{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T16:14:07Z","timestamp":1771258447125,"version":"3.50.1"},"reference-count":33,"publisher":"Societatea Romana de Morfologie","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rom J Morphol Embryol"],"published-print":{"date-parts":[[2025,2,20]]},"abstract":"<jats:p>Cholesteatoma is an otologic pathology that can occur at any age and can lead to a variety of complications including facial palsy, intracranial abscess, hearing loss, venous thrombosis. Cholesteatoma, even if considered a benign condition, associates high risks of recurrency due to its invasiveness. We describe a case of recurrent cholesteatoma in a young boy who presented chronic ear discharge and hearing loss for which had undergone three surgical interventions between the ages of 16 and 19 years old, from 2019 to 2022. Pediatric cholesteatoma is more prone to recurrency. Considering surgical excision as the only treatment at the current moment, it is highly important to understand the biology of cholesteatoma lesional extension for further treatment management improvement. Good research of angiogenesis, chronic inflammation and immune infiltration correlated with surgical approach may be the future for preventing cholesteatoma recurrency.<\/jats:p>","DOI":"10.47162\/rjme.65.4.24","type":"journal-article","created":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T10:37:15Z","timestamp":1740652635000},"page":"775-780","source":"Crossref","is-referenced-by-count":1,"title":["Biology of recurrent cholesteatoma in a Romanian young patient \u2013 a case report"],"prefix":"10.47162","volume":"65","author":[{"name":"PhD Student, Doctoral School, University of Medicine and Pharmacy of Craiova, Romania","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramona Andreea","family":"Bologa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florin","family":"Anghelina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Otorhinolaryngology, University of Medicine and Pharmacy of Craiova, Romania","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihaela Roxana","family":"Mitroi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Otorhinolaryngology, University of Medicine and Pharmacy of Craiova, Romania","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mircea Sorin","family":"Ciolofan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Otorhinolaryngology, University of Medicine and Pharmacy of Craiova, Romania","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen Aurelia","family":"Mogoant\u0103","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Otorhinolaryngology, University of Medicine and Pharmacy of Craiova, Romania","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alina Nicoleta","family":"C\u0103pit\u0103nescu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Otorhinolaryngology, University of Medicine and Pharmacy of Craiova, Romania","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandru Florian","family":"Grecu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Orthopedics and Traumatology, University of Medicine and Pharmacy of Craiova, Romania","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liliana","family":"Anghelina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Pediatrics, University of Medicine and Pharmacy of Craiova, Romania","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihai-Marius","family":"Botezat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Neurology, University of Medicine and Pharmacy of Craiova, Romania","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"26736","published-online":{"date-parts":[[2025,2,13]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"\"[1] Yung M, Tono T, Olszewska E, Yamamoto Y, Sudhoff H, Sakagami M, Mulder J, Kojima H, \u0130ncesulu A, Trabalzini F, \u00d6zgirgin N. EAONO\/JOS Joint Consensus Statements on the definitions, classification and staging of middle ear cholesteatoma. J Int Adv Otol, 2017, 13(1):1-8. https:\/\/doi.org\/10.5152\/iao.2017.3363","DOI":"10.5152\/iao.2017.3363"},{"key":"ref1","unstructured":"[2] Maniu A, Harabagiu O, Perde Schrepler M, C\u0103tan\u0103 A, F\u0103nu\u0163\u0103 B, Mogoant\u0103 CA. Molecular biology of cholesteatoma. Rom J Morphol Embryol, 2014, 55(1):7-13."