung der histopathologischen Merkmale chronisch proliferativer obstruktiver OE.Es wurden sechsundzwanzig Hunde in die Studie aufgenommen, 16 mit bilateraler und 10 mit unilateraler Erkrankung (42 Ohren wurden behandelt). Hunde mit nicht durchgängigem horizontalem Ohrkanal oder makroskopisch sichtbarer Kalzifizierung des Ohrkanals wurden ausgeschlossen. Es wurden Gewebeproben von 11 Hunden (17 Ohren) zur histopathologischen Untersuchung entnommen.Das hyperplastische Gewebe rundum die Öffnung des Ohrkanals sowie innerhalb des vertikalen Ohrkanals wurde herausgeschnitten und mittels CO2 Laser abgetragen. Biopsieproben wurden auf eine Hyperplasie im Bezug auf Talgdrüsen sowie der ceruminösen Drüsen, auf eine epidermale Hyperplasie, Entzündung und Fibrose evaluiert.Nach der CO2 Laser Chirurgie ergab sich ein gutes bis exzellentes Ergebnis mit deutlicher Verbesserung der proliferativen Veränderungen bei 39 der 42 Ohren von 24 der 26 Hunde. Ein chirurgischer Eingriff war bei 21 Hunden ausreichend und drei Hunde hatten zwei Operationen. Bei zwei Hunden trat das proliferative Gewebe nach einer Operation wieder auf und es wurde eine TECABO durchgeführt. Bei zwei Hunden ergab sich kein Wiederauftreten des proliferativen Gewebes nach der Operation, allerdings hatten sie eine ständige luminale Infektion und so wurde auch eine TECABO durchgeführt. Die übrigen Hunde wurden nach der Operation langfristig mit Medikamenten erfolgreich gemanagt. Histologisch zeigten acht Ohren hauptsächlich eine Reaktion der Talgdrüsen, drei zeigten hauptsächlich eine Reaktion der ceruminösen Drüsen und sechs hatten eine gemischt drüsige Reaktion. Das Ausmaß der epidermalen Hyperplasie, der Entzündung und Fibrose reichte von mild bis gravierend.Die CO2 Laser Chirurgie ist eine wirksame Behandlung der proliferativen OE, welche eine Obstruktion der Öffnung des Ohrkanals und des Vertikalkanals verursacht, und sollte als Alternative zur TECABO wenn nur irgend möglich in Betracht gezogen werden.背景: 慢性外耳炎の犬の中には、外耳道の開口部周辺の組織が増殖し、閉塞をきたす症例がいる。従来、全耳道切除および鼓室胞骨切り術(TECABO) が推奨されてきた。 目的: 本研究の目的は、二酸化炭素 (CO2) レーザー手術を用いた新しい治療法の有効性を評価し、慢性増殖性および閉塞性OEの病理組織学的特徴を説明することであった。 供試動物: 26頭の犬が対象となり、両側性疾患が16頭、片側性疾患が10頭であった (42の耳が治療された) 。閉塞性の水平耳道や外耳道に巨視的石灰化のある犬は除外した。病理組織学的評価のために、11頭 (17耳) の犬から組織サンプルを採取した。 材料と方法: 外耳道開口部周辺および垂直耳道内の過形成組織を切開し、CO2レーザーを用いて切除した。生検サンプルは、皮脂腺・耳垢腺過形成、表皮過形成、炎症、線維化を評価した。 結果: CO2レーザー手術後、26頭中24頭の42耳中39耳で増殖性変化が実質的に消失し、良好または優れた結果が得られた。21頭の犬は1回の手術で十分であり、3頭は2回の手術を受けた。2頭は1回の手術で増殖組織が再発し、TECABOを実施した。2頭は手術後に増殖組織の再発はなかったが、腔内感染が持続したためTECABOを実施した。残りの犬は手術後、長期にわたって効果的な内科的管理を受けた。組織学的には、8頭の耳が主に皮脂腺反応を示し、3頭が主に耳垢腺反応を示し、6頭が混合腺パターンを示した。表皮過形成、炎症、線維化は軽度から重度まで様々であった。 結論と臨床的妥当性: CO2レーザー手術は、外耳道開口部および垂直耳道の閉塞を引き起こす増殖性OEの有効な治療法であり、可能な限りTECABOの代替として考慮されるべきである。.背景: 一些慢性外耳炎(OE)患犬存在耳道开口周围组织增生, 导致阻塞。传统上推荐采用骨泡截骨术(TECABO)进行全耳道消融。 目的: 评价使用二氧化碳(CO2)激光手术的新型治疗的疗效, 并描述慢性增生性和阻塞性OE的组织病理学特征。 动物: 纳入了26只犬, 16只为双侧, 10只为单侧发病 (治疗了42个耳道) 。排除水平耳道不通畅或耳道肉眼可见钙化的犬。从11只犬 (17个耳道) 中采集组织样本进行组织病理学评价。 方法和材料: 使用CO2激光切除和和消融耳道开口周围和垂直耳道内的增生组织。评价活检样本的皮脂腺和耵聍腺增生、表皮增生、炎症和纤维化。 结果: CO2激光手术后, 26只犬中的24只的42个耳道中, 有39个的增生性变化显著消退, 结果良好或极佳。21只犬1次手术足矣, 3只犬2次手术。2只犬1次手术后增殖组织复发, 进行TECABO。2只犬术后增殖组织无复发, 但耳道内持续感染, 进行TECABO。其余犬在术后接受了有效的长期药物治疗。组织学上, 8个耳道以皮脂腺反应为主, 3个以耵聍腺反应为主, 而6个呈混合腺体模式。表皮增生、炎症和纤维化从轻度到重度不等。 结论和临床相关性: 对于耳道开口和垂直耳道阻塞的增生性OE,CO2激光手术是有效治疗方法, 应尽可能考虑作为TECABO的替代疗法。.Alguns cães com otite externa (OE) crônica desenvolvem proliferação dos tecidos no entorno da abertura do conduto auditivo externo, resultando em obstrução. Tradicionalmente, a ablação total do conduto auditivo com osteotomia de bulha (TECABO) tem sido recomendada.Avaliar a eficácia de um novo tratamento utilizando cirurgia a laser de dióxido de carbono (COVinte e seis cães foram incluídos, 16 com doença bilateral e 10 unilateral (42 orelhas foram tratadas). Cães com conduto auditivo horizontal não patente ou calcificação macroscópica do conduto auditivo foram excluídos. Para avaliação histopatológica, foram coletadas amostras de tecido de 11 cães (17 orelhas). MÉTODOS E MATERIAIS: O tecido hiperplásico ao redor da abertura do condutol e dentro do conduto auditivo vertical foi dissecado e ablado com laser de COApós a cirurgia com laser de CO

