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A Role for Mast Cell-Mediated Antibodies in the Formation of Cholesteatoma and Cholesteatoma-Induced Bone Erosion. Diagnostics (Basel) 2023; 13:diagnostics13030455. [PMID: 36766559 PMCID: PMC9914080 DOI: 10.3390/diagnostics13030455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
The study aimed to evaluate the effects and relationships between mast cells in the matrix, mast cell enzymes tryptase and chymase, epithelial proliferation, microvascular density, and bone destruction in cholesteatoma. Thirty-five biopsies diagnosed with cholesteatoma and seven healthy skin tissues taken from the retro-auricular region for control were evaluated. Immunohistochemical studies were performed with CD117, CD34, Ki-67, chymase, and tryptase antibodies, in a single session for all cases and the control group. The relationship between erosion size and antibody load was determined. The mean cholesteatoma epithelium Ki-67 was higher than the control group (p < 0.001). CD117-positive mast cells, chymase-positive mast cells, tryptase-positive mast cells, and microvessel density were significantly higher in the cholesteatoma matrix compared to the control group (p < 0.002, p < 0.001, p < 0.005). In the group with bone erosion scores of two and above, immunohistochemical markers tended to be higher. A positive correlation was found between CD117 and chymase, tryptase, and microvessel density; between tryptase, chymase, and microvessel density; and between chymase and microvessel density. CD117-positive mast cells and chymase-positive mast cells stimulate angiogenesis, increase the epithelium's proliferative capacity in the cholesteatoma matrix, and form cholesteatoma. The increased proliferation of cholesteatoma epithelium and increased vascular density in the matrix exacerbate bone erosion.
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Schürmann M, Oppel F, Shao S, Volland-Thurn V, Kaltschmidt C, Kaltschmidt B, Scholtz LU, Sudhoff H. Chronic inflammation of middle ear cholesteatoma promotes its recurrence via a paracrine mechanism. Cell Commun Signal 2021; 19:25. [PMID: 33627146 PMCID: PMC7903614 DOI: 10.1186/s12964-020-00690-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/23/2020] [Indexed: 12/02/2022] Open
Abstract
Background Cholesteatoma disease is an expanding lesion in the middle ear. Hearing loss and facial paralysis alongside with other intracranial complications are found. No pharmaceutical treatment is available today and recurrence after surgical extraction occurs. We investigated possible TLR4-based mechanisms promoting recurrence and explore possible treatments strategies. Methods We isolated fibroblasts and epidermal stem cells from cholesteatoma tissue and healthy auditory canal skin. Subsequently, their expression under standard culture conditions and after stimulation with LPS was investigated by RT-qPCR. Cell metabolism and proliferation were analysed upon LPS treatment, with and without TLR4 antagonist. An indirect co-culture of fibroblasts and epidermal stem cells isolated from cholesteatoma tissue was utilized to monitor epidermal differentiation upon LPS treatment by RT-qPCR and immunocytochemistry. Results Under standard culture conditions, we detected a tissue-independent higher expression of IL-1β and IL-8 in stem cells, an upregulation of KGF and IGF-2 in both cell types derived from cholesteatoma and higher expression of TLR4 in stem cells derived from cholesteatoma tissue. Upon LPS challenge, we could detect a significantly higher expression of IL-1α, IL-1β, IL-6 and IL-8 in stem cells and of TNF-a, GM-CSF and CXCL-5 in stem cells and fibroblasts derived from cholesteatoma. The expression of the growth factors KGF, EGF, EREG, IGF-2 and HGF was significantly higher in fibroblasts, particularly when derived from cholesteatoma. Upon treatment with LPS the metabolism was elevated in stem cells and fibroblasts, proliferation was only enhanced in fibroblasts derived from cholesteatoma. This could be reversed by the treatment with a TLR4 antagonist. The cholesteatoma fibroblasts could be triggered by LPS to promote the epidermal differentiation of the stem cells, while no LPS treatment or LPS treatment without the presence of fibroblasts did not result in such a differentiation. Conclusion We propose that cholesteatoma recurrence is based on TLR4 signalling imprinted in the cholesteatoma cells. It induces excessive inflammation of stem cells and fibroblasts, proliferation of perimatrix fibroblasts and the generation of epidermal cells from stem cells thru paracrine signalling by fibroblasts. Treatment of the operation site with a TLR4 antagonist might reduce the chance of cholesteatoma recurrence. ![]()
Video Abstract
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Affiliation(s)
- Matthias Schürmann
- Department of Otolaryngology, Head and Neck Surgery, Medical School OWL Campus Klinikum Bielefeld, Bielefeld University, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Felix Oppel
- Department of Otolaryngology, Head and Neck Surgery, Medical School OWL Campus Klinikum Bielefeld, Bielefeld University, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Senyao Shao
- Department of Otolaryngology, Head and Neck Surgery, Medical School OWL Campus Klinikum Bielefeld, Bielefeld University, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Verena Volland-Thurn
- Department of Otolaryngology, Head and Neck Surgery, Medical School OWL Campus Klinikum Bielefeld, Bielefeld University, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | | | - Barbara Kaltschmidt
- Department of Cell Biology, Bielefeld University , 33619, Bielefeld, Germany
| | - Lars-Uwe Scholtz
- Department of Otolaryngology, Head and Neck Surgery, Medical School OWL Campus Klinikum Bielefeld, Bielefeld University, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Holger Sudhoff
- Department of Otolaryngology, Head and Neck Surgery, Medical School OWL Campus Klinikum Bielefeld, Bielefeld University, Teutoburger Str. 50, 33604, Bielefeld, Germany.
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Hamed MA, Nakata S, Shiogama K, Suzuki K, Sayed RH, Nishimura Y, Iwata N, Sakurai K, Badawy BS, Inada KI, Tsuge H, Tsutsumi Y. Cytokeratin 13, Cytokeratin 17, and Ki-67 Expression in Human Acquired Cholesteatoma and Their Correlation With Its Destructive Capacity. Clin Exp Otorhinolaryngol 2017; 10:213-220. [PMID: 28073243 PMCID: PMC5545701 DOI: 10.21053/ceo.2016.01263] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/10/2016] [Accepted: 12/14/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Cholesteatoma is a nonneoplastic destructive lesion of the temporal bone with debated pathogenesis and bone resorptive mechanism. Both molecular and cellular events chiefly master its activity. Continued research is necessary to clarify factors related to its aggressiveness. We aimed to investigate the expression of Ki-67, cytokeratin 13 (CK13) and cytokeratin 17 (CK17) in acquired nonrecurrent human cholesteatoma and correlate them with its bone destructive capacity. METHODS A prospective quantitative immunohistochemical study was carried out using fresh acquired cholesteatoma tissues (n=19), collected during cholesteatoma surgery. Deep meatal skin tissues from the same patients were used as control (n=8). Cholesteatoma patients were divided into 2 groups and compared (invasive and noninvasive) according to a grading score for bone resorption based upon clinical, radiologic and intraoperative findings. To our knowledge, the role of CK17 in cholesteatoma aggressiveness was first investigated in this paper. RESULTS Both Ki-67 and CK17 were significantly overexpressed in cholesteatoma than control tissues (P<0.001 for both Ki-67 and CK17). In addition, Ki-67 and CK17 were significantly higher in the invasive group than noninvasive group of cholesteatoma (P=0.029, P=0.033, respectively). Furthermore, Ki-67 and CK17 showed a moderate positive correlation with bone erosion scores (r=0.547, P=0.015 and r=0.588, P=0.008, respectively). In terms of CK13, no significant difference was found between cholesteatoma and skin (P=0.766). CONCLUSION Both Ki-67 and CK17 were overexpressed in cholesteatoma tissue and positively correlated with bone resorption activity. The concept that Ki-67 can be a predictor for aggressiveness of cholesteatoma was supported. In addition, this is the first study demonstrating CK17 as a favoring marker in the aggressiveness of acquired cholesteatoma.
