Middle Ear cholesteatoma invading intracranially with fatal out come

Abstract

A 49-year-old man who underwent a left surgery for otitis media 30 years ago. He had also undergone surgery for left middle ear cholesteatoma in another hospital.
After the surgery, he had left purulent-bloody aural discharge, and received the third operation for partial removement of cholesteatoma in our hospital. Tympanic cavity and mastoid were filled with cholesteatoma, which adhered to the posterior cranial dura and the sigmoid sinus tightly and moreover invaded the temporal bone toward the jugular foramen and carotid canal. Therefore cholesteatoma was not completely removed.
After surgical treatment, the patient was followed up regularly with CT and MRI of the skullbase including the internal and middle ear, however cholesteatoma accelerated to grow into the brain stem with bone destruction, and the patient died.
This drastic course gave us a doubt of malignant change of squamous epithelium, though histopathologic examinations of all specimens showed stratified squamous epithelium and granulation tissue.