Mahmood SHISHEGAR, Mohammad Javad ASHRAF

Comparison of histopathological characteristics and clinical behavior of acquired cholesteatoma

Amaç: Edinilmiş kolesteatom hem yetişkinleri, hem de çocukları etkileyen ciddi bir orta kulak patolojisidir. Kolesteatomun klinik özellikleri, hastalığın histopatolojik özelliklerine bağlıdır. Bu çalışmada, timpanomastoidektomi uygulanan hastalarda edinilmiş kolesteatomun histopatolojik özelliklerinin karşılaştırılması amaçlanmıştır. Hastalar ve Yöntem: Bu retrospektif çalışma 370 hasta üzerinde gerçekleştirilmiştir. Patolojik olarak kolesteatom tesbit edilen hastalara timpanomastoidektomi uygulanmıştır. Tüm kolesteatom örnekleri intraoperatif toplanmış ve histopatolojik inceleme için muhafaza edilmiştir. Hastalar histopatolojik özelliklerine göre iki gruba ayrılmışlardır: 1. saf kolesteatomlu hastalar, 2. kolesteatom ile birlikte diğer patolojileri olan hastalar. Ardından, iki grup arasında yaş, cinsiyet, hastalık süresi, hastalığın tekrarlaması ve komplikasyonlar da dahil olmak üzere klinik özellikler karşılaştırılmıştır. Bulgular: Klinik değişkenler açısından iki grup arasında istatistiki olarak bir fark bulunmamıştır. Bununla birlikte, saf kolesteatom insidansı, hastalığı tekrarlayan ve bir kez daha timpanomastoidektomi uygulanan hastalarda daha yüksek bulunmuştur. Sonuç: Bu çalışmada, hastalığın anlamlı tekrarlama oranı hariç, iki farklı histopatolojik grup arasında klinik değişkenlikler açısından istatistiki olarak bir fark gözlenmemiştir.

Edinilmiş kolesteatomun semptomlarının ve histopatolojik özelliklerinin karşılaştırılması

Objective: Acquired cholesteatoma is a severe middle-ear pathology affecting both adults and children. The clinical behavior of cholesteatoma depends on the histopathological characteristics of the disease. The present study aimed to compare the histophathological characteristics of acquired cholesteatoma in patients who had undergone tympanomastoidectomy. Patients and Methods: This retrospective chart analysis was conducted on 370 patients who had undergone tympanomastoidectomy presenting with the pathological indication of cholesteatoma. All cholesteatoma specimens were collected intraoperatively and were preserved for histopathological examination. The patients were divided into two groups according to the histopathological findings: 1- patients with pure cholesteatoma 2- patients with cholesteatoma plus other pathologies. Then, the two groups were compared regarding the clinical variables, including age, gender, duration of disease, occurrence of relapse, and complications. Results: No significant difference was found between the two groups regarding the clinical variables. Nevertheless, the incidence of pure cholesteatoma was higher among the patients who had experienced the recurrence of the disease and underwent tympanomastoidectomy one more time. Conclusion: In the present study, no significant difference was observed between the two histopathologically different groups regarding the clinical variables, except for recurrence rate.