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Affiliation(s)
- Mahmood A Hamed
- Department of Otorhinolaryngology, Banbuntane-Hotokukai Hospital, Fujita Health University School of Medicine, Nagoya, Japan.,Department of Otorhinolaryngology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Seiichi Nakata
- Department of Otorhinolaryngology, Banbuntane-Hotokukai Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Kazuya Shiogama
- Department of Pathology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kenji Suzuki
- Department of Otorhinolaryngology, Banbuntane-Hotokukai Hospital, Fujita Health University School of Medicine, Nagoya, Japan.,Department of Otorhinolaryngology, Yonaha General Hospital, Kuwana, Japan
| | - Ramadan H Sayed
- Department of Otorhinolaryngology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Yoichi Nishimura
- Department of Otorhinolaryngology, Banbuntane-Hotokukai Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Noboru Iwata
- Department of Otorhinolaryngology, Banbuntane-Hotokukai Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Kouhei Sakurai
- Department of Pathology, Banbuntane-Hotokukai Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Badawy S Badawy
- Department of Otorhinolaryngology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ken-Ichi Inada
- Department of Pathology, Banbuntane-Hotokukai Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Hayato Tsuge
- Department of Otorhinolaryngology, Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yutaka Tsutsumi
- Department of Pathology, Fujita Health University School of Medicine, Toyoake, Japan
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Hamed MA, Nakata S, Sayed RH, Ueda H, Badawy BS, Nishimura Y, Kojima T, Iwata N, Ahmed AR, Dahy K, Kondo N, Suzuki K. Pathogenesis and Bone Resorption in Acquired Cholesteatoma: Current Knowledge and Future Prospectives. Clin Exp Otorhinolaryngol 2016; 9:298-308. [PMID: 27440129 PMCID: PMC5115149 DOI: 10.21053/ceo.2015.01662] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 11/22/2022] Open
Abstract
Cholesteatoma is a cystic non tumorous lesion of the temporal bone that has the ability to destroy nearby structures by its power to cause bone resorption and as a result, fatal complications prevail. We aimed to conduct a comprehensive review for pathogenesis of acquired cholesteatoma, bone resorption mechanisms, and offer a future vision of this serious disease. We have reviewed different theories for pathogenesis of acquired cholesteatoma including the most relevant and updated ones with special emphasis on the mechanisms of bone resorption through Medline/PubMed research using the keywords 'aetiopathogenesis, bone resorption, acquired cholesteatoma, temporal bone, and cytokines.' In order to strengthen our study, we searched the reference lists of identified reviews. Cholesteatoma is a subject of debate among otolaryngologists since it was prescribed firstly. Over many decades, several theories were postulated for aetiopathogenesis of cholesteatoma with a tendency to follow more than one theory to explain the proper nature of that disease. Until now, the mechanism of bone resorption has yet to be more clarified. In the last century, a leap has occurred in the field of biomolecular cholesteatoma research which improved our knowledge about its pathophysiology and bone destructive mechanism. However, surgery is still the only available treatment. We conclude that discovery of new therapeutic choices for cholesteatoma other than surgery by the use of anti-growth, anti-proliferative, apoptotic agents as well as medications that antagonize osteoclastogenesis should be the main concern in the future clinical and experimental research work. Also, searching for predictors of the aggressiveness of cholesteatoma can affect the timing of intervention and prevent occurrence of complications.
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Affiliation(s)
- Mahmood A Hamed
- Department of Otolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan.,Department of Otolaryngology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Seiichi Nakata
- Department of Otolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Ramadan H Sayed
- Department of Otolaryngology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Hiromi Ueda
- Department of Otolaryngology, Aichi Medical University, Nagakute, Japan
| | - Badawy S Badawy
- Department of Otolaryngology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Yoichi Nishimura
- Department of Otolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Takuro Kojima
- Department of Otolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Noboru Iwata
- Department of Otolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Ahmed R Ahmed
- Department of Pathology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Khalid Dahy
- Department of Otolaryngology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Naoki Kondo
- Department of Pathology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Kenji Suzuki
- Department of Otolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan.,Department of Otolaryngology, Yonaha General Hospital, Kuwana, Japan
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Işık Ö, Karlıdağ T, Şimşek BÇ, Keleş E, Kaygusuz İ, Yalçın Ş, Orhan İ, Sapmaz E. Evaluation of bcl-2, bax and c-erbB-2 Levels in Chronic Otitis Patients with or without Cholesteatoma. Turk Arch Otorhinolaryngol 2015; 53:55-61. [PMID: 29391981 DOI: 10.5152/tao.2015.1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 02/05/2015] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of this study was to evaluate bcl-2, bax, and c-erbB-2 expressions in primary and secondary acquired cholesteatoma and to indicate the role of apoptosis and accompanying increased cellular proliferation in the pathogenesis of cholesteatoma. Methods Samples obtained from the skin of the external ear canal (EEC) of patients operated for chronic otitis media (COM) without cholesteatoma constituted Group 1; samples from the EEC skin of patients in Group 3 operated for COM with cholesteatoma and from the EEC skin of patients in Group 4 constituted Group 2; samples obtained from the cholesteatoma matrix of patients operated for COM with primary acquired cholesteatoma constituted Group 3; and samples obtained from the cholesteatoma matrix of patients operated for COM with secondary acquired cholesteatoma constituted Group 4. The assessment of the positive cell ratio was based on the presence of the following findings and was semiquantitatively classified into four groups: 0, no staining; + cell staining (weak positive staining: 1%-33%); ++ cell staining (moderately positive staining: 34%-66%); and +++ cell staining (strong positive staining: 67%-100%). Results Comparison of the staining scores of bcl-2, bax, and c-erbB-2 revealed a statistically insignificant difference in the staining of samples obtained from the EEC skin (p>0.05). Decreased bcl-2 expression and increased bax and c-erbB-2 expressions were determined in primary and secondary acquired cholesteatoma epithelium compared with the EEC skin of patients operated for COM with or without cholesteatoma, and the differences were found to be statistically significant (p<0.05). Conclusion In acquired cholesteatoma epithelium, the finding of decreased bcl-2 expression as well as increased bax and c-erbB-2 expressions compared with the EEC skin is an indicator of the increase in both cellular proliferation and apoptosis.
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Affiliation(s)
- Özgür Işık
- Department of Otorhinolaryngology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Turgut Karlıdağ
- Department of Otorhinolaryngology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | | | - Erol Keleş
- Department of Otorhinolaryngology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - İrfan Kaygusuz
- Department of Otorhinolaryngology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Şinasi Yalçın
- Department of Otorhinolaryngology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - İsrafil Orhan
- Department of Otorhinolaryngology, Kahramanmaraş Sütçü İmam Faculty of Medicine, Kahramanmaraş, Turkey
| | - Emrah Sapmaz
- Department of Otorhinolaryngology, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey
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Britze A, Birkler RID, Gregersen N, Ovesen T, Palmfeldt J. Large-scale proteomics differentiates cholesteatoma from surrounding tissues and identifies novel proteins related to the pathogenesis. PLoS One 2014; 9:e104103. [PMID: 25093596 PMCID: PMC4122447 DOI: 10.1371/journal.pone.0104103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 07/10/2014] [Indexed: 01/23/2023] Open
Abstract
Cholesteatoma is the growth of keratinizing squamous epithelium in the middle ear. It is associated with severe complications and has a poorly understood etiopathogenesis. Here, we present the results from extensive bioinformatics analyses of the first large-scale proteomic investigation of cholesteatoma. The purpose of this study was to take an unbiased approach to identifying alterations in protein expression and in biological processes, in order to explain the characteristic phenotype of this skin-derived tumor. Five different human tissue types (cholesteatoma, neck of cholesteatoma, tympanic membrane, external auditory canal skin, and middle ear mucosa) were analyzed. More than 2,400 unique proteins were identified using nanoLC-MS/MS based proteomics (data deposited to the ProteomeXchange), and 295 proteins were found to be differentially regulated in cholesteatoma. Validation analyses were performed by SRM mass spectrometry. Proteins found to be up- or down-regulated in cholesteatoma were analyzed using Ingenuity Pathway Analysis and clustered into functional groups, for which activation state and associations to disease processes were predicted. Cholesteatoma contained high levels of pro-inflammatory S100 proteins, such as S100A7A and S100A7. Several proteases, such as ELANE, were up-regulated, whereas extracellular matrix proteins, such as COL18A1 and NID2, were under-represented. This may lead to alterations in integrity and differentiation of the tissue (as suggested by the up-regulation of KRT4 in the cholesteatoma). The presented data on the differential protein composition in cholesteatoma corroborate previous studies, highlight novel protein functionalities involved in the pathogenesis, and identify new areas for targeted research that hold therapeutic potential for the disease.
