Immunohistologic analysis of the cholesteatoma matrix in children

Evaluation of the Role of Myofibroblast and Fibronectin in the Aetiopathogenesis of Cholesteatoma

Background

Primary acquired Cholesteatoma is a complex issue for otolaryngologists, with its development mechanisms still unclear due to the intricate anatomy of this region. It's aetiopathogenesis remains poorly understood and this aggressive clinical condition often leads to various complications. Recent research explores myofibroblast and fibronectin's potential roles in pathomechanisms of Cholesteatoma.

Objective

To determine and analyze the role of myofibroblast and fibronectin in the aetiopathogenesis of Cholesteatoma.

Methodology

In a cross-sectional study at a tertiary care hospital, 30 patients with chronic suppurative otitis media with cholesteatoma were surgically treated, and intraoperative biopsy specimens were collected. These specimens were processed and subjected to histopathological examination, including immunohistochemical staining with Alpha-smooth muscle actin and anti-fibronectin antibody to identify myofibroblast and fibronectin presence. The data were then analyzed to investigate the aetiopathogenesis of cholesteatoma in this cohort.

Results

On immunostaining, 25 blocks (83.33%) were positively stained for Alpha-SMA (p-value-0.0007), whereas 29 blocks (96.67%) were positively stained for fibronectin (p-value < 0.0001), suggesting a statistically significant association between the presence of both myofibroblast and fibronectin with cholesteatoma perimatrix. Additionally, a statistically significant association was noted between complications and positive staining for myofibroblast (p-value - 0.0415) and positive staining for fibronectin (p-value-0.0254).

Conclusions

Our study indicates that Cholesteatoma retraction and progression are driven by myofibroblast and fibronectin mechanisms, and also links them to disease severity. This understanding opens avenues for innovative diagnostics and treatments targeting these biomarkers.

Assessment of Subepithelial Angiogenesis in Acquired Cholesteatoma between Pediatric and Adult Patients

Objective

The aim of this study was to compare subepithelial angiogenesis developing within the perimatrix of the cholesteatoma between pediatric and adult patients.

Methods

Sixty-one patients who underwent mastoidectomy for the first intent because of chronic otitis media with cholesteatoma between 1993 and 2013 and from whom appropriate tissue specimens were taken were included in the study. The patients were classified in the pediatric patient group if they were under the age of 18 years and the adult patient group if they were 18 years and older. Immunohistochemical staining for CD-31 was performed on new sections taken during surgery and sections prepared from archived tissues in paraffin blocks. Results were compared between the groups.

Results

A total of 61 patients, of whom 25 were pediatric and 36 were adult patients, were included in the study. The mean CD-31 immunopositive microvessel rates were 8.8 (3-15) and 6.61 (2-14) for the pediatric and adult patient groups, respectively. The difference between the groups was statistically significant (p=0.037). Correlation analysis showed a statistically significant negative correlation between the CD-31 immunopositive microvessel rates and age (p=0.036).

Conclusion

Subepithelial angiogenesis developing within the perimatrix of the cholesteatoma of the pediatric patients was more expressed than that of the adult patients.

Hystology findings' correlation between the ossicular chain in the transoperative and cholesteatomas

Chronic otitis media is hystopathologycaly defined as the presence of irreversible inflammatory tissue changes in the middle ear. Ossicular lesions represent the most prevalent change.

AIM

to correlate the degree of ossicular chain changes seen during surgery with the inflammatory histological degree and the thickness of the cholesteatoma perimatrix.

STUDY DESIGN

Cross-sectional study.

METHODS

Seventy-one descriptions of surgeries done in patients submitted to tympanomastoydectomy were reviewed. Cholesteatoma were collected and fixed in 10% formaldehyde. Two slides were made for each cholesteatoma, one stained with HE and another with picrossirius. Images were obtained from light microscopy and digitally processed and "blindly" analyzed using Image Pro-Plus Software. For statistical analysis we used Spearman's coefficient. Differences were considered statistically significant if P< or =0.05.

RESULTS

the ossicular chain was involved in 65 cases. The incus was the most frequently affected bone, followed by the stapes and the malleus. When the Spearman's coefficient was employed considering ossicular chain change degree with patient's age by the time of surgery, perimatrix thickness and histological degree of inflammation, correlations were not established.

CONCLUSION

Our findings indicate that ossicular chain changes are practically universal when a cholesteatoma is present. We didn't find correlations related with bone erosion and cholesteatoma's histological findings.

Correlação da cadeia ossicular no transoperatório com achados histológicos de colesteatomas

A Otite Média Crônica é definida pela presença de alterações teciduais inflamatórias irreversíveis na fenda auditiva. As lesões ossiculares são as mais prevalentes. OBJETIVO: Correlacionar o grau de comprometimento da cadeia ossicular, visualizada no transoperatório, com o grau histológico de inflamação e com a espessura da perimatriz de colesteatomas. TIPO DE ESTUDO: Estudo transversal. MÉTODOS: Descrições cirúrgicas de 71 pacientes foram revisadas. Colesteatomas coletados e fixados em formol 10% e preparadas uma lâmina em Hematoxilina-Eosina e outra em Picrossírios. A leitura foi "cega", através de imagens digitais, no ImageProPlus. A análise estatística foi realizada através do coeficiente de Spearman, sendo considerados como estatisticamente significativos os valores de P<0,05. RESULTADOS: Havia algum envolvimento da cadeia ossicular em 65 casos. O ossículo mais freqüentemente afetado era a bigorna, seguida pelo estribo e pelo martelo. Ao aplicarmos o coeficiente de Spearman entre o grau de comprometimento da cadeia ossicular com a idade do paciente à cirurgia, a espessura da perimatriz e o grau histológico de inflamação não foram detectadas correlações. CONCLUSÃO: Os nossos achados indicam que é praticamente universal o acometimento da cadeia ossicular na presença de colesteatoma. Não foi encontrada correção entre a erosão ossicular e os achados histológicos.

Non-cholesteatomatous suppurative otitis media: facial nerve palsy in an immunocompromised patient

A 47-year-old man developed a complete facial nerve palsy secondary to non-cholesteatomatous suppurative otitis media. At operation, this was seen to be due to destruction of the nerve from halfway along the horizontal segment to a point just distal to the second genu. The history of recent renal transplantation and subsequent immunosuppression was judged to be significant in the pathogenesis of the palsy.

High levels of fibronectin in the stroma of aural cholesteatoma

PURPOSE

Because abundant fibronectin deposition is a hallmark of healing cutaneous wounds and provides a matrix for hyperproliferative and migratory epidermal cells, the distribution of fibronectin in aural cholesteatoma was investigated immunohistochemically.

MATERIALS AND METHODS

A monoclonal antibody against the major cell binding domain of human fibronectin was used to stain 4-micron cryosections of cholesteatoma tissue by the alkaline phospatase-antialkaline phosphatase method. Section of normal retroauricular skin served as control.

RESULTS

When processed in parallel, fibronectin staining was much stronger in the stroma of cholesteatoma than in normal dermis. The squamous epithelium of both tissues did not show any staining for fibronectin.

CONCLUSIONS

These observations lend support to the view that the growth of cholesteatoma epithelium reflects an aberrant regenerative process.