| Myospherulosis
of the middle ear -- a rare differential diagnosis of cholesteatoma.
Laryngorhinootologie.2004 Jul;83(7):445-9.
BACKGROUND:
Myospherulosis is a chronic-inflammatory lesion that is most
commonly iatrogenic of origin and occurs in tissues exposed to
petrolatum-based products. The disease does not exhibit
characteristic symptoms and is therefore not diagnosed in some
instances. In previous otorhinolaryngological studies,
myospherulosis was mainly found in paranasal sinuses, while only
four otitic cases have been reported. METHODS: A 48-year-old female
Egyptian patient suffered from bilateral chronic otitis media that
had been treated in Egypt by tympanoplasty. The patient presented
few months later at the university ENT department (Mainz) with
deteriorated otorrhea and otalgia. Clinical, otoscopical, and
radiological examination led to the diagnosis of cholesteatoma.
During revision surgery of the right side, ointment-like material
was found, which was embedded in granulation tissue. Middle ear
biopsies were taken from both sides and routinely processed for
standard histological examination and transmission electron
microscopy. RESULTS: Histological examination of the right middle
ear biopsy showed cystic tissue spaces lined by histiocytes and
foreign-body giant cells in a fibrous stroma. In the tissue spaces,
scattered debris and sac-like structures containing round spherules
of aggregated erythrocytes were found. In addition, erosion of
adjacent bone matrix was seen. Diagnosis of myospherulosis was made.
By contrast, histological evaluation of the left middle ear biopsy
revealed cholesterol granuloma. CONCLUSION: Myospherulosis of the
middle ear has been hitherto diagnosed in a very few otitic cases,
but might be overlooked as it mimicks other chronic proliferative
and inflammatory lesions such as cholesteatoma in the present case.
Thus myospherulosis should be considered in otitic cases with a
suspicious history (exposure to petrolatum-based products).
Furthermore, patients with myospherulosis have a significantly
higher likelihood of developing postoperative complications. Since
the lesion exhibits distinct histological findings, microscopy plays
a central role for the diagnosis of this important disease.
Spherulocytosis (myospherulosis)
of the paranasal sinuses. HNO.1995 Sep;43(9):552-5.
Spherulocytosis
(myospherulosis is a disease resulting from the physical emulsion
phenomenon between lipid-containing materials and blood. It can be
caused by the application of lipid-based ointments with or without
antibiotics to wounds. This "foreign-body" reaction
appears as a granulation tissue that will cause symptomatic when
developing under closed wounds or in such cavities as the middle ear
or paranasal sinuses. Poor healing after paranasal sinus surgery may
be due to spherulocytosis. This occurred in several cases managed at
the University Hospital in Kiel as the result of postoperative nasal
packs sensitizing sinus mucosa. These experiences led the authors to
conclude the nasal ointment packs should be avoided in paranasal
sinus surgery.
Myospherulosis in
the operated temporal bone.Eur Arch Otorhinolaryngol.1992;249(4):231-2.
Myospherulosis
is an unusual foreign-body reaction occurring in tissues exposed to
petrolatum-based products. Histopathologically this disorder is
characterized by the presence of large and small tissue spaces
containing amorphous debris and peculiar sac-like structures
enclosing numerous brown spherical bodies. A rare case of
myospherulosis of the middle ear and mastoid is presented and the
literature is reviewed.
Myospherulosis of the
mastoid antrum: a case report. Auris Nasus
Larynx.1990;16(4):199-207.
Myospherulosis
is a recently discovered iatrogenic disease caused by the
implantation during surgery of mineral oil- or petrolatum-based
products into various tissues. The condition results from the action
of lipid substances on extravasated erythrocytes. The case report
presented is the first detailed description of this uncommon, unique
inflammatory lesion occurring in the mastoid and is the second
otitic case reported in the literature. The lesion mimicked
recurrent cholesteatoma 6 years following an intact canal wall
mastoidectomy. As in myospherulosis of the paranasal sinuses, the
symptoms and findings of otitic myospherulosis are those of the
preceding disease.
Myospherulosis of
the paranasal sinuses, nose and middle ear. A possible iatrogenic
disease. Am J Clin Pathol.1977 Feb;67(2):118-30.
Sixteen
cases of myospherulosis, a disease of unknown etiology previously
reported only from East Africa, were found in the St. Louis
metropolitan area. Although the disease in Africa occurred in the
peripheral deep and superficial soft tissues, in St. Louis it
involved the paranasal sinuses, nose, and middle ear. All patients
had previously had surgical procedures involving the regions
subsequently shown to contain the structures of myospherulosis. A
common denominator in these cases was the operative use of
hemostatic packing containing petrolatum-based ointments and gauze.
These ointments, usually containing an antibiotic, were nonsterile.
This raised the possibility that the as yet unidentified structures
of myospherulosis may be introduced via these petrolatum-based
substances.
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