BACKGROUND: Naturally the ear produces soft wax from the sebaceous and ceruminous gland. This is what is referred to as earwax. This wax is important for protection of the ear by trapping dust and other foreign particles that could damage the eardrum. It also has some antibacterial properties. Jaw movements, like during chewing, moves the old earwax from inside the ear canal to the outside and finally flakes off. Build-up of this wax in the ear causes hearing loss, pain in the ear, irritation, dizziness and ringing in the ears. Self-ear cleaning refers to self-insertion of objects into the ear canal, with an attempt to remove the wax to get rid of these symptoms. It is a common practice amongst many individuals. Potentially, this rids the ear of its protective defences in addition to posing a risk of ear related injuries. This review paper aims to determine the prevalence of self-ear cleaning, the common methods used and the complications associated with this practice. METHODS: Electronic retrieval of articles for review was done from PubMed, Google and Google scholar with key-ward – self-ear cleaning, ear-wax, cerumen. Many articles were retrieved but only a few were about self-ear cleaning and only seven could be included in this review. The inclusion criteria included: article published in English language; study carried between 2005 and 2020 inclusive; article discussing materials used and complications associated with self-ear cleaning. Articles older than 15 years or published in languages other than English were excluded. RESULTS: On average the prevalence of self-ear cleaning amongst all studies was 76.6%. The commonest method used for ear cleaning was cotton buds with an average of 69.6%. Wax/dirt removal was the commonest reason for engaging in this practice. Several complications arising from this practice included perforation of eardrum, retained foreign body and otitis externa. CONCLUSION: In addition to ridding the ear of its natural protection, self-ear cleaning is associated with a risk of injury to the ear drum and retention of foreign bodies. Community education to avoid this practice is therefore of paramount importance. Trained health care providers should be consulted whenever someone has a problem related to hearing or any other symptoms.

