Role of Langerhans cells, Ki-67 protein and apoptosis in acquired cholesteatoma: prospective clinical study

Objective: To investigate the role of Langerhans cells in the pathogenesis and clinical picture of middle-ear cholesteatoma. Subjects and methods: The study included 40 patients operated upon for a diagnosis of chronic otitis due to acquired cholesteatoma. Results and analysis: A closed surgical technique was used in 20 per cent of patients and an open technique in 80 per cent. Langerhans cells were more densely accumulated in cholesteatoma epithelium, compared with external ear canal skin (p < 0.001). Staining for Ki-67 protein was greater in cholesteatoma epithelium (p < 0.001) and Apo2.7 protein staining (indicating apoptosis) was more prominent (p < 0.001), compared with ear canal skin. Regarding significant relationships between clinical and pathological findings, staining for Ki-67 (p = 0.046) and Apo2.7 (p = 0.037) was more prominent in patients undergoing open versus closed surgery. Conclusion: Using cell proliferation and apoptosis markers, a dense Langerhans cell infiltration was found to occur as a host response to middle-ear cholesteatoma.