title: Correlation of clinical and surgical findings to histological features (koilocytosis, papillary hyperplasia) suggesting papillomavirus involvement in the pathogenesis of cholesteatoma.
abstract: BACKGROUND
  The clinical course of cholesteatoma is rather unpredictable, as some cases show aggressive development, while others have a mild, more 'benign' nature. The aim was to correlate the clinical course and surgical findings of cholesteatomas with histological features.
  
  
  METHODS
  The study included 45 patients with cholesteatoma, 29 of whom had surgically aggressive and 16 simple (not surgically aggressive) cholesteatoma. All patients underwent mastoid surgery and the cholesteatoma specimens were sent for histological examination.
  
  
  RESULTS
  The clinical course of the cholesteatomas had a statistically significant association (p < 0.001) with the 'aggressiveness' found in surgery, suggesting that clinical history correlates well with surgical findings. All 29 specimens of patients with surgically aggressive cholesteatoma had characteristic papillary hyperplasia of the epithelium and marked koilocytosis, suggesting papillomavirus-incduced lesions. In contrast, none of the specimens of the 16 patients with simple (non-aggressive) cholesteatoma had papillary hyperplasia and there was no marked koilocytosis, as few koilocytes could occasionally be found. The difference was statistically significant (p < 0.001). In situ hybridization for human papillomnavirus (HPV) was performed in 14 specimens (7 each with aggressive and simple cholesteatomna). Positive staining was found in three aggressive cholesteatomas. All seven simple cholesteatomas were negative for HPV.
  
  
  CONCLUSIONS
  The results of the present paper suggest that papillomaviruses may play an important role in the pathogenesis of cholesteatomas. Further studies with controls and the development of new methods to identify known and unknown types of papillomavirus are needed to explore their exact role.
authors.affiliation: Department of Otorhinolaryngology, Athens University, Ippokration Hospital, Athens, Greece.
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Ferekidis
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Nikolopoulos
authors.forename: John
authors.initials: J
authors.lastname: Yiotakis
authors.forename: Elisa
authors.initials: E
authors.lastname: Ferekidou
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kandiloros
authors.forename: Konstantina
authors.initials: K
authors.lastname: Papadimitriou
authors.forename: Antonios
authors.initials: A
authors.lastname: Tzangaroulakis
mesh_terms: D000328:Adult; D018424:Cholesteatoma, Middle Ear / Q000473:pathology / Q000601:surgery / Q000821:virology*; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000473:pathology / Q000601:surgery / Q000821:virology; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000473:pathology*