Cholesteatoma

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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]
    • Keratosis obturans - accumulation in the external ear canal - is considered to be a different process;[2] though some consider it a synonym.[3]
  • 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:

Images

  • Cholesteatoma --very low mag.

  • Cholesteatoma -- low mag.

  • Cholesteatoma -- intermed. mag.

  • Cholesteatoma -- intermed. mag.

  • Cholesteatoma -- high mag.

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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

  1. ↑ URL: http://www.harrisonspractice.com/practice/ub/view/Harrisons%20Practice/141015/all/otitis_media_and_mastoiditis. Accessed on: 16 March 2011.
  2. ↑ Piepergerdes MC, Kramer BM, Behnke EE (March 1980). "Keratosis obturans and external auditory canal cholesteatoma". Laryngoscope 90 (3): 383–91. PMID 7359960.
  3. ↑ 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. ↑ 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. ↑ 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. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ URL: http://path.upmc.edu/cases/case273/dx.html. Accessed on: 14 January 2012.
  11. ↑ Dallari, S.; Cavani, A.; Bergamini, G.; Girolomoni, G. (Mar 1994). "Integrin expression in middle ear cholesteatoma.". Acta Otolaryngol 114 (2): 188-92. PMID 7515549.
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