Otomastoid cholesteatoma in children: histopathological findings.

Clinical experience has shown that the otomastoid cholesteatoma is more aggressive and has a less favourable prognosis in the child than in the adult. In an attempt to verify whether, in children, the clinical behaviour of the cholesteatoma depends on the histomorphological characteristics of the perimatrix, we carried out a study of samples taken from 30 subjects under 16 years of age and from 30 adults (control group) during surgery for otomastoid cholesteatoma. The study took into account the number of plasmacytes, lymphocytes, macrophages, granulocytes and giant cells per high potency field (X 630). The results showed that in young subjects the perimatrix of the cholesteatoma is richer in mononuclear inflammatory elements with evidence of enzyme-collagenase activity. On the basis of this behaviour the authors conclude that the histomorphological characteristics of the surrounding matrix can play an important role in the pathogenesis of cholesteatoma and may explain the clinical differences that can be seen between cholesteatoma in children and in adults.