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Affiliation(s)
- Anders Britze
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | | | - Niels Gregersen
- Research Unit for Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Therese Ovesen
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Johan Palmfeldt
- Research Unit for Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
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Thorup MB, Munk M, Poulsen SS, Gaihede M, Nexo E, Sorensen BS, Ovesen T. Expression of the epidermal growth factor system in human middle ear cholesteatoma. Acta Otolaryngol 2014; 134:124-34. [PMID: 24256036 DOI: 10.3109/00016489.2013.847282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The detection of the HER4 receptor in 50% of cholesteatomas but never in the reference tissue, and the increased expression of its activating ligand EPI, suggest that EPI-mediated activation of HER4 might play a role in cholesteatoma growth. OBJECTIVE To investigate the expression of the epidermal growth factor (EGF) system in human middle ear cholesteatoma. METHODS Forty-seven patients referred for surgery due to cholesteatoma were included in the study. Clinical data were collected. Biopsies of cholesteatoma and skin from the external ear canal were obtained during surgery. mRNA expression was quantified with real-time PCR. The corresponding proteins were visualized using immunohistochemistry. RESULTS A systematic investigation of all four receptors, HER1, HER2, HER3, and HER4, and the ligands EGF, transforming growth factor (TGF)-α, amphiregulin (AR), heparin-binding EGF-like growth factor (HB-EGF), and epiregulin (EPI) of the EGF system is presented. At the mRNA level, the study demonstrates an up-regulation of mRNA encoding EPI and AR. In contrast HER1 and EGF were down-regulated. HER4 mRNA could be detected in 50% of cholesteatoma and 20% of reference tissues, and the HER4 protein was detectable only in cholesteatoma tissue. HER1 and HER2 were also visualized by immunohistochemistry, whereas the ligands EPI, AR, and EGF were undetectable with our methods.
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Levy LL, Jiang N, Smouha E, Richards-Kortum R, Sikora AG. Optical imaging with a high-resolution microendoscope to identify cholesteatoma of the middle ear. Laryngoscope 2013; 123:1016-20. [PMID: 23299781 DOI: 10.1002/lary.23710] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 05/29/2012] [Accepted: 08/09/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS High-resolution optical imaging is an imaging modality that allows visualization of structural changes in epithelial tissue in real time. Our prior studies using contrast-enhanced microendoscopy to image squamous cell carcinoma in the head and neck demonstrated that the contrast agent, proflavine, has high affinity for keratinized tissue. Thus, high-resolution microendoscopy with proflavine provides a potential mechanism to identify ectopic keratin production, such as that associated with cholesteatoma formation, and distinguish between uninvolved mucosa and residual keratin at the time of surgery. STUDY DESIGN Ex vivo imaging of histopathologically confirmed samples of cholesteatoma and uninvolved middle ear epithelium. METHODS Seven separate specimens collected from patients who underwent surgical treatment for cholesteatoma were imaged ex vivo with the fiberoptic endoscope after surface staining with proflavine. Following imaging, the specimens were submitted for hematoxylin and eosin staining to allow histopathological correlation. RESULTS Cholesteatoma and surrounding middle ear epithelium have distinct imaging characteristics. Keratin-bearing areas of cholesteatoma lack nuclei and appear as confluent hyperfluorescence, whereas nuclei are easily visualized in specimens containing normal middle ear epithelium. Hyperfluorescence and loss of cellular detail is the imaging hallmark of keratin, allowing for discrimination of cholesteatoma from normal middle ear epithelium. CONCLUSIONS This study demonstrates the feasibility of high-resolution optical imaging to discriminate cholesteatoma from uninvolved middle ear mucosa based on the unique staining properties of keratin. Use of real-time imaging may facilitate more complete extirpation of cholesteatoma by identifying areas of residual disease. Laryngoscope, 2012.
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Affiliation(s)
- Lauren L Levy
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, New York, New York 10029, USA
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Min HJ, Park CW, Jeong JH, Cho SH, Kim KR, Lee SH. Comparative analysis of the expression of involucrin, filaggrin and cytokeratin 4, 10, 16 in cholesteatoma. KOREAN JOURNAL OF AUDIOLOGY 2012; 16:124-9. [PMID: 24653886 PMCID: PMC3936667 DOI: 10.7874/kja.2012.16.3.124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 12/05/2012] [Accepted: 12/07/2012] [Indexed: 11/22/2022]
Abstract
Background and Objectives The aim of this study is to determine whether the hyperproliferative and hyperkeratotic characters of cholesteatoma are associated with differentiation of keratinocytes in cholesteatoma by examining the localization of marker proteins, such as involucrin, filaggrin, and cytokeratins. Materials and Methods Immunohistochemical study was carried out in 30 cholesteatoma tissues and 10 retroauricular skins to examine the expression of involucrin, filaggrin, cytokeratin 4, 10 and 16. The staining results were graded as negative, weakly positive (<10%), moderately positive (10-70%), and strongly positive (>70%). Results Involucrin was strongly expressed in upper spinous, granular, and corneal layer of cholesteatoma. Filaggrin was strongly expressed in granular and corneal layer of cholesteatoma. Cytokeratin 4 was expressed in basal layer of retroauricular skin, but occasionally expressed in suprabasal layer of cholesteatoma. Cytokeratin 10 was homogenously expressed in all suprabasal layer of retroauricular skin, whereas pattern of shift to surface layer was showed in cholesteatoma. Cytokeratin 16 was moderately expressed at suprabasal layer in cholesteatoma. Conclusions It can be suggested that early differentiation of suprabasal layer may lead to hyperdifferentiation and hyperkeratosis. Different expression of cytokeratins possibly indicates the altered differentiation of cholesteatoma.
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Affiliation(s)
- Hyun Jung Min
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Chul Won Park
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jin Hyeok Jeong
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Seok Hyun Cho
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Kyung Rae Kim
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Seung Hwan Lee
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
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Abstract
OBJECTIVES The aim of this study was to characterize primary cultured fibroblasts derived from cholesteatoma (CHO) tissue to get evidence of their possible role for determining the different biological behavior of this aural pathology. MATERIALS AND METHODS Primary cultures of human fibroblasts were obtained from middle ear CHO specimens and from controls of normal human skin collected during surgical procedures. Cells were incubated with anti-vimentin monoclonal antibody, anti-cytokeratins monoclonal antibody and anti-α-smooth muscle actin monoclonal antibody. For reactive oxygen species detection, fibroblasts were incubated with 2',7'-dichlorofluorescein diacetate. Immunofluorescence, flow cytometry, confocal, and transmission electron microscopy were carried out. RESULTS Cholesteatoma-associated fibroblasts (CHO-AFs) were characterized by a higher degree of cytoplasmic complexity, by the expression of α-smooth muscle actin and by a greater basal production of reactive oxygen species in comparison with controls, reflecting a more differentiated phenotype consistent with myofibroblasts. CONCLUSION It is possible to suggest that the differentiated phenotype of CHO-AFs might be coupled with a more or less aggressive clinical behavior, and hence, these cultures might represent powerful tools for investigating biology and clinical evolution of this disease.