An adenoid cystic carcinoma (AdCC) of the ceruminous glands is very rare; its diagnosis is most often challenging, and simple biopsies may be misleading. Our paper describes a case of a circumferential mass of the left ear canal that was initially reported as a basal cell carcinoma on biopsies in the clinic and on frozen sections intraoperatively. The final pathology was an AdCC of the ceruminous glands of the external auditory canal. Our case reflects the difficulty in the diagnosis of an AdCC of the ceruminous gland and the importance of keeping broad differential diagnoses in mind when counseling patients with masses in the ear canals until final pathology is obtained.

Ceruminous adenoma (CA) is a rare, benign tumor of the ceruminous gland found in the cartilaginous part of the external auditory canal (EAC). The tumor is diagnosed on histopathology and shows a characteristic dual population of luminal epithelial cells and basal myoepithelial cells. However, CA can be diagnosed on fine-needle aspiration cytology (FNAC) prior to surgery and the cytopathologist should be well aware of its cytological findings to avoid any misdiagnosis. The tumor shows an excellent prognosis with possible recurrence and malignant transformation. The present case emphasizes the cytological features of CA, which have been scantily described in the literature and highlights the role of cytopathologists in preoperative diagnosis.

Background Patulous Eustachian tube (pET) is a rare dysfunction of the Eustachian tube described in humans. It is characterized by failure of the ET to close, resulting in unrestricted passage of air, sound and material between the nasopharynx and the middle ear. Objective To report a case of pET associated with otitis in a dog. Animal A 6-year old-female spayed Dachshund dog. Methods and materials Otoscopic examination, cytological evaluation, culture and susceptibility, computerized tomography (CT), video-otoscopic flushing and surgery. Results Left ear otoscopic examination revealed erythema, purulent frothy discharge, ceruminous gland hyperplasia, stenosis and a partial tear of the tympanum. Cytological evaluation from the left external canal showed neutrophils, macrophages, rods and cocci. Aerobic culture showed predominantly multidrug-resistant Pseudomonas aeruginosa. The CT findings of the left ear included chronic changes in the external canal, marked lysis of the tympanic bulla and marked dilation of the ET. During video-otoscope flushing, saline drained through the mouth. Bilateral incomplete hypoplasia of the soft palate was noted. Total ear canal ablation and bulla osteotomy with ET dissection were curative. Histopathological findings were compatible with chronic otitis externa (OE) and media. Conclusion and clinical importance To the best of the authors' knowledge, this is the first case of pET described in animals. The ET dysfunction and palatine defect were likely the cause of the otitis in this dog. Clinicians should investigate pET in animals with signs of OE characterized by frothy liquid and food fragments in the ear canal in addition to sneezing after drinking water.

The 2017 fourth edition of the World Health Organization Classification of Tumours, specifically as it relates to the ear (Chap. 9), has several changes. Importantly, the number of entities has been significantly reduced by omitting tumors or lesions if they do not occur exclusively or predominantly at this site or if they are discussed in detail elsewhere in the book. These entities include: embryonal rhabdomyosarcoma, osteoma, exostosis, angiolymphoid hyperplasia with eosinophilia, Schneiderian papilloma, inverted papilloma, lipoma of the internal auditory canal, hemangioma, hematolymphoid tumors, and secondary tumors. Paraganglioma was included in the neck chapter. New entries include otosclerosis and cholesteatoma, while refinements to nomenclature, classification and criteria were incorporated into the ceruminous gland tumors and epithelial tumors of the middle and inner ear. Specifically, the middle and inner ear were combined, as practical limitations of origin and imaging make a definitive separation artificial. The classification reflects the state of current understanding for these uncommon entities, with this update only highlighting selected entities that were the most significantly changed.

