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Published on: March 11, 2014
Malignant Transformation of Temporal Bone Schneiderian Papilloma Associated with HPV-6
O Marzouk1, F Brasch2, I Todt1
1Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty OWL, Bielefeld University, Campus Klinikum, Bielefeld, Germany.
Introduction:
Temporal bone Schneiderian papillomas (TBSPs) rarely present as a primary tumors arising from the middle ear and mastoid process. The clinical findings and imaging of TBSPs are not specific. Therefore, diagnosis can only reliably be definitively established by histopathology.
Objective:
To report a novel case of a malignant transformation of TBSP associated with HPV-6 and to present its management. Case Report. A 68-year-old woman presented with conductive hearing loss and recurrent right-sided otorrhoea. Initially, we performed a lateral temporal bone resection and obliteration with abdomen fat. Early histology described TBSP associated with HPV-6. Follow-up detected malignant transformation of the Schneiderian papillomatous variant. Postoperative radiotherapy combined with extended temporal bone resection resulted in a disease-free 17-month period of follow-up. Discussion. TBSPs are not very specific, and the diagnosis can only reliably be established by histopathology. There is a risk of malignant transformation, and due to the absence of reliable prognostic markers, strict postoperative follow-up is mandatory and should consist of regular otoscopy, nasal endoscopy, and imaging. This case also supports the importance of extended temporal bone resections as salvage surgery, combining radical surgery with radiotherapy for improved survival rates.
Insights
Temporal bone Schneiderian papillomas (TBSPs) can rarely become malignant, especially those associated with HPV-6. This case highlights the need for vigilant follow-up and aggressive treatment for these rare tumors.
Area of Science:
- Otolaryngology
- Oncology
- Pathology
Background:
- Temporal bone Schneiderian papillomas (TBSPs) are rare primary tumors of the middle ear and mastoid.
- Clinical and imaging findings for TBSPs lack specificity, necessitating histopathological diagnosis.
Observation:
- A 68-year-old woman presented with conductive hearing loss and recurrent otorrhoea.
- Initial surgery revealed a TBSP associated with HPV-6; follow-up showed malignant transformation.
- Management involved extended temporal bone resection and radiotherapy.
Findings:
- This case demonstrates malignant transformation of a TBSP linked to HPV-6.
- A 17-month disease-free period was achieved with combined surgical and radiotherapy treatment.
- Histopathology is crucial for definitive TBSP diagnosis and risk assessment.
Implications:
- TBSPs carry a risk of malignant transformation, underscoring the need for strict postoperative surveillance.
- Extended temporal bone resections and radiotherapy are vital for managing malignant TBSPs.
- Proactive management strategies are essential due to the absence of reliable prognostic markers for TBSPs.