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Cholesteatoma-associated fibroblasts modulate epithelial growth and differentiation through KGF/FGF7 secretion. Histochem Cell Biol 2012; 138:251-69. [PMID: 22481617 PMCID: PMC3407559 DOI: 10.1007/s00418-012-0947-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2012] [Indexed: 11/04/2022]
Abstract
The keratinocyte growth factor (KGF/FGF7), produced by stromal cells, is a key paracrine mediator of epithelial proliferation, differentiation and migration. Expression of the growth factor is increased in wound healing and in hyperproliferative epithelial diseases, as a consequence of the activation of dermal fibroblasts by the inflammatory microenvironment. The middle ear cholesteatoma, an aural epidermal pathology characterized by keratinocyte hyperproliferation and chronic inflammation, may represent a model condition to study the epithelial-mesenchymal interactions. To develop an in vitro model for this disease, we isolated and characterized human primary cultures of fibroblasts associated with the cholesteatoma lesion, analyzing their secretory behaviour and degree of differentiation or activation. Compared to the perilesional or control normal fibroblasts, all cultures derived from cholesteatoma tissues were less proliferating and more differentiated and their highly variable activated phenotype correlated with the secretion of KGF as well as of metalloproteases 2 and 9. Culture supernatants collected from the cholesteatoma-associated fibroblasts were able to increase the proliferation and differentiation of human keratinocytes assessed by the expression of Ki67 and keratin-1 markers. The single crucial contribution of the KGF released by fibroblasts on the keratinocyte biological response was shown by the specific, although partial, block induced by inhibiting the KGF receptor or by immunoneutralizing the growth factor. Altogether, these results suggest that the activation of the stromal fibroblasts present in the pathological tissue, and the consequent increased secretion of KGF, play a crucial role in the deregulation of the epidermal proliferation and differentiation.
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Paracrine loops of keratinocyte stimulation in cholesteatoma tissue: an immunofluorescence, transmission electron microscopy, and molecular study. Otol Neurotol 2010; 31:1163-9. [PMID: 20679958 DOI: 10.1097/mao.0b013e3181ec1bb9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS In relation to the keratinocyte growth factor (KGF) expression in cholesteatoma tissue, the inflammatory infiltrate present in this disease could play a relevant role in the paracrine stimulation of keratinocytes. BACKGROUND Cholesteatoma is a temporal bone pathologic disease characterized by active proliferation of epithelial cells, with progressive growth and involvement of the neighboring middle/inner ear structures. The pathogenetic mechanism underlying the hyperproliferation of keratinocytes is not yet fully clarified. It has been suggested that keratinocyte proliferation and migration could be mediated by several autocrine and paracrine growth factors and their receptors. A previous study has reported that the expression of KGF receptor is increased in more differentiated areas of the cholesteatoma tissue, whereas the expression of the epidermal growth factor receptor is associated with proliferative and migratory areas of the lesion. METHODS Fresh cholesteatoma samples were collected during surgical procedures. Serial cryosections were examined by conventional hematoxylin and eosin or by immunofluorescence with antipancytokeratin antibodies. The ultrastructural features were analyzed by transmission electron microscopy. The expression of KGF, K1, and filaggrin in the samples was evaluated by quantitative reverse transcription-polymerase chain reaction and correlated with the dermal degree of inflammatory infiltrate and the presence of stromal cells. RESULTS Increased expression of KGF was associated with strong levels of the inflammatory infiltrate. CONCLUSION These results would suggest that KGF up-modulation is a consequence of fibroblast stimulation by inflammatory cells and that this paracrine loop could be responsible not only for the hyperproliferation of keratinocytes in cholesteatoma tissue but also for the deregulation of epidermal differentiation.
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Kuczkowski J, Bakowska A, Pawelczyk T, Narozny W, Mikaszewski B. Cell cycle inhibitory protein p27 in human middle ear cholesteatoma. ORL J Otorhinolaryngol Relat Spec 2006; 68:296-301. [PMID: 16825801 DOI: 10.1159/000094377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Accepted: 12/02/2005] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the immunohistochemical and molecular presentation of protein p27 in cholesteatoma. METHODS 42 cholesteatoma samples and 6 external ear canal skin (EECS) specimens were investigated and analyzed taking into consideration congenital, acquired, recurrent cholesteatoma, and EECS. RESULTS The expression of p27 was found in 16 (38.1%) out of 42 specimens of cholesteatoma and in 5 (83.3%) out of 6 specimens of EECS. There was a significant difference in p27-positive staining rate between EECS and cholesteatoma epithelium (p < 0.008). The presence of p27 was detected in 10 cases of acquired cholesteatoma, 2 cases of congenital and 3 cases of recurrent cholesteatoma. There was no significant difference between the presence of p27 in cholesteatoma and EECS (p = 0.01). CONCLUSION The down-regulation of p27 is a key player in cell cycle control and plays an undefined role in the pathogenesis of all types of cholesteatoma.
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Affiliation(s)
- Jerzy Kuczkowski
- Department of Otolaryngology, Medical University of Gdansk, Gdansk, Poland.
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Dornelles C, Costa SSD, Meurer L, Schweiger C. Some considerations about acquired adult and pediatric cholesteatomas. Braz J Otorhinolaryngol 2005; 71:536-45. [PMID: 16446973 PMCID: PMC9441961 DOI: 10.1016/s1808-8694(15)31212-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Authors debate about cholesteatomas, from the first time this word was employed, by Muller, in 1838, until the recent updates. They dissert about its definition, etiology and pathology and present basic concepts about its biology. They also make a wide review about pediatric cholesteathoma, its epidemiology and biology, and compare it with adult cholesteatoma. Finally, they describe some articles about ossicle chain erosion and its correlation with cholesteatoma perimatrix, collagen and collagenase.
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Dornelles C, Costa SSD, Meurer L, Schweiger C. Algumas considerações sobre colesteatomas adquiridos pediátricos e adultos. ACTA ACUST UNITED AC 2005. [DOI: 10.1590/s0034-72992005000400023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Neste artigo, os autores dissertam sobre o tema colesteatoma, desde a primeira vez em que foi utilizada a palavra por Mueller (1838), até informações atuais. Fazem uma abordagem de sua definição, passam pela etiopatogênese e apresentam noções básicas sobre sua biologia. Ainda realizam uma ampla revisão sobre colesteatoma pediátrico, apresentam dados clínicos epidemiológicos e biológicos e mostram um paralelo com o colesteatoma em adultos. Para finalizar, descrevem alguns trabalhos sobre erosão da cadeia ossicular correlacionando-a com dados sobre a perimatriz, colágeno e colagenase.
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Olszewska E, Lautermann J, Koc C, Schwaab M, Dazert S, Hildmann H, Sudhoff H. Cytokeratin expression pattern in congenital and acquired pediatric cholesteatoma. Eur Arch Otorhinolaryngol 2005; 262:731-6. [PMID: 15754169 DOI: 10.1007/s00405-004-0875-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Accepted: 08/13/2004] [Indexed: 11/28/2022]
Abstract
Pediatric cholesteatoma can be classified as congenital or acquired based on clinical criteria. We studied the expression patterns of five distinctive cytokeratins in both types of cholesteatoma in order to improve understanding of their pathogenesis and origin. A comparable expression pattern for CK10, CK14, CK18, CK19 and 34betaE12 antigens was found in the matrix of congenital and acquired pediatric cholesteatoma. Our results demonstrate that congenital and acquired pediatric cholesteatoma exhibit an identical cytokeratin distribution pattern, suggesting that they share a common origin. Therefore, it seems possible that a portion of the so-called "acquired" cholesteatoma may actually originate from advanced congenital cholesteatoma with secondary destruction of the tympanic membrane in the pediatric patient population.