OBJECTIVES The earwax (cerumen) that covers external auditory canal (EAC) skin contains a mixture of ceruminous and sebaceous gland substances, such as lipids, peptides, and proteins. The components secreted from the ceruminous gland that is a modified sweat gland form cerumen and contain several antimicrobial factors. Since substance P (SP) and calcitonin gene-related peptide (CGRP), known as a secretagogue, have been found in sweat glands, our purpose was to determine the expression of SP and CGRP in the glands of EAC skin. METHODS Sections of normal human EAC skins were immunostained for the presence of SP and CGRP using polyclonal antibodies. Immunoreactivity was detected using an avidin-biotin peroxidase complex method. RESULTS SP staining was found in ceruminous gland acini and myoepithelial cells. But the SP staining was not found in the sebaceous glands and epidermal region. CGRP was strongly stained in the ceruminous gland and weakly in the sebaceous gland cells. Interestingly, most prominent staining of SP and CGRP was noted in the myoepithelial cells of the ceruminous gland. CONCLUSION The findings in this study suggest that SP and CGRP are expressed in the glands of the EAC skin and secreted in the process of ceruminous gland secretion.

The present study was designed to characterize and diagnose different spontaneously occurring canine neoplasms using conventional and advanced diagnostic techniques. Fifty eight tumour samples were collected from dogs irrespective of their sex, breed, age and were grouped in three categories viz. mammary, skin and visceral tumours. Location wise overall occurrence of tumours was highest in skin (50%) followed by visceral organs (25.86%) and mammary gland (24.13%). Cytological diagnosis from 30 freshly incised tissues revealed 14 benign and 16 malignant cases. Histopathological diagnosis (n=58) evinced 1 (1.72%) benign mammary tumour (carcinoma-in situ); 13 (22.41%) malignant mammary tumours (mixed carcinoma-4, tubular carcinoma-4, tub- ulopapillary carcinoma-3, comedocarcinoma-1 and poorly differentiated carcinoma-1); 12 (20.68%) benign skin tumours (perianal gland adenoma-5, trichoblastoma-4, trich of olliculoma-1, tricholemmoma-1 and haemangioma-1); 17 (29.31%) malignant skin tumours (fibrosarcoma-6, mast cell tumour-3, apocrine adenocarcinoma-3, haemangiopericytoma-1, perianal gland adenocarcinoma-1, chondrosarcoma-1, melanoma-1, poorly differentiated carcinoma-1); 9 (15.51%) benign visceral tumours (oral papilloma-4, sertoli cell tumour-1, angioleiomyoma-1, ceruminous gland adenoma-1, ameloblastic fibro-odontoma-1, haemangioma-1); and 6 (10.34%) malignant visceral tumours (haemangiosarcoma-4, round cell sarcoma-1 and vaginal haemangiopericytoma-1). Immunohistochemistry was performed in 30 tumours for various molecular markers, viz. F8, SMA, Desmin, S-100, HER2 and ER. All mammary tumours were found negative for ER and HER2, whereas fibrosarcoma and haemangiosarcoma were found positive for SMA and F8, respectively. Real time PCR was employed to study the overexpression of ERBB2 gene in tumour tissues. Over expression of ERB-B2 was found only in skin fibrosarcoma (10 fold) and apocrine adenocarcinoma (112 fold).

This case report describes the skin condition ceruminous gland hyperplasia of the ears of a cat. The diagnosis was made through histopathology. Treatment consisted of carbon dioxide laser ablation of the cystic structures and postoperative care associated with the surgery, as well as a hydrolyzed protein diet, weekly ear cleaning and intermittent topical corticosteroid drops in the ears to minimize the reoccurrence of the cysts.

A case of aural carcinoma with chondroid metaplasia at metastatic foci in an 8-year-old male pug is described. Multiple metastases in both lungs and the right submandibular, parotid, retropharyngeal, cervical and prescapular lymph nodes were detected. Histologically, the skin of the right ear canal appeared to be diffusely infiltrated by cords and nests of neoplastic epithelial cells, showing multifocal contiguity with the overlying hyperplastic squamous epithelium. Most of the carcinomatous cells were arranged in a glandular-like pattern, with formation of lumens containing epithelial cells attached to the peripheral cell layer by elongated intercellular bridges. Scattered foci of keratinization with central accumulations of compact, laminated keratin were also observed, and histochemical stains failed to detect mucinous secretory material. Even though histological and histochemical findings were compatible with a diagnosis of acantholytic squamous cell carcinoma, CAM5.2 immunostaining was detectable in the majority, although not all, neoplastic cells, confirming a diagnosis of poorly differentiated ceruminous gland carcinoma. Pulmonary metastatic nodules revealed multifocal areas of cartilaginous metaplasia with apparent transition of carcinomatous cells to chondroid cells, showing nuclear atypia and focal cytokeratin immunostaining. Carcinomatous cells surrounding chondroid areas also revealed focal vimentin and S100 immunoreactivity. Histological evidence of transition between the two components, as well as the presence of intermediate cells displaying both epithelial and mesenchymal immunohistochemical features, strongly indicated a final diagnosis of carcinosarcoma, in which chondrosarcomatous elements were derived from carcinoma cells.

