Morphologic and immunohistochemical observation of otosclerotic stapes: a preliminary study.

Stapes with otosclerotic lesions obtained during stapedectomies were examined with light microscopy, histochemistry, immunochemistry, and electron microscopy to elucidate the cellular mechanism(s) involved in this disease process. Three types of lesions were identified: cellular (spongiotic), fibrotic, and sclerotic. The cellular type is characterized by monocyte, macrophage, osteoblast, and osteoclast recruitment and their activation. Macrophage recruitment is an early event of otosclerosis. The fibrotic type is characterized by extensive fibrosis of the bone, and the sclerotic type is characterized by a paucity of bone cells. Cytochemical results showed a large accumulation of granular substances positive for periodic acid-Schiff stain along the edge of the marrow spaces coinciding with ultrastructural calcospherite deposits, suggesting that glycosaminoglycans are involved in the mineralization process. Acid phosphatase is largely localized in the osteoclasts, but a sporadic diffusion of this enzyme was observed in the demineralizing front of the preotosclerotic lesion. Immunoglobulin G and complement C3 were colocalized in pericapillary tissue, suggesting deposit of immune complex in the spongiotic lesion. This finding indicates a possibility that immune mechanisms are involved in otosclerosis.