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Paul P. C. A. Vennix, MD; Wim Kuijpers, PhD; Theo A. Peters; Edith L. G. M. Tonnaer, MA; Frans C. S. Ramaekers, PhD

Arch Otolaryngol Head Neck Surg. 1996;122(8):825-832.

Abstract
Objective
To evaluate the type of differentiation of keratinocytes of acquired cholesteatoma and its significance for cholesteatoma invasiveness.

Design
Forty acquired cholesteatomas and 10 tympanic membranes with persisting perforations were snap frozen and processed for immunohistochemical studies. Cytokeratin antibodies that represented all subgroups and antibodies that were directed against collagen components of the basal lamina were applied. Expression of these constituents was scored by using light microscopy.

Results
The phenotype of the matrix was generally characterized by an extension of expression of basal cell cytokeratin 14 and hyperproliferation-associated cytokeratins 6, 16, and 17 into the suprabasal cell layers, while the expression of keratinization marker cytokeratin 10 was down-regulated. These features varied greatly at different sites of the matrix and were most marked at the advancing front of the cholesteatoma. A comparable expression pattern, but less pronounced, was observed at the epidermal front of the mucocutaneous junction of the tympanic membrane perforations. This phenomenon was invariably associated with a mononuclear cell infiltrate in the dermis at both junctions. The basal lamina was always intact.

Conclusions
Acquired cholesteatomas show hyperproliferative features. There is a striking similarity between the pronounced expression of this phenotype and the associated inflammation at the mucocutaneous junctions of cholesteatomas and tympanic membrane perforations and those that are observed after epidermal injury. This indicates that epidermis and middle ear epithelium do not form stable junctions and the front can be considered to be a persisting epidermal defect. This involves the permanent presence of "activated keratinocytes" in the junction area that will lead to proliferation and migration, when additional triggers are present.

Arch Otolaryngol Head Neck Surg. 1996;122:825-832

Author Affiliations
From the Departments of Otorhinolaryngology, Universities of Leiden (Dr Vennix) and Nijmegen (Dr Kuijpers, Mr Peters, and Ms Tonnaer), the Netherlands, and the Department of Molecular Cell Biology and Genetics, University of Limburg, Maastricht, the Netherlands (Dr Ramaekers). Dr Vennix died May 31, 1995.

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