This study aimed to better characterise the gross anatomy of the normal ear canal, and to compare histological features of the normal ear canal to those affected by chronic otitis externa. In 40 normal ears from 20 dogs, the length of the annular and auricular cartilage was 1.2 +/- 0.2 and 4.1 +/- 0.9 cm, respectively; overall length of the external ear canal was 5.3 +/- 1.0 cm. The maximal internal diameter at the distal end of the external ear canal, the proximal opening of the auricular cartilage and the proximal end of the annular cartilage was 5.8 +/- 1.5, 0.7 +/- 0.2 and 0.5 +/- 0.1 cm, respectively. Body weight correlated positively with the overall length and diameter of the distal end of the ear canal (r = 0.78, P < 0.001; r = 0.42, P < 0.05). Morphometric evaluation was carried in 28 clinically healthy ears of 14 dogs, and 15 otitic ears of 13 dogs. Histological features of this integument revealed that the density and distribution of sebaceous and ceruminous gland tissue exhibits marked variation between individuals. Nevertheless, general patterns were observed; sebaceous tissue increases gradually from the proximal to the distal parts of the ear canal, whilst ceruminous gland tissue by contrast decreases. In otitic canine ears, the distribution of sebaceous and ceruminous glandular tissue was similar to normal ears but the glands became larger and hyperplastic (P < 0.05). Density of hair follicles was not different between healthy and otitic ears (P = 0.16), but the hair follicles became hyperplastic in otitic ears.

Background Ceruminal gland carcinomas are rare neoplasms confined to the skin lining the cartilaginous part of the external auditory canal. Design Retrospective. Results The patients included 11 men and 6 women, aged 33–82 years (mean, 59.5 years). Patients presented clinically with a mass of the outer half of the external auditory canal (n = 14), hearing changes (n = 5), drainage (n = 4), or paralysis of the facial nerve (n = 3). The polypoid masses ranged in size from 0.5 to 3 cm in greatest dimension (mean, 1.8 cm). Histologically, the tumors demonstrated a solid to cystic pattern, composed of an infiltrating glandular to cribriform arrangement of epithelial cells. Histologic features included a dual cell population (although not the dominant histology), increased cellularity, moderate to severe nuclear pleomorphism, irregular nucleoli, increased mitotic figures (mean, 3/10 HPF), including atypical forms, and tumor necrosis (n = 2). Tumors were divided into three types of adenocarcinoma based on pattern of growth and cell type (ceruminous, NOS [n = 12], adenoid cystic [n = 4], mucoepidermoid [n = 1]). CK7 and CD117 highlighted the luminal cells, while S1-00 protein showed a predilection for the basal cells of ceruminous and adenoid cystic carcinomas. Metastatic adenocarcinoma or direct extension from salivary gland neoplasms are the principle differential considerations. Surgical resection was used in all patients with radiation used in four patients. Eleven patients were alive or had died of unrelated causes without evidence of disease (mean, 11.2 years); six patients had died with disease (mean, 4.9 years), all of whom had developed local recurrence. Conclusion Ceruminous-type carcinomas, with the exception of ceruminous mucoepidermoid carcinoma, all demonstrated a dual cell population of basal myoepithelial-type cells and luminal apocrine cells. The specific histologic sub-type does not influence the long-term patient outcome.

A 6-year-old, castrated male Shiba-inu displayed a mass showing invasive growth in the external auditory canal of the left ear. Histologically, the tumor mass predominantly comprised spindle-shaped neoplastic cells, arranged in solid nests admixed with irregular tubulo-acinar structures, lined by cuboidal to polygonal neoplastic cells. Neoplastic cells had extensively infiltrated into deep tissues. No bone formation or chondroid matrix was observed in the tumor stroma. Both types of neoplastic cells showed nuclear atypia and high mitotic activities. Luminal epithelial elements were immunohistochemically positive for pan-cytokeratin and cytokeratin 8. Spindle-shaped cells showed intense immunoreactivity for vimentin, pan-cytokeratin and α-smooth muscle actin, indicating that spindle-shaped cells retained the original histological characteristics of myoepithelial cells. These findings were consistent with a diagnosis of ceruminous gland carcinoma with malignant proliferation of acinar epithelial and myoepithelial tumor cells, which rarely occurs in dogs. Following resection with wide surgical margins, no recurrence or metastases have been observed as of 6 months postoperatively.