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Affiliation(s)
- Ewa Olszewska
- Department of Otorhinolaryngology and Head and Neck Surgery, St. Elisabeth Hospital, University of Bochum, Bleichstrasse 15, 44787, Bochum, Germany
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Olszewska E, Wagner M, Bernal-Sprekelsen M, Ebmeyer J, Dazert S, Hildmann H, Sudhoff H. Etiopathogenesis of cholesteatoma. Eur Arch Otorhinolaryngol 2004; 261:6-24. [PMID: 12835944 DOI: 10.1007/s00405-003-0623-x] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2003] [Accepted: 04/03/2003] [Indexed: 11/26/2022]
Abstract
Cholesteatoma is a destructive lesion of the temporal bone that gradually expands and causes complications by erosion of the adjacent bony structures. Bone resorption can result in destruction of the ossicular chain and otic capsule with consecutive hearing loss, vestibular dysfunction, facial paralysis and intracranial complications. Surgery is the only treatment of choice. The etiopathogenesis of cholesteatoma, however, is still controversial. This review was designed to understand the reasons for these disparities and to reduce or eliminate them. Future studies focused on developmental, epidemiological, hormonal and genetic factors as well as on treatment are likely to contribute to further understanding of cholesteatoma pathogenesis.
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Affiliation(s)
- Ewa Olszewska
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical Academy, Bialystok, Poland
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18
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Mallet Y, Nouwen J, Lecomte-Houcke M, Desaulty A. Aggressiveness and quantification of epithelial proliferation of middle ear cholesteatoma by MIB1. Laryngoscope 2003; 113:328-31. [PMID: 12567091 DOI: 10.1097/00005537-200302000-00024] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess an easy method that predicts cholesteatoma aggressiveness. STUDY DESIGN An experimental prospective study. METHODS Monoclonal antibody MIB1 was used to determine epithelium proliferation in 91 cholesteatomatous ears. Clinical and surgical parameters were compared with proliferation activity to determine pathological and clinical correlation. RESULTS Statistical correlations were established between hyperproliferation of the cholesteatoma and severe bone erosion (leading to major cholesteatoma complications) and between hyperproliferation and middle ear inflammation (associated with more surgical difficulties and a higher risk of recurrence). A high proliferation index was also found in children's cholesteatoma, which is known to have more aggressive behavior. CONCLUSION Immunohistochemical use of the MIB1 antibody is a simple technique that can help to determine the aggressiveness of a cholesteatoma.
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Affiliation(s)
- Y Mallet
- Departments of Otorhinolaryngology, Centre Hospitalier Universitaire Lille, Lille, France. y-mallet@o-lambret
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Motamed M, Powe D, Kendall C, Birchall JP, Banerjee AR. p53 Expression and keratinocyte hyperproliferation in middle ear cholesteatoma. CLINICAL OTOLARYNGOLOGY AND ALLIED SCIENCES 2002; 27:505-8. [PMID: 12472520 DOI: 10.1046/j.1365-2273.2002.00622.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Keratinocytes in middle ear cholesteatoma have hyperproliferative properties. There is controversy regarding the role of p53 and its effect on cellular proliferation in cholesteatoma. This study was instituted to examine this. Cholesteatoma and deep meatal skin control specimens were analysed for MIB-1 (n = 7, controls = 7), a marker of cellular proliferation, and p53 (n = 17, controls = 17) expression by immunocytochemistry. Expression of p53 was minimal or absent in both cholesteatoma and controls (P = 0.2). MIB-1 expression was higher, but not significantly so, in cholesteatoma than in controls (P = 0.09). Our study has shown no significant p53 expression in cholesteatoma epithelium. This suggests that there is no dysfunction in the p53-mediated cell cycle control mechanisms in cholesteatoma.
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Affiliation(s)
- M Motamed
- Department of ORL/H & N Surgery, Queens Medical Centre, University Hospital, Nottingham, UK.
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20
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Kim HJ, Tinling SP, Chole RA. Increased proliferation and migration of epithelium in advancing experimental cholesteatomas. Otol Neurotol 2002; 23:840-4. [PMID: 12438843 DOI: 10.1097/00129492-200211000-00005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS Hyperproliferative and migratory process of keratinocytes are part of the pathogenesis of cholesteatoma. BACKGROUND Cytokeratin (CK) changes were prominent in the most rapidly expanding regions of cholesteatoma formation. METHODS The three types of animal model-canal ligation (CL), retraction pocket (RP), and propylene glycol (PG)-were induced in Mongolian gerbils. The monoclonal antibodies to CK1/10, CK5/6, and CK13/16 were used for immunohistochemistry. The intensity of immunostaining in the pars tensa of the tympanic membrane was measured using the densitometry and compared with respect to the stage of cholesteatoma and the type of animal model. RESULTS With cholesteatoma formation, CK expressions were significantly increased at the peripheral part of the pars tensa, the expanding part of cholesteatoma. Among the CKs tested, the prominent changes were observed in expression of CK13/16, a marker for hyperproliferation. Among the animal models, CK changes of CK5/6 and CK1/10 were most prominent in the CL type, whereas those of CK13/16 were more persistent in the RP type. CONCLUSION These results suggested that complex alterations of epidermal keratinocytes occur during cholesteatoma formation and that hyperproliferative and migratory processes play important roles in the pathogenesis of cholesteatoma.
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Affiliation(s)
- Hyung-Jong Kim
- Department of Otorhinolaryngology, College of Medicine, Hallym University, Anyang, Korea
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21
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Abstract
OBJECTIVES To investigate the patterns of cytokeratin (CK) expression in retraction pocket cholesteatoma. STUDY DESIGN An animal model study. METHODS Retraction pocket cholesteatomas were induced by electrocautery of the eustachian tube orifice in 24 mongolian gerbils. They were divided into normal and cholesteatoma groups of clinical stages I to IV. The antibodies to pan-cytokeratin CK 1/10, CK 5/6, CK 4, and CK 13/16 were used for immunohistochemical staining. The intensity of staining in each group as measured with densitometry was compared regarding anatomical sites and clinical stages. RESULTS In retraction pocket cholesteatoma, CK expression was altered only at focal sites such as the pars tensa of the tympanic membrane. The change of CK expression was observed only at certain stages of cholesteatoma formation. In keratinocytes from cholesteatomas, CK 13/16 was overexpressed compared with control specimens, indicating hyperproliferation. The site with the most prominent change in retraction pocket cholesteatoma was somewhat different from that in canal ligation cholesteatoma in a previous study. CONCLUSIONS The results suggested that aural cholesteatoma is a disease with a spectrum of pathological conditions and that the transmigration and hyperproliferation process of squamous epithelium occurs in areas adjacent to the cholesteatoma.
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Affiliation(s)
- H J Kim
- Department of Otorhinolaryngology, College of Medicine, Hallym University, Anyang, Korea
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Bayazít YA, Karakök M, Uçak R, Kanlíkama M. Cycline-dependent kinase inhibitor, p27 (KIP1), is associated with cholesteatoma. Laryngoscope 2001; 111:1037-41. [PMID: 11404617 DOI: 10.1097/00005537-200106000-00019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Cyclin-dependent kinases (CDKis) can arrest the cell cycle, which in turn inhibits the cell proliferation. P27 (KIP1) is a CDKi and acts as a tumor suppressor gene. In this study, we aimed to investigate the role of p27 CDKi in cholesteatoma, a disease characterized by the presence of hyperproliferative squamous epithelium. STUDY DESIGN Immunohistochemical staining of 15 cholesteatoma and 18 control ear canal skin samples, which were taken intraoperatively, was performed for p27 positivity. METHODS The monoclonal antibodies to p27 were used for immunohistochemical staining of the sections. The streptavidin-biotin horseradish method was used. The number of cells staining positive for p27 was calculated, and the intensity of p27 positivity was graded. RESULTS P27 positivity was obtained in 9 (50%) of 18 skin tissues. In the cholesteatoma tissues, p27 positivity was found only in 2 (13.3%) tissue samples. The difference between the groups were statistically significant (P =.03). The mean numbers of p27 positivity were 11.8 +/- 15.5 and 1.4 +/- 3.8 (mean +/- standard deviation) in the skin and cholesteatoma samples, respectively. This difference was also statistically significant (P =.02). The p27 results of primary and secondary cholesteatoma samples were not significantly different (P =.3). The results of p27 were not related to the gender of the patients (P =.8). CONCLUSION P27 is involved directly or indirectly in the occurrence of cholesteatoma. Alterations of p27 levels in keratinocytes can influence the proliferative state of the keratinocytes. Altered p27 levels in cholesteatoma may suggest a molecular pathology in cholesteatoma. The search for significance of CDKis seems promising to better understand the pathogenesis of cholesteatoma.
