Problem Cholesteatoma is characterized by the presence of a squamous epithelium invading the middle ear altering its growth properties. This epithelium believed to have hyperproliferative properties. Inflammatory stimulation of the underlying connective tissue, as well as an autocrine mechanism, may be responsible for the dysregulation and abnormal proliferative feature of the keratinocytes in cholesteatoma. Methods Comparative investigations were performed to assess the epithelial cell kinetics of cholesteatoma and auditory meatal skin. Monoclonal antibody PCNA and Ki‐67 immunohistochemical staining were applied. Results Specimens of cholesteatoma samples (n=30) showed an average PCNA score of 26.6% and an average Ki‐67 score of 15.9%. Auditory meatal skin(n=8) revealed an average PCNA score of 8.2% and average Ki‐67 score of 4.9%. The results of this study confirm a highly increase in the proliferation rate of cholesteatoma keratinocytes, which had an PCNA score that was 3.24 times higher than the score for keratinocyte of auditory meatal skin and Ki‐67 score of cholesteatoma was 3.24 times higher than auditory meatal skin. Conclusion We conclude that cholesteatoma is a hyperproliferative activity and that PCNA and Ki‐67 immunohistochemical staining are valuable tool for assessing cell kinetics in cholesteatoma. Significance The cholesteatoma possesses a variable degree of proliferative activities depending on its histologic composition. The formation and accumulation of the keratin due to the continuous epithelial growth probably are important elements in inducing the inflammation.
A fungus ball is an extramucosal fungal proliferation that completely fills one or more paranasal sinuses and usually occurs as a unilateral infection. It is mainly caused by Aspergillus spp in an immunocompetent host, but some cases of paranasal fungal balls reportedly have been caused by Mucor spp. A Mucor fungus ball is usually found in the maxillary sinus and/or the sphenoid sinus and may be black in color. Patients with mucormycosis, or a Mucor fungal ball infection, usually present with facial pain or headache. On computed tomography, there are no pathognomonic findings that are conclusive for a diagnosis of mucormycosis. In this article we report a case of mucormycosis in a 56-year-old woman and provide a comprehensive review of the literature on the "Mucor fungus ball." To the best of our knowledge, 5 case reports (8 patients) have been published in which the fungus ball was thought to be caused by Mucor spp.
Schwannoma, also referred to as neurilemmoma, is an encapsulated benign soft tissue tumor arising from the schwann cells of the nerve sheath. Although 25 to 45% of schwannomas arise in the head and neck region, pterygopalatine fossa is the rarest sites of involvement with only 23 cases reported in the medical literature. It is usually seen in the second and fifth decades, but sex or racial predilection has not been noted. Clinical features of this tumor are dependent on the involved anatomical site, nerve of origin, and compression of adjacent structures. The differential diagnosis of masses in pterygopalatine fossa includes angiofibroma, fibrous histiocytoma, malignant melanoma, lymphoma, and low-grade rhabdomyosarcoma. The treatment of choice is that the tumor is completely removed with careful preservation of its nerve. Recently, the authors experienced a case of schwannoma arising in pterygopalatine fossa, which was removed with transantral approach. Hence, we report a rare case with a review of literature. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:552-5)
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