Case Report
A 31-year-old male patient was admitted to the Ear Nose Throat Clinic in
Semptember 2019 with complaint of left fullnes, discharge and conductive
hearing loss. Symmetrical nodular cutaneous lesions on malar region,
tragus and bilateral meatus acusticus externus were noted first (Figure
1).The patient’s history and family history were competible with TSC. On
physical examination, total obstruciton of MAE was detected due to TSC
angiofibroma (Figure 2). The lesions were pushed with a 2 mm
auto-endoscope by passing through the MAE for external auditory canal
(EAC) examination. On EEC examination, there was a slight purulent
secretions and cerumen impaction was detected, the tympanic membrane was
intact. Temporal bone Computed Tomography showed bilaterall soft tissue
thickening of the one-third exteranl part of EAC. The structures of
middle ear cavity and temporal bone were natural. EAC aspiration for
cerumen and discharge was performed weekly. Ciprofloxacin /
dexamethasone local therapy prescirebed for three consequtive week, But
normal self-cleaning EAC has not been achieved for 3 weeks. Upon this,
it was decided to meatoplasty. The surgery was performed under local
anesthesia. Angiofibromas on the MAE and tragus were excised. The defect
was repaired by sliding a 3x2x3 cm fasciocutaneous island flap
inferiorly created in the preauricular area (Figure 3). Self-cleaning
EAC was achieved with an open and MAE. Immunohistochemistry analysis
showed that some tumor cells were positive for CD31, Actin(SM), CD34 and
vimentin, negative expression for smooth muscle actin (SMA), desmin,
S100, and AE1/AE3. Ki-67 proliferation index was less than 5%. The
pathology specimen was histopathologically diagnosed as angiofibroma.