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Affiliation(s)
- Y A Bayazít
- Department of Otolaryngology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.
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Miyazaki H, Kojima H, Tanaka Y, Shiwa M, Koga T, Moriyama H. Terminal differentiation of epithelial cells in middle ear cholesteatoma: investigation of patterns of expression of protein kinase C-delta and protein kinase C-eta. Laryngoscope 1999; 109:1785-92. [PMID: 10569408 DOI: 10.1097/00005537-199911000-00012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this study was to elucidate the differentiation mechanism of keratinocytes in cholesteatoma. STUDY DESIGN To achieve the objective, we analyzed the expressions of various cellular proteins: the delta and eta isoforms of protein kinase C (PKCdelta and PKCeta), which are thought to play key roles in signal transduction in differentiation; cytokeratin 1 (CK1) and cytokeratin 10 (CK10) (cytoskeletal constitutive proteins); and involucrin (a marker of differentiation). METHODS The materials used in this study were tissue specimens obtained from cholesteatoma epidermis, normal external ear canal skin, normal inguinal skin, and psoriatic skin. Immunohistochemical staining techniques were applied to compare the expressions of the above proteins (i.e., PKCdelta, PKCeta, CK1, CK10 and involucrin) in those various tissues. RESULTS No clear differences in the patterns of expression of PKCdelta and PKCeta were found between the cholesteatoma epidermis and the normal external ear canal skin. These proteins were expressed mainly in the stratum spinosum and stratum granulosum, and their patterns of expression were almost the same as those of the CK1, CK10, and involucrin proteins. CONCLUSION The findings of this study indicate that the terminal differentiation of keratinocytes in the cholesteatoma epidermis is the same as in normal skin tissues. It was concluded that the growth of epidermis which has undergone hyperproliferation of keratinocytes because of increased levels of various cytokines is being regulated by means of normal terminal differentiation.
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Affiliation(s)
- H Miyazaki
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
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Choufani G, Mahillon V, Decaestecker C, Lequeux T, Danguy A, Salmon I, Gabius HJ, Hassid S, Kiss R. Determination of the levels of expression of sarcolectin and calcyclin and of the percentages of apoptotic but not proliferating cells to enable distinction between recurrent and nonrecurrent cholesteatomas. Laryngoscope 1999; 109:1825-31. [PMID: 10569415 DOI: 10.1097/00005537-199911000-00019] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To investigate in a series of cholesteatomas 1. whether subgroups of cholesteatomas with specific proliferative/apoptotic features exhibit distinct differentiation markers and 2. whether these different subgroups identified at the biological level relate to specific groups of clinically identified cholesteatomas. STUDY DESIGN Analysis of 55 cholesteatomas resected by the same surgeon, by means of canal wall up and canal wall down surgical procedures. METHODS Two differentiation markers were used: biotinylated sarcolectin (to identify sarcolectin-binding sites) and a monoclonal antibody directed against calcyclin (which is the S100A6 protein). The growth pattern in cholesteatomas was characterized at three distinct levels: 1. the cell proliferation level determined by means of the MIB-1 antibody, which enables the Ki-67 cell-cycle-related antigen to be identified on archival material; 2. the apoptosis level determined by means of the in situ labeling of nuclear DNA fragmentation (TUNEL staining); and 3. the p53 tumor suppressor gene-related product determined by means of p53 immunohistochemistry. RESULTS The cholesteatomas that exhibited the highest proportion of apoptotic cells were those which exhibited the highest level of sarcolectin-binding sites (i.e., sialic acids). In contrast, the cholesteatomas exhibiting the lowest level of both proliferation and apoptosis showed the highest level of calcyclin. Recurrent cholesteatomas can be identified from nonrecurrent ones on the basis of three features, namely, the level of apoptotic cells, the way in which the apoptotic cells are distributed (i.e., homogeneously vs. heterogeneously), and the percentage of calcyclin-positive cells. CONCLUSIONS The present data emphasize the existence of distinct subgroups of cholesteatomas identifiable at both cell kinetic and differentiation levels. Some of the biological variables used here to identify distinct biological subgroups of cholesteatomas in turn enabled some biological variables to be identified, so making it possible to classify the cholesteatomas in terms of recurrence versus nonrecurrence.
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Affiliation(s)
- G Choufani
- Department of Otolaryngology & Head and Neck Surgery, Erasmus University Hospital, Brussels, Belgium
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Ergün S, Carlsöö B, Zheng X. Apoptosis in meatal skin, cholesteatoma and squamous cell carcinoma of the ear. CLINICAL OTOLARYNGOLOGY AND ALLIED SCIENCES 1999; 24:280-5. [PMID: 10472461 DOI: 10.1046/j.1365-2273.1999.00258.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Apoptosis in normal meatal skin, cholesteatoma and squamous cell carcinoma (SCC) of the ear was investigated by using morphological analysis and in-situ specific labelling of fragmented DNA. In meatal skin, apoptotic cells were localized mainly in the granular layers, but were not so restricted in cholesteatoma, while in SCC they were even more dispersed. The apoptotic index (AI) was low (1.59 +/- 0.10 SEM) in normal skin. It was increased in cholesteatoma (2.09 +/- 0.11), and was intermediate in SCC (1.72 +/- 0.14). By contrast, the mitotic index (MI) increased from 0.19 +/- 0.02 in normal skin, to 0.25 +/- 0.01 in cholesteatoma and to 0.25 +/- 0.02 in SCC. Our findings indicate that apoptosis is involved in the epithelial homeostasis of meatal skin, cholesteatoma and SCC of the ear. The hyperproliferation of epithelial cells in cholesteatoma is counteracted by an increased apoptosis rate, while in SCC the increased cell proliferation without a compensatory increase in apoptosis may be associated with the malignant transformation.
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Affiliation(s)
- S Ergün
- Department of Otolaryngology, Huddinge University Hospital, Sweden
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Tanaka Y, Shiwa M, Kojima H, Miyazaki H, Kamide Y, Moriyama H. A study on epidermal proliferation ability in cholesteatoma. Laryngoscope 1998; 108:537-42. [PMID: 9546266 DOI: 10.1097/00005537-199804000-00014] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With the objective of estimating proliferation ability of epidermis of middle ear cholesteatoma, the difference in proliferating cell nuclear antigen (PCNA) staining between the skin of the bone region of the external ear canal (control skin) and cholesteatoma epidermis and the effects on PCNA staining of subepidermal inflammatory cell infiltration of cholesteatoma were immunohistochemically studied using an antibody against PCNA. Transforming growth factor-alpha (TGF-alpha) is known to promote epidermal proliferation based on autocrine mechanism. But it is not clear that cholesteatoma epidermis is actually in the state of hyperproliferation under the effect of this growth factor. To estimate the effect of TGF-alpha on epidermal proliferation ability, the authors compared the location of PCNA and TGF-alpha in the same specimen. Unlike the control skin, not only epidermal basal cell layer and suprabasal cell layer, but also more superior layers were found to have high levels of PCNA staining in the epidermis of cholesteatoma. However, in the same cholesteatoma epidermal tissue, the PCNA staining was varied and the difference was ascribable to subepidermal cell inflammation. It appeared that the proliferation ability was high in regions where subepidermal inflammatory cell infiltration was severe. These differences in microenvironment are inferred to greatly affect proliferation ability of cholesteatoma epidermis.
