title: Metastasizing middle ear carcinoid:  an unusual case report, with focus on ultrastructural and immunohistochemical findings.
abstract: BACKGROUND
  There are only 4 unequivocal cases of metastasizing middle ear carcinoid previously reported.
  
  
  OBJECTIVE
  To present a case of metastasizing middle ear carcinoid, to review previously reported cases, and to discuss the clinical nature of this tumor, which is similar to "orthotopic" carcinoids bearing definite metastatic potential.
  
  
  METHODS
  Case report. PATIENT, INTERVENTION, RESULTS: We present a 72-year-old woman who developed ipsilateral parotid gland and cervical lymph node metastases 8 and 11 months after surgical removal of a primary middle ear lesion. She subsequently required 2 revision procedures and radiotherapy for local recurrences. Her case was complicated by nonsurgically induced permanent facial nerve paralysis, the cause of which remains obscure. At the end of the 8-year follow-up, the patient was alive with locally, recurrent tumor eroding the cranial base and invading the posterior intracranial fossa but with no signs of metastases.
  
  
  METHODS
  Light microscopy and immunohistochemical analysis.
  
  
  CONCLUSIONS
  Considering the reported high rate of recurrence and their consequent metastases, a middle ear carcinoid should be classified as a neuroendocrine low-grade carcinoma.
authors.affiliation: ENT Department, Derriford Hospital, Plymouth, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Salzman
authors.forename: Ivo
authors.initials: I
authors.lastname: Stárek
authors.forename: Vlastislava
authors.initials: V
authors.lastname: Tichá
authors.forename: Alena
authors.initials: A
authors.lastname: Skálová
authors.forename: Jiří
authors.initials: J
authors.lastname: Kučera
mesh_terms: D000368:Aged; D002276:Carcinoid Tumor / Q000473:pathology* / Q000648:ultrastructure; D002558:Cerebrospinal Fluid Otorrhea / Q000209:etiology; D003389:Cranial Nerve Diseases / Q000209:etiology; D004428:Ear Neoplasms / Q000473:pathology* / Q000648:ultrastructure; D004432:Ear, Middle / Q000473:pathology*; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D034381:Hearing Loss / Q000209:etiology; D006801:Humans; D007150:Immunohistochemistry; D008207:Lymphatic Metastasis / Q000473:pathology; D046529:Microscopy, Electron, Transmission; D009362:Neoplasm Metastasis / Q000473:pathology; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010307:Parotid Neoplasms / Q000473:pathology / Q000556:secondary; D011183:Postoperative Complications / Q000473:pathology; D016707:Tissue Fixation; D014057:Tomography, X-Ray Computed