Cholesteatoma associated with squamous cell carcinoma of the external auditory canal: Case report and literature review

Abstract Introduction Squamous cell carcinoma (SCC) is a rare cancer entity. Only a few cases of squamous cell carcinoma associated with cholesteatoma have been reported in the literature so far. Aim To describe the case of a squamous cell carcinoma associated with a primary acquired cholesteatoma and discuss the management modalities and the outcome of the disease. Results We report the case of a 42-year-old man who presented with a chronic otorrhea and a progressive hearing loss. Otoscopy showed a polypoid external auditory canal. Tonal audiometry revealed a mixed hearing loss with an air conduction threshold of 60 dB. Tomodensitometry and MRI showed erosion of the EAC, lysis of the tympanic bone and the second portion of the facial nerve. Histological examination of the polypoid tissue concluded with a SCC. According to the Pittsburgh staging system, the tumor was classified as T4 N0 M0. The patient underwent a subtotal petrectomy carrying the tumor and sacrificing the facial nerve, a total parotidectomy and a neck dissection of level II–V lymph nodes. Intraoperatively, the tumor tissue was associated with an attic cholesteatoma responsible for ossicular chain destruction. A postoperative radiotherapy was delivered at a dose of 65 Gy. No recurrence or metastases have been reported after a one year follow-up. Conclusion SCC of the external auditory canal can mimic cholesteatoma. A precise diagnosis of the disease is important to predict the treatment outcome. Optimal management relies on early surgery and postoperative radiotherapy, thus offering the greatest chance of cure.