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Affiliation(s)
- Y Tanaka
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
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Bujía J, Holly A, Antolí-Candela F, Tapia MG, Kastenbauer E. Immunobiological peculiarities of cholesteatoma in children: quantification of epithelial proliferation by MIB1. Laryngoscope 1996; 106:865-8. [PMID: 8667984 DOI: 10.1097/00005537-199607000-00015] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cholesteatoma in children is characterized by a more extensive and rapid growth in the middle ear and mastoid cavities. The growth characteristics of the cholesteatoma in 20 children were studied using the monoclonal antibody MIB 1, which recognizes a nuclear antigen expressed by cells in the G1, S, and G2/M phases. Specimens of normal adult auditory meatal skin (n = 15) and adult cholesteatoma (n = 15) served as controls. The tissue specimens were prepared for immunohistochemical examination using the alkaline phosphatase-antialkaline phosphatase method and an automatic image analyzer. Specimens of normal skin revealed an average MIB 1 score of 9.2 +/- 3.10%. Child and adult cholesteatomas showed higher values. The average MIB 1 score was higher in child cholesteatoma (42 +/- 9.4%) than in adult cholesteatoma (28.2 +/- 6%). This difference was statistically significant (P<.01). Our results confirm a significant increase of the proliferative rate of cholesteatoma keratinocytes in children, giving an explanation for the more aggressive clinical behavior observed in these patients.
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Affiliation(s)
- J Bujía
- Department of Otorhinolaryngology, Ludwig-Maximilians-University of Munich, Germany
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Bujía J, Kim C, Boyle D, Hammer C, Firestein G, Kastenbauer E. Quantitative analysis of interleukin-1-alpha gene expression in middle ear cholesteatoma. Laryngoscope 1996; 106:217-20. [PMID: 8583857 DOI: 10.1097/00005537-199602000-00021] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Regardless of its origin, cholesteatoma is characterized by the presence of a keratinizing epithelium with an hyperproliferative behavior leading to a very important bone resorption. Previous studies have demonstrated overexpression of interleukin-1 (IL-1 protein in middle ear cholesteatoma by immunohistochemistry and enzyme-linked immunosorbent assay, suggesting a significant role for IL-1-alpha. In this study, the presence of IL-1-alpha messenger ribonucleic acid (mRNA) was quantified by in situ hybridization on frozen sections (n = 10) and by computer-assisted image analysis. Human skin obtained from the external ear canal (n = 10) was used as the control. A higher percentage of cells hybridized for the antisense probes IL-1-alpha mRNA was found in cholesteatoma epithelium. Furthermore, keratinocytes of the suprabasal cell layers were also found to contain specific hybridizations. Some cells in cholesteatoma stroma also contained IL-1-alpha mRNA transcripts. The results of this study confirm the central role of IL-1-alpha in the epithelium hyperproliferation and bone resorption observed in middle ear cholesteatoma.
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Affiliation(s)
- J Bujía
- Department of Otolaryngology, Head-Neck Surgery, Ludwig Maximilians-University of Munich, Germany
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Bujia J, Sudhoff H, Holly A, Hildmann H, Kastenbauer E. Immunohistochemical detection of proliferating cell nuclear antigen in middle ear cholesteatoma. Eur Arch Otorhinolaryngol 1996; 253:21-4. [PMID: 8932424 DOI: 10.1007/bf00176697] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cholesteatoma epithelium is characterized by a keratinocyte dysregulation accompanied by destruction of the ossicles and temporal bone. Immunohistochemical methods using antibodies to cell-cycle-related antigens can be used as a means for assessing various aspects of proliferation in cholesteatoma tissue. They also have the important advantage of preserving the spatial orientation of proliferating cells in histological sections. Proliferating cell nuclear antigen (PCNA) is a 36 kDa DNA-delta-polymerase-associated protein that is directly involved in the mechanisms of DNA synthesis. In the present study the expression of PCNA was investigated in formalin-fixed, paraffin-embedded biopsy specimens of cholesteatomas and normal skin. Normal skin revealed nuclear staining in a small number of keratinocytes (PCNA grade, 1.5) located in the basal cell layer. In contrast, an increased number of PCNA-labeled basal and suprabasal epidermal cells (PCNA grade, 9.3) were found in cholesteatoma samples. Our findings indicate that PCNA represents a reliable marker for epithelial proliferation, showing that cholesteatoma epithelium proliferates at a higher rate than normal epidermis. These findings also support the concept of keratinocyte dysregulation in middle ear cholesteatoma.
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Affiliation(s)
- J Bujia
- Department of Otorhinolaryngology, Ludwid-Maximilians-University, Klinikum Grobhadern, Munich, Germany
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Bujía J, Kim C, Ostos P, Kastenbauer E, Hültner L. Role of interleukin 6 in epithelial hyperproliferation and bone resorption in middle ear cholesteatomas. Eur Arch Otorhinolaryngol 1996; 253:152-7. [PMID: 8652157 DOI: 10.1007/bf00615113] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Locally produced pro-inflammatory cytokines are considered to play an important role in the initiation and/or maintenance of inflammatory diseases. In cholesteatomatous lesions there are increased levels of some cytokines and inflammatory mediators like interleukin 1, tumor necrosis factor and colony-stimulating factor, etc. Interleukin 6 (IL-6) can be produced by different cells present in cholesteatoma (e.g. keratinocytes, lymphocytes, fibroblasts and macrophages). Until now, no data have been available on the role of IL-6 in cholesteatoma. In this study we used immunohistochemistry to investigate the presence and distribution of IL-6 in tissue samples from cholesteatoma patients. Levels of the cytokine were quantified in tissue extracts using an enzyme-linked immunosorbent assay. Finally, the presence of biologically active IL-6 was analyzed in the murine cell line 7TD1. Human skin samples obtained from the external ear canal were used as controls. Using the anti-IL-6 antibody in an alkaline phosphatase anti alkaline phosphatase technique, a moderate diffuse staining of the whole epidermis was observed in sections of normal skin. In cryostat sections of cholesteatoma samples, a stronger staining of the whole epithelium was observed. Many of the cells infiltrating the cholesteatoma stroma also showed positive immunostainings. The concentration of IL-6 in relation to the total protein concentration in cholesteatoma (119.33 +/- 30) were higher than in human skin (9.16 +/- 13). While IL-6 activity was not detected in skin samples, two of the ten cholesteatoma samples studied showed a stimulatory effect when incubated with the cell line 7TD1. The overexpression of IL-6 in middle ear cholesteatoma suggests a participation of this cytokine in some of the clinical features seen: epithelial hyperproliferation and bone resorption. The absence of biological activity in the majority of the cholesteatoma samples points to the presence of natural inhibitors for IL-6.
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Affiliation(s)
- J Bujía
- Department of Otolaryngology, Head and Neck Surgery, Ludwig Maximilians University, Munich, Germany
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Kakoi H, Tamagawa Y, Kitamura K, Anniko M, Hiraide F, Kitajima Y. Cytokeratin expression patterns by one- and two-dimensional electrophoresis in pars flaccida cholesteatoma and pars tensa cholesteatoma. Acta Otolaryngol 1995; 115:804-10. [PMID: 8749203 DOI: 10.3109/00016489509139405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Expression patterns of cytokeratins (CKs) in normal skin, in pars flaccida type cholesteatoma (PFTC), and in pars tensa type cholesteatoma (PTTC) were examined by means of one- and two-dimensional electrophoretic techniques. Both CKs 14 and 5 pair (CKs 14/5) and CKs 10/1 were found in all materials. Neither CKs 16/6 nor 19 was found in the skin. CKs 16/6 and 19 were both found in 3 out of 5 PFTCs, only CKs 16/6 in 1 out of 5 and neither CKs 16/6 nor 19 in 1 out of 5. CKs 16/6 and 19 were both found in 1 out of 3 PTTCs, only CKs 16/6 in 1 out of 3 and neither CKs 16/6 nor 19 in 1 out of 3. There was no significant difference in the CKs expression patterns between PFTC and PTTC. The expression of CKs 16/6 and 19 suggested that their matrix epithelia were hyperproliferative. However, not all of the cholesteatomas were always hyperproliferative. Patterns of the terminal differentiation of CKs 1, 5, 10 and 14 in the PFTC or the PTTC were basically the same as those in the skin. In the cholesteatoma, eack CK gradually diminished in molecular weight in the cornified layer and debris. Desmosomal proteins were abundant in skin but not in cholesteatomas.
