title: Middle ear squamous papilloma: A report of four cases analyzed by HPV and EBVin situhybridization.
abstract: Squamous papilloma involving the middle ear as a primary lesion is an extremely rare occurrence. The aims of the present study were to investigate the presence of human papilloma virus (HPV) and Epstein-Barr virus (EBV) infections in primary middle ear squamous papilloma and to describe the clinical and pathological features of the disease along with therapeutic strategies. A retrospective review was conducted of four patients with clinical and pathological diagnoses of middle ear squamous papilloma.In situhybridization (ISH) for a wide range of HPV DNA subtypes and EBV-encoded RNA was performed in the tissue samples obtained from these patients. Only two cases of primary squamous papilloma in the middle ear have been previously reported in the English literature. These papillomas developed in males of ~60-years of age and otorrhea was the most frequent complaint. Premalignant changes were observed in two of the present cases and ISH of HPV and EBV was negative in all four cases. The results of the present study indicated that chronic inflammatory stimulation, not HPV and EBV infection, is involved in the occurrence of middle ear squamous papilloma and its malignant transformation. Radical surgery and long-term postoperative follow-up are recommended due to its malignant and recurrent potential. Further genetic investigations with additional new cases are required to clarify the pathogenesis of squamous papilloma involving the middle ear.
authors.affiliation: Department of Otolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China.
authors.forename: Han
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Department of Otolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China.
authors.forename: Zhibin
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Pathology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China.
authors.forename: Weiming
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Otolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China.
authors.forename: Guangqian
authors.initials: G
authors.lastname: Xing
keywords: Epstein-Barr virus; human papilloma virus; in situ hybridization; middle ear; squamous papilloma