},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"[3] Cantone E, Di Nola C, De Corso E, Cavaliere M, Grimaldi G, Fetoni AR, Motta G. Endotyping of cholesteatoma: which molecular biomarkers? A systematic review. J Pers Med, 2022, 12(8):1347. https:\/\/doi.org\/10.3390\/jpm12081347","DOI":"10.3390\/jpm12081347"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"[4] Louw L. Acquired cholesteatoma: summary of the cascade of molecular events. J Laryngol Otol, 2013, 127(6):542-549. https:\/\/doi.org\/10.1017\/S0022215113000601","DOI":"10.1017\/S0022215113000601"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"[5] Hussein MRA, Sayed RH, Abu-Dief EE. Immune cell profile in invasive cholesteatomas: preliminary findings. Exp Mol Pathol, 2010, 88(2):316-323. https:\/\/doi.org\/10.1016\/j.yexmp.2009.12.006","DOI":"10.1016\/j.yexmp.2009.12.006"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"[6] Louw L. Acquired cholesteatoma pathogenesis: stepwise explanations. J Laryngol Otol, 2010, 124(6):587-593. https:\/\/doi.org\/10.1017\/S0022215109992763","DOI":"10.1017\/S0022215109992763"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"[7] Vangrinsven G, Bernaerts A, Deckers F, van Dinther J, Zarowski A, De Foer B. Beyond the otoscope: an imaging review of congenital cholesteatoma. Insights Imaging, 2024, 15(1):194. https:\/\/doi.org\/10.1186\/s13244-024-01761-1","DOI":"10.1186\/s13244-024-01761-1"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"[8] Tos M. A new pathogenesis of mesotympanic (congenital) cholesteatoma. Laryngoscope, 2000, 110(11):1890-1897. https:\/\/doi.org\/10.1097\/00005537-200011000-00023","DOI":"10.1097\/00005537-200011000-00023"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"[9] Aquino JEAP, Cruz Filho NA, Aquino JNP. Epidemiology of middle ear and mastoid cholesteatomas: study of 1146 cases. Braz J Otorhinolaryngol, 2011, 77(3):341-347. https:\/\/doi.org\/10.1590\/s1808-86942011000300012","DOI":"10.1590\/S1808-86942011000300012"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"[10] Olszewska E, Wagner M, Bernal-Sprekelsen M, Ebmeyer J, Dazert S, Hildmann H, Sudhoff H. Etiopathogenesis of cholesteatoma. Eur Arch Otorhinolaryngol, 2004, 261(1):6-24. https:\/\/doi.org\/10.1007\/s00405-003-0623-x","DOI":"10.1007\/s00405-003-0623-x"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"[11] Nelson M, Roger G, Koltai PJ, Garabedian EN, Triglia JM, Roman S, Castellon RJ, Hammel JP. Congenital cholesteatoma: classification, management, and outcome. Arch Otolaryngol Head Neck Surg, 2002, 128(7):810-814. https:\/\/doi.org\/10.1001\/archotol.128.7.810","DOI":"10.1001\/archotol.128.7.810"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"[12] \u00d6zdemir \u00c7, Kuzu S, \u015eenol Y, Yi\u011fit T, G\u00fcld\u00fcn E, Bucak A, Ulu \u015e, Tokyol \u00c7. A role for mast cell-mediated antibodies in the formation of cholesteatoma and cholesteatoma-induced bone erosion. Diagnostics (Basel), 2023, 13(3):455. https:\/\/doi.org\/10.3390\/diagnostics13030455","DOI":"10.3390\/diagnostics13030455"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"[13] Jin BJ, Min HJ, Jeong JH, Park CW, Lee SH. Expression of EGFR and microvessel density in middle ear cholesteatoma. Clin Exp Otorhinolaryngol, 2011, 4(2):67-71. https:\/\/doi.org\/10.3342\/ceo.2011.4.2.67","DOI":"10.3342\/ceo.2011.4.2.67"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"[14] Landskron G, De la Fuente M, Thuwajit P, Thuwajit C, Hermoso MA. Chronic inflammation and cytokines in the tumor microenvironment. J Immunol Res, 2014, 2014:149185. https:\/\/doi.org\/10.1155\/2014\/149185","DOI":"10.1155\/2014\/149185"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"[15] Olszewska E, Lautermann J, Koc C, Schwaab M, Dazert S, Hildmann H, Sudhoff H. Cytokeratin expression pattern in congenital and acquired pediatric cholesteatoma. Eur Arch Otorhinolaryngol, 2005, 262(9):731-736. https:\/\/doi.org\/10.1007\/s00405-004-0875-0","DOI":"10.1007\/s00405-004-0875-0"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"[16] Amendola M, Sacco R, Sammarco G, Donato G, Montemurro S, Ruggieri E, Patruno R, Marech I, Cariello M, Vacca A, Gadaleta CD, Ranieri G. Correlation between serum tryptase, mast cells positive to tryptase and microvascular density in colorectal cancer patients: possible biological-clinical significance. PLoS One, 2014, 9(6):e99512. https:\/\/doi.org\/10.1371\/journal.pone.0099512","DOI":"10.1371\/journal.pone.0099512"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"[17] Artuc M, Steckelings UM, Henz BM. Mast cell-fibroblast interactions: human mast cells as source and inducers of fibroblast and epithelial growth factors. J Invest Dermatol, 2002, 118(3):391-395. https:\/\/doi.org\/10.1046\/j.0022-202x.2001.01705.x","DOI":"10.1046\/j.0022-202x.2001.01705.x"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"[18] Sch\u00fcrmann M, Goon P, Sudhoff H. Review of potential medical treatments for middle ear cholesteatoma. Cell Commun Signal, 2022, 20(1):148. https:\/\/doi.org\/10.1186\/s12964-022-00953-w","DOI":"10.1186\/s12964-022-00953-w"},{"key":"ref18","unstructured":"[19] Albino AP, Reed JA, Bogdany JK, Sassoon J, Parisier SC. Increased numbers of mast cells in human middle ear cholesteatomas: implications for treatment. Am J Otol, 1998, 19(3):266-272."