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1. Ferlito AKO, Devaney A, Rinaldo CM, Milroy BM, Wenig SI, McCabe BF. Clinicopathological consultation: Ear cholesteatoma versus cholesterol granuloma. Ann Otol Rhinol Laryngol 1997; 106:79. doi: 10.1177/000348949710600114
2. Bassiouny M, Badour N, Omran A, Osama H. Histopathological and immunohistochemical characteristics of acquired cholesteatoma in children and adults. Egypt J Ear Nose Throat Allied Sci 2012; 13:7-12. doi:10.1016/j.ejenta.2012.02.007
3. Dornelles C, da Costa SS, Meurer LS, Rosito LCPS, da Silva AR, Alves SL. Comparison of acquired cholesteatoma between pediatric and adult patients. Eur Arch Oto-Rhino-Laryngol 2009; 266: 1553-61. doi:10.1007/s00405-009-0957-0
4. Persaud R, Hajioff D, Trinidade A, et al. Evidence-based review of aetiopathogenic theories of congenital and acquired cholesteatoma. J Laryngol Otol 2007; 121:1013-9. doi: 10.1017/S0022215107000503
5. Albino AP, Kimmelman CP, Parisier SC. Cholesteatoma: a molecular and cellular puzzle. Otol Neurotol 1998; 19:7-19.
6. Aberg B, Westin T, Tjellstrom A, Edstrom S. Clinical characteristics of cholesteatoma. Am J Otolaryngol 1991; 12:254-8. doi:10.1016/0196-0709(91)90002-W
7. Yamamoto-Fukuda T, Hishikawa Y, Shibata Y, Kobayashi T, Takahashi H, Koji T. Pathogenesis of middle ear cholesteatoma: a new model of experimentally induced cholesteatoma in Mongolian gerbils. Am J Pathol 2010; 176:2602-26. doi:10.2353/ajpath.2010.091182
8. Dornelles C, Costa SSD, Meurer LS, Schweiger C. Correlation of cholesteatomas perimatrix thickness with patients age. Braz J Otorhinolaryngol 2005; 71:792-7. 10.1590/S0034- 72992005000600017
9. Sheehy JL. Management of cholesteatoma in children. Adv Otorhinolaryngol 1978; 23:58-64.
10. Tos M. Treatment of cholesteatoma in children: A long-term study of results. Otol Neurotol 1983; 4:189-97.
11. Edelstein DR, Parisier SC, Han JC. Acquired cholesteatoma in the pediatric age group. Otolaryngol Clin North Am 1989; 22:955.
12. Glasscock ME, Dickins JR, Wiet R. Cholesteatoma in children. Laryngoscope 1981; 91:1743-53.
13. Ruah CB, Schachern PA, Paparella MM, Zelterman D. Mechanisms of retraction pocket formation in the pediatric tympanic membrane. Arch Otolaryngol Head Neck Surg 1992; 11:1298. doi:10.1001/archotol.1992.01880120024005.
14. Bujia J, Holly A, Antoli-Candela F, Tapia MG, Kastenbauer E. Immunobiological peculiarities of cholesteatoma in children: quantification of epithelial proliferation by MIB 1. Laryngoscope 1996; 106:865-8. doi: 10.1097/00005537- 199607000-00015
15. Palva A, Karma P, Karja J. Cholesteatoma in children. Arch Otolaryngol Head Neck Surg 1977; 103:74. doi:10.1001/ archotol.1977.00780190054003
16. Sudhoff H, Dazert S, Gonzales AM, et al. Angiogenesis and angiogenic growth factors in middle ear cholesteatoma. Otol Neurotol 2000; 21:793-8.
17. Welkoborsky HJ, Jacob RS, Hinni ML. Comparative analysis of the epithelium stroma interaction of acquired middle ear cholesteatoma in children and adults. Europ Arch Oto-Rhino- Laryngol 2007; 264:841-8. doi:10.1007/s00405-007-0328-7
18. Dornelles C, Meurer LS, De Costa SS, Schweiger C. Histologic description of acquired cholesteatomas: comparison between children and adults. Braz J Otorhinolaryngol 2006; 72:641-8. doi:10.1590/S0034-72992006000500010
19. Quaranta A, Resta L, Santangelo A. Otomastoid cholesteatoma in children: histopathological findings. Int J Pediatr Otorhinolaryngol 1986; 12:121-6. doi:10.1016/ S0165-5876(86)80069-6
20. Sade J, Fuchs C. A comparison of mastoid pneumatization in adults and children with cholesteatoma. Europ Arch Oto- Rhino-Laryngol 1994; 251:191-5. doi:10.1007/BF00628421
21. Kircher ML, Thottam PJ, Bojrab DI, Babu SC. Utility and cost analysis of cholesteatoma histopathologic evaluation. The Laryngoscope 2013; 124:538-40. doi: 10.1002/lary.24282
22. Vikram BK, Udayashankar SG, Naseeruddin K, Venkatesha BK, Manjunath D, Savantrewwa IR. Complications in primary and secondary acquired cholesteatoma: a prospective comparative study of 62 ears. Am J Otolaryngol 2008; 29:1-6. doi:10.1016/j.amjoto.2006.11.014
23. Leskinen K. Complications of acute otitis media in children. Curr Allergy Asthma Rep 2005; 5:308-12. doi:10.1016/j. ijporl.2003.10.018
24. Mostafa BE, El Fiky LM, El Sharnouby MM. Complications of suppurative otitis media: still a problem in the 21st century. ORL 2009; 71:87-92.
25. Schraff SA, Strasnick B. Pediatric cholesteatoma: a retrospective review. Int J Pediatr Otorhinolaryngol 2006; 70:385-93. doi:10.1016/j.ijporl.2005.10.006
26. De Corso E, Marchese MR, Scarano E, Paludetti G. Aural acquired cholesteatoma in children: surgical findings, recurrence and functional results. Int J Pediatr Otorhinolaryngol 2006; 70:1269-73. doi:10.1016/j.ijporl.2006.01.006