Annales Francaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale - Vol. 124 - N° 6 - p. 314-317

In this study, we examined the prevalence, pathology, and epidemiology of tumors in free-ranging island foxes occurring on three islands in the California Channel Islands, USA. We found a remarkably high prevalence of ceruminous gland tumors in endangered foxes (Urocyon littoralis catalinae) occurring on Santa Catalina Island (SCA)--48.9% of the dead foxes examined from 2001-2008 had tumors in their ears, and tumors were found in 52.2% of randomly-selected mature (≥ 4 years) foxes captured in 2007-2008, representing one of the highest prevalences of tumors ever documented in a wildlife population. In contrast, no tumors were detected in foxes from San Nicolas Island or San Clemente Island, although ear mites (Otodectes cynotis), a predisposing factor for ceruminous gland tumors in dogs and cats, were highly prevalent on all three islands. On SCA, otitis externa secondary to ear mite infection was highly correlated with ceruminous gland hyperplasia (CGH), and tumors were significantly associated with the severity of CGH, ceruminous gland dysplasia, and age group (older foxes). We propose a conceptual model for the formation of ceruminous gland tumors in foxes on SCA that is based on persistent, ubiquitous infection with ear mites, and an innate, over exuberant inflammatory and hyperplastic response of SCA foxes to these mites. Foxes on SCA are now opportunistically treated with acaricides in an attempt to reduce mite infections and the morbidity and mortality associated with this highly prevalent tumor.

Ear mites (Otodectes cynotis) and ear canal tumors are highly prevalent among federally endangered Island foxes (Urocyon littoralis catalinae) living on Santa Catalina Island off the coast of Southern California. Since studies began in the 1990s, nearly all foxes examined were found to be infected with ear mites, and ceruminous gland tumors (carcinomas and adenomas) were detected in approximately half of all foxes ≥ 4 years of age. We hypothesized that reduction of ear mite infection would reduce otitis externa and ceruminous gland hyperplasia, a risk factor for tumor development. In this study, we conducted a randomized field trial to assess the impact of acaricide treatment on ear mite prevalence and intensity of infection, otitis externa, ceruminous gland hyperplasia, and mite-specific IgG and IgE antibody levels. Treatment was highly effective at eliminating mites and reducing otitis externa and ceruminous gland hyperplasia, and mite-specific IgG antibody levels were significantly lower among uninfected foxes. Ceruminous gland hyperplasia increased in the chronically infected, untreated foxes during the six month study. Our results provide compelling evidence that acaricide treatment is an effective means of reducing ear mites, and that mite removal in turn reduces ear lesions and mite-specific IgG antibody levels in Santa Catalina Island foxes. This study has advanced our understanding of the underlying pathogenesis which results in ceruminous gland tumors, and has helped inform management decisions that impact species conservation.

Syringocystadenoma papilliferum (SCAP) usually occurs on the face or the scalp and is very rare in the external auditory canal (EAC). There has been no information on magnetic resonance (MR) imaging of this tumor irrespective of its site. We report here a case of 57-year-old man having this tumor, which was surgically removed and its histopathology was confirmed. MR imaging demonstrated a lobulated 4-cm mass with clearly defined margins in the EAC. Although the tumor was bulky, these MR findings were different from the malignancies. The mass lesion showed intermediate signal intensity both on T1- and T2-weighted MR images and showed slight enhancement on gadolinium-enhanced T1-weighted images. Signal intensities on T2-weighted images of this tumor were low compared to those of pleomorphic adenoma. All ceruminous gland tumors including SCAP are thought to be potentially malignant; therefore, pre-operative biopsy should not be performed. Even though incisional biopsy is sometimes needed as in our case, the current MR features would be helpful for differential diagnosis of this rare condition and assessing the extension of the tumor.