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Affiliation(s)
- H Kakoi
- Department of Otorhinolaryngology and Head & Neck Surgery, Jichi Medical School, Tochigi, Japan
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Sudhoff H, Bujía J, Fisseler-Eckhoff A, Holly A, Schulz-Flake C, Hildmann H. Expression of a cell-cycle-associated nuclear antigen (MIB 1) in cholesteatoma and auditory meatal skin. Laryngoscope 1995; 105:1227-31. [PMID: 7475881 DOI: 10.1288/00005537-199511000-00017] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Middle ear cholesteatoma is often invasive with consequent bone destruction. Inflammatory stimulation of the underlying connective tissue, as well as an autocrine mechanism, may be responsible for the dysregulation and abnormal proliferative features of the keratinocytes in cholesteatoma. Comparative investigations were performed to assess the epithelial cell kinetics of cholesteatoma and normal auditory meatal skin. Monoclonal antibody MIB 1 immunostaining (which recognizes a nuclear antigen expressed by dividing cells) was applied using the alkaline phosphatase antialkaline phosphatase immunolabeling method. Specimens of normal auditory meatal skin (n = 7) revealed an average MIB 1 score (quotient of the MIB 1-positive cells and the total number of cells) of 7.6 +/- 2.2%. Cholesteatoma samples (n = 13) showed an average MIB 1 score of 17.4 +/- 8.9% and a heterogeneity of proliferating epithelial areas. Epithelial cones growing toward the underlying stroma exhibited high mitotic activity. Statistically, the results of this study confirm a highly significant increase in the proliferation rate of cholesteatoma keratinocytes, which had an MIB 1 score that was 2.3 times higher than the score for keratinocytes of normal external auditory meatal skin.
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Affiliation(s)
- H Sudhoff
- Department of Otorhinolaryngology, St. Elisabeth-Hospital, University of Bochum, Germany
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Holly A, Sittinger M, Bujia J. Immunohistochemical demonstration of c-myc oncogene product in middle ear cholesteatoma. Eur Arch Otorhinolaryngol 1995; 252:366-9. [PMID: 8679157 DOI: 10.1007/bf00178279] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cholesteatoma epithelium is characterized by a dysregulation with a hyperproliferative growth and altered differentiation. In a variety of cells c-myc oncogene was found to be highly linked to the control of growth and differentiation. Expression of c-myc was studied in cholesteatoma epithelium using a monoclonal antibody directed against the 67 kDa c-myc protein product and the alkaline phosphatase-antialkaline phosphatase method. For quantitative analysis a computer-linked analyzing system was used. In contrast to normal skin, keratinocytes of basal and suprabasal layers showed nuclear staining in cholesteatoma epithelium. The extent of nuclear staining of epithelial cells in the cholesteatomas studied was significantly increased. Concurrent cytoplasmic staining was observed in both skin and cholesteatoma, but with a stronger reactivity in the latter. These findings suggest participation of the c-myc oncogene in cholesteatoma epithelium.
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Affiliation(s)
- A Holly
- Department of Otorhinolaryngology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany
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Schilling V, Holly A, Bujía J, Schulz P, Kastenbauer E. High levels of fibronectin in the stroma of aural cholesteatoma. Am J Otolaryngol 1995; 16:232-5. [PMID: 7573742 DOI: 10.1016/0196-0709(95)90148-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
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.
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Affiliation(s)
- V Schilling
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University, Munich, Germany
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Lee RJ, Sidey C, Narula AA, James RF. The nature of the epithelium in acquired cholesteatoma: Part 3--Cytokeratin patterns in aural epithelial and cholesteatoma cells grown in cell culture. Clin Otolaryngol 1994; 19:516-20. [PMID: 7534665 DOI: 10.1111/j.1365-2273.1994.tb01280.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The nature and origin of the epithelial layers in acquired cholesteatoma is still unclear. Although previous morphological studies comparing external meatal and cholesteatoma epithelium have shown no significant difference, bone resorption is generally much more severe with cholesteatoma than with chronic otitis media without cholesteatoma. It is possible that cholesteatoma epithelium has undergone transformation leading to its enhanced bone destroying role. In this study the cytokeratin patterns of aural and cholesteatoma epithelia grown in cell culture were compared using monoclonal antibodies. No significant difference in staining patterns were found suggesting that there has been no change in cell phenotype which maintains that of external auditory meatus epithelium. This study therefore supports the immigration theory of cholesteatoma genesis.
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Affiliation(s)
- R J Lee
- Department of Otolaryngology, Kettering General Hospital, UK
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Sittinger M, Bujia J, Burmester GR. Inexpensive computer analysis of cell and tissue stainings. In Vitro Cell Dev Biol Anim 1994; 30A:559-61. [PMID: 7529624 DOI: 10.1007/bf02631252] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Kojima H, Shiwa M, Kamide Y, Moriyama H. Expression and localization of mRNA for epidermal growth factor and epidermal growth factor receptor in human cholesteatoma. Acta Otolaryngol 1994; 114:423-9. [PMID: 7976315 DOI: 10.3109/00016489409126081] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The roles of epidermal growth factor (EGF) and epidermal growth factor receptor (EGF-R) in the proliferation and progression of the epithelium of middle ear cholesteatoma were studied. An attempt was made to elucidate the site and degree of localization of the EGF mRNA and EGF-R mRNA in the epithelium of the cholesteatoma by means of the non-radioactive in situ hybridization method. Ten cholesteatoma specimens excised during operations and six normal skin specimens (control) collected from the external ear canal were used in this study. The signal of the EGF mRNA was slightly expressed in part of the basal cells in only one of the six control specimens, while the signal was strongly expressed along the basal cells of the cholesteatoma epithelium in five of the ten specimens. The signal of the EGF-R mRNA was observed along the basal cell layer in five of the six control specimens, while the signal was strongly expressed in all layers of the cholesteatoma epithelium in all ten specimens. The expression was especially marked in the basal cell layer. These findings suggest the possibilities that abnormal expression of the EGF-R mRNA in nearly entire epithelial layers of cholesteatoma is due to overexpression of EGF-R gene, and that there is a mechanism of epithelial basal cell proliferation through an autocrine regulatory system via EGF and EGF-R.
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Affiliation(s)
- H Kojima
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
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Dallari S, Cavani A, Bergamini G, Girolomoni G. Integrin expression in middle ear cholesteatoma. Acta Otolaryngol 1994; 114:188-92. [PMID: 7515549 DOI: 10.3109/00016489409126040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cholesteatoma is lined by a squamous keratinizing epithelium exhibiting most of the features of normal epidermis. In this study, we investigated by immunohistochemistry the expression of integrin adhesion molecules in primary acquired and recurrent cholesteatomas, and compared it with common epidermal cysts and normal human skin. The results showed that cholesteatoma epithelium exhibited a markedly augmented expression of alpha v integrin subunit and a corresponding increased deposition of vitronectin (alpha v ligand) in the surrounding stroma as compared to epidermal cyst and normal human skin. In contrast, the expression pattern of alpha 2 beta 1, alpha 3 beta 1, and alpha 6 beta 4 integrins as well as the distribution of laminin, collagen IV and fibronectin were similar in cholesteatomas, epidermal cysts and normal human skin. Similar staining pattern was observed in primary acquired and recurrent cholesteatoma.
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Affiliation(s)
- S Dallari
- Department of Otorhinolaryngology, University of Modena, Italy
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