鼓室硬化患者中耳黏膜及硬化灶组织病理学特点

The Clinicopathologic and Electron-microccopic Characteristics of Patients with Tympanosclerosis

目的了解鼓室硬化患者中耳黏膜及硬化灶的组织病理学特点,以进一步了解鼓室硬化的发病机理。方法取68例鼓室硬化患者中耳不同位置的黏膜及硬化灶标本,分两组,一组68例予福尔马林固定,苏木精-伊红染色后于光镜下检查,另一组12例于电镜下观察。结果鼓室黏膜内大量肉芽组织增生并炎症细胞浸润,黏膜下层见纤维化;硬化灶内可见密集的玻璃样变性的胶原纤维束和大量散在分布的钙化区,在某些区域还可见无血管的肉芽组织。电镜下见纤维细胞不规则变形、伸长、退变,嗜锇细胞质含有小囊泡及大量大小不等胶原纤维束,核周的胞浆内有聚集线粒体,胞内的小体中见大量富含高密度电子的钙质沉着,为纤维细胞的变性线粒体或溶酶体。结论鼓室硬化患者中耳黏膜及硬化灶组织病理学表现为结缔组织纤维化、玻璃样变性、钙化。电镜下见胶原纤维显著增生,在纤维样变性的细胞内可见有富含电子的钙质沉着。

Objective The light and electron-microscopic examination was utilized to study the tissue from middle ears diagnosed as having tympanosclerosis.The main purpose of this article is to understand the clinicopathologic and electron-microscopic characteristics of 68 patients with tympanosclerosis.Methods The material for histopathologic and electron-microscopic studies were taken from the tympanic mucosa in various localities,especially from the whitish sclerotic masses in the tympanum of the patients with tympanosclerosis,during middle ear surgeries between 2006 and 2008.Specimens were divided into two groups： one group of 68 specimens was fixed and stained for light microscopic study with hematoxylin-eosin;the second group of 12 specimens was viewed in the electron microscope.Results The specimens from tympanic mucosa showed granulation tissue with infiltration of chronic inflammatory cells,and slight fibrosis in the submucosal layer.The histopathology of the plaques after haemaoxylin and eosin staining revealed dense bundles of collagen with hyaline degeneration and scattered areas of calcification.An ultrastructural examination of these specimens revealed fibrocytes that were irregularly shaped,elongated,and degenerating.The osmiophilic cytoplasm contained vesicles and collagen bundles.There were clusters of mitochondria in perinuclear cytoplasm and lots of electron dense calcareous deposits within lysosomes and degenerated mitochondria in fibrocyte cells.Conclusion The histopathologic examinations of tympanosclerosis revealed dense fibrous and collagenous connective tissues,poor in cell,with hyaline degeneration and occasional calcification in the tympanic mucosa.Electron-microscopic studies further revealed marked proliferation of collagen fibers and electron dense calcareous deposits within lysosomes and degenerated mitochondria in fibrocyte cells.