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Specimens from
the middle ear are less often received than those from the external
ear.
Those more
commonly received include tissues with inflammatory conditions,
cholesteatoma,
small specimens from ossicles, larger specimens from the mastoid air
cells and other rarer specimens such as "petrosectomies".
Visit:
Normal
Anatomy of the Ear
;
Aural Biopsy: Clinical details required for the
diagnosis
;
Histopathological examination of Aural Biopsy - External Ear
;
Histopathological examination of Aural Biopsy- Inner Ear.
Histopathology report:
Specimens
taken for the diagnosis and treatment of chronic inflammatory
conditions :
The report should comment on whether there is:
- Mucosal
inflammation: acute, chronic, nonspecific, granulomatous, eosinophilic
;
- Involvement of : ossicles; middle
ear glands; bony septa of mastoid air cells ;
-Presence of : i) cholesterol granulomas ; ii)
fibrosis;
iii)
tympanosclerosis;
- Stratified
squamous epithelium with keratin in cholesteatoma.
Specimens
of aural polyp:
The report should comment on :
-The type of
covering epithelium: columnar, ciliated, or stratified squamous
;
-Inflammation:
type and severity ; associated granulation tissue ;
-The presence of
middle ear glands.
-Foreign body
giant cell reaction to: keratin squames which suggests
cholesteatoma ; hair shafts ; starch granules.
Stapedectomy specimens for otosclerosis:
The stapes has a
footplate that articulates with the temporal bone at the oval window,
a head that articulates with the incus, and two crura which link the
two.
All of the stapes
may be excised, or occasionally the footplate may be left behind.
Otosclerotic bone
is seen only in the footplate near the anterior or posterior crus, and
so may not be evident when only the head and crura of the stapes are
removed.
In some cases,
the otosclerotic process affects only the temporal bone and the oval
window, and the entire stapedectomy will then show no significant
pathological abnormality.
The report should comment on:
- presence and
integrity of the footplate and arch of the stapes ;
-
Otosclerosis
;
- inflammation
of mucosa included with the specimen ;
- intensity of
the inflammatory cell infiltrate ;
- vascularity
of the bone , mucosa and other tissues.
Specimens
for the diagnosis and treatment of neoplasia:
The report should comment on :
- the type and
differentiation of the tumour:
1.
Middle Ear Adenoma
(with or without neuroendocrine differentiation);
2.
Squamous Cell Carcinoma;
3.
Adenocarcinoma
;
4.
Paraganglioma
;
5.
Meningioma
;
- whether the
ossicles are involved by tumour ;
- the presence
of middle ear glands, middle ear cuboidal epithelium, tympanic
membrane tissue.
‘Petrosectomy’ specimens for
carcinoma:
This is never
an excision specimen of petrous bone, but consists of
external and middle ear tissues.
The report should
list the tissues present
- such as external ear structures, ossicles and tympanic
membrane.
In addition the
report should comment on:
- the type of
neoplasia ;
- the tissues
involved by the neoplasm ;
- the sites of
origin of tumour, such as external canal, tympanic membrane, middle
ear epithelium ;
- the
proximity of the tumour to excision margins.
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