},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"[20] Hamzei M, Ventriglia G, Hagnia M, Antonopolous A, Bernal-Sprekelsen M, Dazert S, Hildmann H, Sudhoff H. Osteoclast stimulating and differentiating factors in human cholesteatoma. Laryngoscope, 2003, 113(3):436-442. https:\/\/doi.org\/10.1097\/00005537-200303000-00009","DOI":"10.1097\/00005537-200303000-00009"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"[21] Hamed MA, Nakata S, Sayed RH, Ueda H, Badawy BS, Nishimura Y, Kojima T, Iwata N, Ahmed AR, Dahy K, Kondo N, Suzuki K. Pathogenesis and bone resorption in acquired cholesteatoma: current knowledge and future prospectives. Clin Exp Otorhinolaryngol, 2016, 9(4):298-308. https:\/\/doi.org\/10.21053\/ceo.2015.01662","DOI":"10.21053\/ceo.2015.01662"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"[22] Iwamoto Y, Nishikawa K, Imai R, Furuya M, Uenaka M, Ohta Y, Morihana T, Itoi-Ochi S, Penninger JM, Katayama I, Inohara H, Ishii M. Intercellular communication between keratinocytes and fibroblasts induces local osteoclast differentiation: a mechanism underlying cholesteatoma-induced bone destruction. Mol Cell Biol, 2016, 36(11):1610-1620. https:\/\/doi.org\/10.1128\/MCB.01028-15","DOI":"10.1128\/MCB.01028-15"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"[23] Peek FAW, Huisman MA, Berckmans RJ, Sturk A, Van Loon J, Grote JJ. Lipopolysaccharide concentration and bone resorption in cholesteatoma. Otol Neurotol, 2003, 24(5):709-713. https:\/\/doi.org\/10.1097\/00129492-200309000-00002","DOI":"10.1097\/00129492-200309000-00002"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"[24] Y\u0131ld\u0131z E, Kuzu S, G\u00fcnebakan \u00c7, Balc\u0131 A. A new biomarker in differentiation of mucosal chronic otitis media from squamous chronic otitis media: the systemic immune-inflammation index (SII). Indian J Otolaryngol Head Neck Surg, 2022, 74(4):476-482. https:\/\/doi.org\/10.1007\/s12070-021-02857-6","DOI":"10.1007\/s12070-021-02857-6"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"[25] Kim DH, Oh JH, Kim J, Cho CH, Lee JH. Predictive values of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and other prognostic factors in pediatric patients with bell's palsy. Ear Nose Throat J, 2021, 100(10):720-725. https:\/\/doi.org\/10.1177\/0145561320922097","DOI":"10.1177\/0145561320922097"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"[26] Elbistanli MS, Ko\u00e7ak HE, Acipayam H, Yi\u011fider AP, Keskin M, Kayhan FT. The predictive value of neutrophil-lymphocyte and platelet-lymphocyte ratio for the effusion viscosity in otitis media with chronic effusion. J Craniofac Surg, 2017, 28(3):e244-e247. https:\/\/doi.org\/10.1097\/SCS.0000000000003452","DOI":"10.1097\/SCS.0000000000003452"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"[27] Tansuker HD, Ero\u011flu S, Yenig\u00fcn A, Ta\u015fkin \u00dc, Oktay MF. Can serum neutrophil-to-lymphocyte ratio be a predictive biomarker to help differentiate active chronic otitis media from inactive chronic otitis media? J Craniofac Surg, 2017, 28(3):e260-e263. https:\/\/doi.org\/10.1097\/SCS.0000000000003484","DOI":"10.1097\/SCS.0000000000003484"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"[28] Olszewska E, Chodynicki S, Chyczewski L. Apoptosis in the pathogenesis of cholesteatoma in adults. Eur Arch Otorhinolaryngol, 2006, 263(5):409-413. https:\/\/doi.org\/10.1007\/s00405-005-1026-y","DOI":"10.1007\/s00405-005-1026-y"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"[29] Madana J, Yolmo D, Kalaiarasi R, Gopalakrishnan S, Sujatha S. Microbiological profile with antibiotic sensitivity pattern of cholesteatomatous chronic suppurative otitis media among children. Int J Pediatr Otorhinolaryngol, 2011, 75(9):1104-1108. https:\/\/doi.org\/10.1016\/j.ijporl.2011.05.025","DOI":"10.1016\/j.ijporl.2011.05.025"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"[30] Mustafa A, Heta A, Kastrati B, Dreshaj Sh. Complications of chronic otitis media with cholesteatoma during a 10-year period in Kosovo. Eur Arch Otorhinolaryngol, 2008, 265(12):1477-1482. https:\/\/doi.org\/10.1007\/s00405-008-0707-8","DOI":"10.1007\/s00405-008-0707-8"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"[31] Hafidh MA, Keogh I, Walsh RM, Walsh M, Rawluk D. Otogenic intracranial complications. A 7-year retrospective review. Am J Otolaryngol, 2006, 27(6):390-395. https:\/\/doi.org\/10.1016\/j.amjoto.2006.03.004","DOI":"10.1016\/j.amjoto.2006.03.004"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"[32] Getaneh A, Ayalew G, Belete D, Jemal M, Biset S. Bacterial etiologies of ear infection and their antimicrobial susceptibility pattern at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia: a six-year retrospective study. Infect Drug Resist, 2021, 14:4313-4322. https:\/\/doi.org\/10.2147\/IDR.S332348","DOI":"10.2147\/IDR.S332348"},{"key":"ref32","unstructured":"[33] Goan\u0163\u0103 CM, Cirpaciu D, Tusaliu M, Georgescu M, Di\u0163u LM, Budu VA. Probiotics as a therapeutic option to reduce the duration of upper respiratory tract infections in children. 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