This paper reports the first case of fibroepithelial polyp arising independently of the external auditory canal. A 16-year-old female patient presented to our clinic for aural fullness of the left side. Physical examination revealed a papillomatous tumor at the posterior wall of the inlet of the left external auditory canal. After biopsy, which yielded a diagnosis of benign papilloma, the patient underwent tumor excision. Final diagnosis was fibroepithelial polyp. One week after resection, aural fullness had resolved. Fibroepithelial polyp is a benign lesion and occurs mainly in the skin, ureteropelvic system, and genitals. In the head and neck area, there are reports on fibroepithelial polyp of the tongue, piriform fossa, inferior nasal turbinate, and tonsil, in addition to the skin, but none on independent fibroepithelial polyp of the external auditory canal. Excision of fibroepithelial polyp of the external auditory canal is advisable, especially in the presence of any symptoms, and should be preceded by confirmation of nonmalignancy by biopsy, if possible.
Fibroepithelial polyp is a benign lesion of mesothelial origin and is one of the most common cutaneous lesions. It is generally an incidental finding on the skin of the neck, trunk, or face and is also known as fibroma or acrochordon, representing a nonspecific and benign growth pattern as opposed to a specified entity [
To the best of our knowledge, there is no report on fibroepithelial polyp arising independently of the external auditory canal. Although only one report about fibroepithelial polyp of the external auditory canal has been published, this was believed to be a reactive change in the skin overlying an osteoma [
A 16-year-old female Japanese patient was referred to our clinic by an otolaryngologist for suspected papilloma of the external auditory canal; she presented to our clinic with a 2-week history of aural fullness of the left side. She had no other medical problems except allergic rhinitis triggered by house dust, mites, and pollen from Japanese cedar and cypress trees.
On physical examination, a papillomatous tumor was observed at the posterior wall of the inlet of the left external auditory canal (Figure
Endoscopic photographs of the left external auditory canal. (a) Fibroepithelial polyp at the posterior wall of the inlet of the left external auditory canal. (b) Left external auditory canal 1 week after resection of the fibroepithelial polyp.
Histopathological investigation revealed that the tumor was covered by epidermis with hyperkeratosis and had irregular epidermal projections and interstitial proliferation (Figure
Fibroepithelial polyp covered by epidermis with hyperkeratosis leading to irregular epidermal projections and interstitial proliferation (hematoxylin-eosin staining: (a) ×40; (b) ×400).
One week after resection of the polyp, the postoperative wound at the external auditory canal had almost completely epithelialized (Figure
Fibroepithelial polyp is regarded as a pseudotumor caused by inflammation or hyperplasia secondary to local lesions. It is a benign lesion with an extremely low incidence of malignancy, and its etiology remains largely unknown [
Table
Literature review of fibroepithelial polyp occurring independently in the head and neck area (excluding skin) since 2000.
Site of lesion formation | Age/sex | Biopsy before surgery | Anesthesia for surgery | Treatment |
|
---|---|---|---|---|---|
Tongue | 42/M | − | Unknown | Excision | Lloyd et al., 2001 [ |
Piriform fossa | 60/M | − | General | Excision | Mangar et al., 2004 [ |
Inferior nasal turbinate | 69/F | − | General | Excision | Perić et al., 2009 [ |
Tonsil | 33/M | − | Unknown | Tonsillectomy | Farboud et al., 2010 [ |
External auditory canal | 16/F | + | Local | Excision | Tanaka |
M: male; F: female.
Generally, tumor-like lesions of the external auditory canal, so-called “aural polyps,” include exostosis, osteoma, fibrous dysplasia, granuloma, ceruminous gland tumor, epidermoid cholesteatoma, papilloma, and malignancies [
There is only one previous report on fibroepithelial polyp of the external auditory canal, and in this case, the polyp was caused by a reactive change in the skin overlying an osteoma [
Mass lesions that narrow or occlude the auditory canal can cause hearing loss, otitis externa with resultant otalgia and otorrhea, tinnitus, aural fullness, and vertigo [
Fibroepithelial polyp is a benign lesion and seldom undergoes malignant transformation. “Aural polyps,” however, should be resected to confirm the diagnosis even if no symptoms are described because an association between “aural polyp” and cholesteatoma and an external auditory canal polyp accompanying squamous cell carcinoma have been reported previously [
We have reported a case of fibroepithelial polyp of the external auditory canal. It is advocated that “aural polyps” are resected for confirmation of diagnosis and possible resolution of ear symptoms, such as hearing loss, tinnitus, and aural fullness, after confirmation of nonmalignancy by biopsy.
The authors have no conflict of interest to declare.