Difference between revisions of "Cholesteatoma"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Consistent with cholesteatoma -- low mag.jpg | |||
| Width = | |||
| Caption = Keratinaceous debris consistent with cholesteatoma. [[H&E stain]]. (WC/Nephron) | |||
| Synonyms = | |||
| Micro = keratinaceous debris (key feature), +/-squamous epithelium, +/-macrophages and giant cells giant cell, +/-chronic inflammation (lymphocytes) | |||
| Subtypes = | |||
| LMDDx = cholesterol granuloma, [[squamous cell carcinoma]], [[epidermal inclusion cyst]] - history different | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Staging = | |||
| Site = middle ear - see ''[[head and neck pathology]]'' | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = +/-family history, +/-history of trauma | |||
| Signs = whitish mass in the middle ear | |||
| Symptoms = | |||
| Prevalence = | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = benign | |||
| Other = | |||
| ClinDDx = | |||
| Tx = | |||
}} | |||
'''Cholesteatoma''' is a [[head and neck pathology]] [[ditzel]]. | |||
==General== | |||
*Squamous epithelium in the middle ear - leading to accumulation of keratinaceous debris.<ref>URL: [http://www.harrisonspractice.com/practice/ub/view/Harrisons%20Practice/141015/all/otitis_media_and_mastoiditis http://www.harrisonspractice.com/practice/ub/view/Harrisons%20Practice/141015/all/otitis_media_and_mastoiditis]. Accessed on: 16 March 2011.</ref> | |||
**''Keratosis obturans'' - accumulation in the external ear canal - is considered to be a different process;<ref>{{cite journal |author=Piepergerdes MC, Kramer BM, Behnke EE |title=Keratosis obturans and external auditory canal cholesteatoma |journal=Laryngoscope |volume=90 |issue=3 |pages=383–91 |year=1980 |month=March |pmid=7359960 |doi= |url=}}</ref> though some consider it a synonym.<ref>{{cite journal |author=Shire JR, Donegan JO |title=Cholesteatoma of the external auditory canal and keratosis obturans |journal=Am J Otol |volume=7 |issue=5 |pages=361–4 |year=1986 |month=September |pmid=3538893 |doi= |url=}}</ref> | |||
*The etiology is ''not'' well understood.<ref name=pmid20860924>{{Cite journal | last1 = Nevoux | first1 = J. | last2 = Lenoir | first2 = M. | last3 = Roger | first3 = G. | last4 = Denoyelle | first4 = F. | last5 = Ducou Le Pointe | first5 = H. | last6 = Garabédian | first6 = EN. | title = Childhood cholesteatoma. | journal = Eur Ann Otorhinolaryngol Head Neck Dis | volume = 127 | issue = 4 | pages = 143-50 | month = Sep | year = 2010 | doi = 10.1016/j.anorl.2010.07.001 | PMID = 20860924 }}</ref><ref name=pmid20156369>{{Cite journal | last1 = Louw | first1 = L. | title = Acquired cholesteatoma pathogenesis: stepwise explanations. | journal = J Laryngol Otol | volume = 124 | issue = 6 | pages = 587-93 | month = Jun | year = 2010 | doi = 10.1017/S0022215109992763 | PMID = 20156369 }}</ref> | |||
**Theories include migration/hyperplasia, and metaplasia.<ref name=pmid20156369/> | |||
*Rarely transforms into [[squamous cell carcinoma]].<ref name=pmid19563937>{{Cite journal | last1 = Rothschild | first1 = S. | last2 = Ciernik | first2 = IF. | last3 = Hartmann | first3 = M. | last4 = Schuknecht | first4 = B. | last5 = Lütolf | first5 = UM. | last6 = Huber | first6 = AM. | title = Cholesteatoma triggering squamous cell carcinoma: case report and literature review of a rare tumor. | journal = Am J Otolaryngol | volume = 30 | issue = 4 | pages = 256-60 | month = | year = | doi = 10.1016/j.amjoto.2008.06.011 | PMID = 19563937 }}</ref><ref name=pmid15699729>{{Cite journal | last1 = Takahashi | first1 = K. | last2 = Yamamoto | first2 = Y. | last3 = Sato | first3 = K. | last4 = Sato | first4 = Y. | last5 = Takahashi | first5 = S. | title = Middle ear carcinoma originating from a primary acquired cholesteatoma: a case report. | journal = Otol Neurotol | volume = 26 | issue = 1 | pages = 105-8 | month = Jan | year = 2005 | doi = | PMID = 15699729 }}</ref> | |||
===Classification=== | |||
May be subdivided into:<ref name=pmid20860924/> | |||
