Orman Halil Orkan, Dağlı Muharrem, Taşkın Türkmenoğlu Tuğba
Dışkapı Yıldırım Beyazıt Research and Training Hospital, Clinic of Otorhinolaryngology and Head and Neck Surgery, Ankara, Türkiye
Dışkapı Yıldırım Beyazıt Research and Training Hospital, Clinic of Pathology, Ankara, Türkiye
Turk Arch Otorhinolaryngol. 2025 Jun 19;63(1):3-9. doi: 10.4274/tao.2025.2024-9-7. Epub 2025 May 9.
This study aimed to investigate squamous metaplasia in mastoid cells of patients undergoing surgery for chronic otitis media (COM) with or without cholesteatoma. Bone dust was stained with hematoxylin and eosin (H&E) for squamous cells and keratin and immunohistochemically for p63. Additionally, the feasibility of routine pathological examination of bone dust via H&E staining was evaluated for cost-effectiveness and for identifying patient groups needing advanced follow-up.
Thirty-one patients with COM were enrolled: 14 with cholesteatoma (study group) and 17 without cholesteatoma (control group). Mastoid bone dust obtained during surgery was examined specifically for the presence of squamous cells, keratin, and p63, with evaluation performed using H&E and immunohistochemical staining techniques. Findings were compared between the study and control groups.
Keratin was significantly more frequent in the study group than in controls (43% vs. 6%, p=0.01). No significant differences were observed for squamous cell (p=0.43) or p63 expression (p=0.20). However, when any of the three markers were positive, a statistically significant difference was found between the groups (43% vs. 12%, p=0.049).
These findings suggest that the mastoid air cell systems of patients with cholesteatoma may be affected differently prior to cholesteatoma spreading to the mastoid system. This could be linked to microcirculation of inflammatory proteins, impaired aeration, and the formation of retraction pouches. These results align with the metaplasia theory as a possible explanation for the etiopathogenesis of acquired cholesteatoma.
本研究旨在调查患有或不患有胆脂瘤的慢性中耳炎（COM）手术患者乳突细胞中的鳞状化生情况。骨粉用苏木精和伊红（H&E）染色以检测鳞状细胞和角蛋白，并进行p63免疫组织化学染色。此外，评估通过H&E染色对骨粉进行常规病理检查在成本效益方面以及识别需要进一步随访的患者群体方面的可行性。
纳入31例COM患者：14例患有胆脂瘤（研究组），17例不患有胆脂瘤（对照组）。对手术期间获取的乳突骨粉专门检查鳞状细胞、角蛋白和p63的存在情况，采用H&E和免疫组织化学染色技术进行评估。比较研究组和对照组的结果。
研究组中角蛋白的出现频率显著高于对照组（43%对6%，p = 0.01）。鳞状细胞（p = 0.43）或p63表达（p = 0.20）未观察到显著差异。然而，当三种标志物中的任何一种呈阳性时，两组之间存在统计学显著差异（43%对12%，p = 0.049）。
这些发现表明，在胆脂瘤扩散至乳突系统之前，患有胆脂瘤患者的乳突气房系统可能受到不同影响。这可能与炎性蛋白的微循环、通气受损以及内陷袋的形成有关。这些结果与化生理论相符，可作为后天性胆脂瘤发病机制的一种可能解释。
