Difference between revisions of "Cholesteatoma"

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Cholesteatoma (view source)

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#redirect [[Ditzels#Cholesteatoma]]
{{ 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:Diagnosis]]
[[Category:Ditzels]]
Michael
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