The ceruminous glands in the skin of the human external auditory canal are modified apocrine glands, which, together with sebaceous glands, produce the cerumen, the ear wax. Cerumen plays an important role in the protection of the ear canal against physical damage and microbial invasion. We studied the morphology of the glandular cells by light and electronmicroscopy. Antimicrobial and cytoskeletal components of the ceruminous glands were investigated by immunohistochemical methods. Numerous antimicrobial proteins and peptides are present in the ceruminous glandular cells: beta-defensin-1, beta-defensin-2, cathelicidin, lysozyme, lactoferrin, MUC1, secretory component of IgA. These data indicate a crucial role in the innate host defense against diverse pathogens. The apocrine secretion mechanism is a special mode of secretion by which the apical part of the cell cytoplasm surrounded by a membrane is pinched off. We could show that the presence of actin filaments, CK 19 and CK 7, seems to play a role in the pinching-off mechanism. Finally, we showed the secretion of lipid vesicles from the ceruminous gland. We could extend the number of detected antimicrobial peptides and proteins in human ceruminous glandular cells that protect the surface of the external auditory meatus. In addition, we detected proteins involved in the apocrine secretion mode of the ceruminous gland.

BACKGROUND: The cytologic diagnosis of ear canal tumors is difficult or impossible by swab alone because cell exfoliation may be poor and neoplastic cells may be masked by associated inflammation. Fine-needle biopsy (FNB) can be used to obtain a higher yield of cells for diagnosis. OBJECTIVE: The purpose of this study was to assess the efficacy and diagnostic value of FNB and cytologic examination in providing an accurate diagnosis of masses growing in the external ear canal of cats. METHODS: Cytologic specimens from masses in the external ear canal, taken under inhaled, general anesthesia, were classified into 4 groups: 1) ceruminous gland hyperplasia or adenoma, 2) ceruminous gland adenocarcinoma, 3) inflammatory polyps, and 4) other neoplastic and non-neoplastic masses. Cytopathologic diagnoses were compared with the final histopathologic diagnoses, and indices of diagnostic test accuracy (sensitivity, specificity, likelihood ratios, diagnostic-odds ratios) were calculated. RESULTS: Twenty-seven masses (from 25 cats, including 2 cats affected bilaterally) were included in the study. The results showed good correspondence between cytologic and histologic diagnoses with an overall agreement index (kappa) of.74, a diagnostic odds ratio of 22, and 100% (27/27) agreement in the diagnosis of inflammatory polyps versus neoplasia (both benign and malignant). CONCLUSIONS: FNB cytopathology of external ear masses in the cat was sufficiently accurate for distinguishing inflammatory polyps from neoplasia. For differentiation of benign proliferation and malignant neoplasia, however, histopathologic confirmation is recommended.

Background: Ceruminous gland neoplasms are rare neoplasms. To date, a large clinicopathologic study of benign ceruminous gland neoplasms has not been reported. Design: Forty-one cases of ceruminous gland adenomas diagnosed between 1970 and 2000 were retrieved from the files of the Armed Forces Institute of Pathology. Histologic features were reviewed, immunohistochemical analysis was performed (n = 21), and patient follow-up was obtained (n = 40). Results: The patients included 22 men and 19 women, 24 to 85 years of age (mean, 54.2 years). Patients presented clinically with a painless mass of the outer half of the external auditory canal (n = 33) or with hearing changes (n = 11). Symptoms were present for an average of 16.3 months. The polypoid masses affected the external auditory canal only and ranged in size from 0.4 to 2 cm in greatest dimension (mean, 1.1 cm). Histologically, the tumors demonstrated glands and small cysts lined by a tubuloglandular proliferation of inner ceruminous cells (cerumen-secreting epithelium with decapitation secretion) subtended by a spindled to cuboidal myoepithelial layer. A hyalinized stroma created an infiltrative pattern of growth; surface involvement (n = 8) was seen. Tumors were divided into ceruminous adenoma (n = 36), ceruminous pleomorphic adenoma (n = 4), and syringocystadenoma papilliferum (n = 1) types. The luminal cells were strongly and diffusely immunoreactive with CK7, while the basal cells were highlighted with CK5/6, S-100 protein, and p63. CDI 17 highlighted the luminal cells preferentially. The proliferation markers revealed a low index. Adenocarcinoma and middle ear adenoma are the principal differential consideration. Surgical excision was used in all patients. Four patients developed a recurrence due to incomplete excision. All patients were without evidence of disease at the last follow-up: alive (n = 28, mean 16.3 years) or dead (n = 12, mean 11.8 years). Conclusion: Ceruminous gland adenomas are the most common external auditory canal tumors. They demonstrate a dual cell population of basal myoepithelial-type cells and luminal ceruminous (ceruminal) cells. Cerumen pigment, CK7, and p63 can help to distinguish this tumor from other neoplasms that occur in the region. Complete surgical excision results in an excellent long-term clinical outcome.