*Acquired - due to trauma, surgery or infection. | |||
*Congenital. | |||
==Gross== | |||
*Whitish mass in the middle ear.<ref name=pmid23217274>{{Cite journal | last1 = Al Balushi | first1 = T. | last2 = Naik | first2 = JZ. | last3 = Al Khabori | first3 = M. | title = Congenital cholesteatoma in identical twins. | journal = J Laryngol Otol | volume = 127 | issue = 1 | pages = 67-9 | month = Jan | year = 2013 | doi = 10.1017/S0022215112002757 | PMID = 23217274 }}</ref> | |||
===Image=== | |||
<gallery> | |||
Image:Cholesteatom_kuppelraum_1a.jpg | Cholesteatoma. (WC) | |||
</gallery> | |||
==Microscopic== | |||
Features:<ref name=pmid1694387>{{cite journal |author=Iino Y, Toriyama M, Ohmi S, Kanegasaki S |title=Activation of peritoneal macrophages with human cholesteatoma debris and alpha-keratin |journal=Acta Otolaryngol. |volume=109 |issue=5-6 |pages=444–9 |year=1990 |pmid=1694387 |doi= |url=}}</ref> | |||
*Keratinaceous debris - '''key feature'''. | |||
*Squamous epithelium. | |||
*Macrophages +/- giant cell (containing keratinceous debris). | |||
*Chronic inflammation (lymphocytes). | |||
DDx: | |||
*Cholesterol granuloma.<ref>URL: [http://path.upmc.edu/cases/case273/dx.html http://path.upmc.edu/cases/case273/dx.html]. Accessed on: 14 January 2012.</ref> | |||
*[[Squamous cell carcinoma]].<ref name=pmid19563937/> | |||
*[[Epidermal inclusion cyst]] - history different. | |||
**Obscure immunostains different.<ref name=pmid7515549>{{Cite journal | last1 = Dallari | first1 = S. | last2 = Cavani | first2 = A. | last3 = Bergamini | first3 = G. | last4 = Girolomoni | first4 = G. | title = Integrin expression in middle ear cholesteatoma. | journal = Acta Otolaryngol | volume = 114 | issue = 2 | pages = 188-92 | month = Mar | year = 1994 | doi = | PMID = 7515549 }}</ref> | |||
===Images=== | |||
<gallery> | |||
Image: Consistent with cholesteatoma -- very low mag.jpg | Cholesteatoma --very low mag. | |||
Image: Consistent with cholesteatoma -- low mag.jpg | Cholesteatoma -- low mag. | |||
Image: Consistent with cholesteatoma -- intermed mag.jpg | Cholesteatoma -- intermed. mag. | |||
Image: Consistent with cholesteatoma - alt -- intermed mag.jpg | Cholesteatoma -- intermed. mag. | |||
Image: Consistent with cholesteatoma -- high mag.jpg | Cholesteatoma -- high mag. | |||
</gallery> | |||
==Sign out== | |||
<pre> | |||
Submitted as "Left Mastoid Cholesteatoma", Excision: | |||
- Keratinaceous debris and benign squamous epithelium, consistent with cholesteatoma. | |||
</pre> | |||
<pre> | |||
Soft tissue, left ear ("left ear keratosis"), excision: | |||
- Keratinaceous debris, squamous epithelium and bone (consistent with cholesteatoma). | |||
</pre> | |||
===Block letters=== | |||
<pre> | |||
SOFT TISSUE (CHOLESTEATOMA), SITE NOT FURTHER SPECIFIED, REMOVAL: | |||
- KERATINACEOUS DEBRIS, COMPATIBLE WITH CHOLESTEATOMA. | |||
</pre> | |||
<pre> | |||
TISSUE ("CHOLESTEATOMA"), LEFT, REMOVAL: | |||
- KERATINACEOUS DEBRIS AND GIANT CELLS, COMPATIBLE WITH CHOLESTEATOMA. | |||
</pre> | |||
===Micro=== | |||
The section shows keratinaceous debris and benign squamous epithelium with a granular layer. There is no significant cellular atypia and giant cells are not present. | |||
==See also== | |||
*[[Ditzels]]. | |||
==References== | |||
{{Reflist|1}} | |||
[[Category:Diagnosis]] | |||
[[Category:Ditzels]] | |||
Latest revision as of 16:40, 25 April 2017
| Cholesteatoma | |
|---|---|
| Diagnosis in short | |
 Keratinaceous debris consistent with cholesteatoma. H&E stain. (WC/Nephron) | |
|
| |
| LM | keratinaceous debris (key feature), +/-squamous epithelium, +/-macrophages and giant cells giant cell, +/-chronic inflammation (lymphocytes) |
| LM DDx | cholesterol granuloma, squamous cell carcinoma, epidermal inclusion cyst - history different |
| Site | middle ear - see head and neck pathology |
|
| |
| Clinical history | +/-family history, +/-history of trauma |
| Signs | whitish mass in the middle ear |
| Prognosis | benign |
Cholesteatoma is a head and neck pathology ditzel.
