title: Analysis of histopathological aspects and bone destruction characteristics in acquired middle ear cholesteatoma of pediatric and adult patients.
abstract: OBJECTIVE
  The aim of this study was to investigate the proliferative and apoptotic activity of middle ear cholesteatoma in pediatric and adult patients, in addition to comparing its histopathological aspects and the severity of advanced bone destruction.
  
  
  METHODS
  Medical records of 223 patients treated for chronic otitis media with cholesteatoma at the Otolaryngology Department of Dokuz Eylul University between January 1992 and December 2013 were retrospectively evaluated. Sixty-one patients subjected to tympanomastoidectomy due to middle ear cholesteatoma, with sufficient specimens for histopathological examination, were included in the study. Sections of archived tissues in paraffin blocks were subjected to new histopathological examinations. The proliferative and apoptotic activities of cholesteatoma were determined by immunohistochemical staining for epithelial thickness (ET), and Ki-67 and caspase-3 expression. A novel scoring system, the Bone Erosion Score (BES), was developed to estimate the severity of bone destruction. The Austin-Kartush classification score (AKCS) was also calculated.
  
  
  RESULTS
  ET and Ki-67 expression was higher in adult patients than in the pediatric patients (p=0.009 and 0.01, respectively); however, caspase-3 immunopositivity did not show any significant intergroup differences (p=0.106). The differences in AKCS and BES between pediatric and adult patients were not statistically significant. According to the correlation analysis, a significant positive correlation was observed between AKCS and BES (p=0.001), and between ET and Ki-67 expression (when histopathological data were compared) (p=0.001).
  
  
  CONCLUSIONS
  The proliferative activity of cholesteatoma was higher in adult patients. Therefore, these findings do not support the theory that the aggressive clinical course of cholesteatoma in pediatric patients is correlated with its histopathological characteristics.
authors: Dokuz Eylul University School of Medicine, Department of Otorhinolaryngology, Izmir, Turkey. Electronic address: mustafa.aslier@gmail.com.
authors: Mustafa
authors: M
authors: Aslıer
authors: Dokuz Eylul University School of Medicine, Department of Otorhinolaryngology, Izmir, Turkey.
authors: Taner Kemal
authors: TK
authors: Erdag
authors: Dokuz Eylul University School of Medicine, Department of Pathology, Izmir, Turkey.
authors: Sulen
authors: S
authors: Sarioglu
authors: Dokuz Eylul University School of Medicine, Department of Otorhinolaryngology, Izmir, Turkey.
authors: Enis Alpin
authors: EA
authors: Güneri
authors: Dokuz Eylul University School of Medicine, Department of Otorhinolaryngology, Izmir, Turkey.
authors: Ahmet Omer
authors: AO
authors: Ikiz
authors: Dokuz Eylul University School of Medicine, Department of Pathology, Izmir, Turkey.
authors: Evren
authors: E
authors: Uzun
authors: Dokuz Eylul University School of Medicine, Department of Pathology, Izmir, Turkey.
authors: Erdener
authors: E
authors: Özer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D053148:Caspase 3 / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D002908:Chronic Disease; D004429:Ear Ossicles / Q000473:pathology*; D004848:Epithelium / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010033:Otitis Media / Q000150:complications; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D019394:Ki-67 Antigen; D053148:Caspase 3
keywords: Bone Erosion Score; Cholesteatoma; Epithelium; Immunohistochemistry; Ki-67; Pediatric