Objective—To compare pathologic changes of the horizontal ear canal associated with chronic severe otitis externa between Cocker Spaniels and dogs of other breeds. Design—Retrospective study. Animals—80 dogs with severe otitis externa that required total ear canal ablation with lateral bulla osteotomy. Procedure—Medical records were reviewed for breed, sex, and age at time of surgery. Histologic specimens from the horizontal ear canal were evaluated by a single examiner for overall tissue response pattern and scored for sebaceous gland hyperplasia, ceruminous gland hyperplasia, ceruminous gland ectasia, fibrosis, pigment-laden macrophages, and osseous metaplasia. Results—48 of 80 (60%) dogs were Cocker Spaniels. Thirty-five of 48 (72.9%) Cocker Spaniels had a predominately ceruminous tissue response pattern; only 9 of 32 (28.1%) dogs of other breeds had the same pattern. Other breeds most commonly had a pattern dominated by fibrosis (n = 13 [40.6%]); fibrosis was the predominant pattern in only 4 of 48 (8.3%) Cocker Spaniels. Discriminant analysis and K-means clustering of 4 histopathologic criteria correctly classified 75% of the dogs as Cocker Spaniels or all other breeds. Conclusions and Clinical Relevance—Cocker Spaniels are at increased risk for chronic severe otitis externa requiring total ear canal ablation with lateral bulla osteotomy, indicating that earlier and more aggressive management of the primary otitis externa and secondary inflammation is warranted in this breed. Cocker Spaniels with chronic severe otitis externa have distinct differences in pathologic characteristics of the horizontal ear canal, compared with other breeds. (J Am Vet Med Assoc 2002;221: 1000–1006)

As glândulas ceruminosas são glândulas apócrinas modificadas encontradas na região profunda da derme que reveste a porção cartilaginosa do meato acústico externo. Os tumores originados dessas glândulas são raros. Existem controvérsias em relação ao termo ceruminoma, que nos parece impróprio. Na verdade, esses tumores são atualmente classificados como adenoma, adenocarcinoma, carcinoma adenóide cístico e adenoma pleomórfico. Relatamos o caso de uma mulher de 39 anos, apresentado-se com cefaléia, hipoacusia e zumbidos à direita, além de vertigem e náuseas. A TC de crânio evidenciou tumoração do ouvido médio, invadindo os limites ósseos e cartilaginosos, com extensão intracraniana. Foi submetida a cirurgia, com exérese parcial do tumor, seguida de radioterapia (6000 cG). A histologia mostrou tratar-se de carcinoma adenóide cístico de glândulas ceruminosas. A paciente apresentou no pós-operatório paralisia facial periférica à direita, mantendo os déficits anteriores. Após um ano da cirurgia encontra-se estável clinicamente.Ceruminous glands are modified apocrine glands, confined to the skin lining of the cartilaginous part of the external auditory meatus. Tumors arising from these glands are rare. Controversy exists regarding the term "ceruminoma". Actually this neoplasia should be classified as adenoma, adenocarcinoma, adenoid cystic carcinoma and pleomorphic ceruminous adenoma. We report a 39-year-old woman first seen at Santa Casa of Belo Horizonte, in 1998, presenting with headache, nausea, vertigo, hearing loss and tinitus on the right for the past two years. CT scan showed a tumor eroding cartilaginous and bony limits with intracranial invasion. She was submitted to multidisciplinary treatment with surgery followed by radiotherapy (6000 cG). Histology showed a ceruminous adenoid cystic carcinoma. The patient manifested a right peripherical facial palsy and had no recovery of the previous deficits. After one year from surgery she is clinically stable.