General
- Squamous epithelium in the middle ear - leading to accumulation of keratinaceous debris.[1]
- The etiology is not well understood.[4][5]
- Theories include migration/hyperplasia, and metaplasia.[5]
- Rarely transforms into squamous cell carcinoma.[6][7]
Classification
May be subdivided into:[4]
- Acquired - due to trauma, surgery or infection.
- Congenital.
Gross
- Whitish mass in the middle ear.[8]
Image
Cholesteatoma. (WC)
Microscopic
Features:[9]
- Keratinaceous debris - key feature.
- Squamous epithelium.
- Macrophages +/- giant cell (containing keratinceous debris).
- Chronic inflammation (lymphocytes).
DDx:
- Cholesterol granuloma.[10]
- Squamous cell carcinoma.[6]
- Epidermal inclusion cyst - history different.
- Obscure immunostains different.[11]
Images
Cholesteatoma --very low mag.
Cholesteatoma -- low mag.
Cholesteatoma -- intermed. mag.
Cholesteatoma -- intermed. mag.
Cholesteatoma -- high mag.
Sign out
Submitted as "Left Mastoid Cholesteatoma", Excision: - Keratinaceous debris and benign squamous epithelium, consistent with cholesteatoma.
Soft tissue, left ear ("left ear keratosis"), excision:
- Keratinaceous debris, squamous epithelium and bone (consistent with cholesteatoma).
Block letters
SOFT TISSUE (CHOLESTEATOMA), SITE NOT FURTHER SPECIFIED, REMOVAL: - KERATINACEOUS DEBRIS, COMPATIBLE WITH CHOLESTEATOMA.
TISSUE ("CHOLESTEATOMA"), LEFT, REMOVAL:
- KERATINACEOUS DEBRIS AND GIANT CELLS, COMPATIBLE WITH CHOLESTEATOMA.
Micro
The section shows keratinaceous debris and benign squamous epithelium with a granular layer. There is no significant cellular atypia and giant cells are not present.
See also
References
- ↑ URL: http://www.harrisonspractice.com/practice/ub/view/Harrisons%20Practice/141015/all/otitis_media_and_mastoiditis. Accessed on: 16 March 2011.
- ↑ Piepergerdes MC, Kramer BM, Behnke EE (March 1980). "Keratosis obturans and external auditory canal cholesteatoma". Laryngoscope 90 (3): 383–91. PMID 7359960.
- ↑ Shire JR, Donegan JO (September 1986). "Cholesteatoma of the external auditory canal and keratosis obturans". Am J Otol 7 (5): 361–4. PMID 3538893.
- ↑ 4.0 4.1 Nevoux, J.; Lenoir, M.; Roger, G.; Denoyelle, F.; Ducou Le Pointe, H.; Garabédian, EN. (Sep 2010). "Childhood cholesteatoma.". Eur Ann Otorhinolaryngol Head Neck Dis 127 (4): 143-50. doi:10.1016/j.anorl.2010.07.001. PMID 20860924.
- ↑ 5.0 5.1 Louw, L. (Jun 2010). "Acquired cholesteatoma pathogenesis: stepwise explanations.". J Laryngol Otol 124 (6): 587-93. doi:10.1017/S0022215109992763. PMID 20156369.
- ↑ 6.0 6.1 Rothschild, S.; Ciernik, IF.; Hartmann, M.; Schuknecht, B.; Lütolf, UM.; Huber, AM.. "Cholesteatoma triggering squamous cell carcinoma: case report and literature review of a rare tumor.". Am J Otolaryngol 30 (4): 256-60. doi:10.1016/j.amjoto.2008.06.011. PMID 19563937.
- ↑ Takahashi, K.; Yamamoto, Y.; Sato, K.; Sato, Y.; Takahashi, S. (Jan 2005). "Middle ear carcinoma originating from a primary acquired cholesteatoma: a case report.". Otol Neurotol 26 (1): 105-8. PMID 15699729.
- ↑ Al Balushi, T.; Naik, JZ.; Al Khabori, M. (Jan 2013). "Congenital cholesteatoma in identical twins.". J Laryngol Otol 127 (1): 67-9. doi:10.1017/S0022215112002757. PMID 23217274.
- ↑ Iino Y, Toriyama M, Ohmi S, Kanegasaki S (1990). "Activation of peritoneal macrophages with human cholesteatoma debris and alpha-keratin". Acta Otolaryngol. 109 (5-6): 444–9. PMID 1694387.
- ↑ URL: http://path.upmc.edu/cases/case273/dx.html. Accessed on: 14 January 2012.
- ↑ Dallari, S.; Cavani, A.; Bergamini, G.; Girolomoni, G. (Mar 1994). "Integrin expression in middle ear cholesteatoma.". Acta Otolaryngol 114 (2): 188-92. PMID 7515549.