Confirmation of mucin in lymphatic vessels of acquired cholesteatoma

Abundant inflammatory cells infiltrate in the advancing front of the cholesteatoma perimatrix towards the middle ear mucosa. However, the cause of inflammation is not yet clear. The middle ear mucosa is often embedded in the cholesteatoma perimatrix. We hypothesized that the embedded mucosa is the cause of inflammation. Surgical specimens obtained from 20 cases of acquired cholesteatoma were used for the study. Lymphatic vessels were stained by the immunohistochemical method using the antibody against podoplanin. Mucin was simultaneously stained by alcian blue. The results of our examination were the following: (1) the presence of infiltrating mucin in the perimatrix; (2) the degeneration and reduction of lymphatic vessels; (3) the accumulation of inflammatory cells around morbid lymphatic vessels. Based on our findings, cholesteatoma can be defined as an inflammation affected by infiltrating mucin that escaped from embedded mucosa in the perimatrix.