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BACKGROUND The aim of this study was to compare the differential Ki-67 and p27 staining properties of acquired cholesteatoma in adult patients for prognostic analysis. METHODS Forty-two adult patients with acquired cholesteatoma were enrolled. The cholesteatoma and matched meatal skin tissues of the patients were immunostained with Ki-67 and p27 antibodies. Canal wall down mastoidectomy was performed in all patients. The differential staining properties--positive staining in the cholesteatoma and negative staining in the skin tissue (C+S-), negative staining in the cholesteatoma and positive staining in the skin tissue(C-S+)--were compared for bone erosion scores (BES), stage, and recurrence rates. RESULTS Isolated findings in the cholesteatoma tissues, without matching with the skin tissues, demonstrated that stage and recurrence rates were not related to findings in the cholesteatoma tissues (P > .05). However, C+S- for Ki-67 and C-S+ for p27 are risk factors for worse prognosis including advanced stage (P < .001 for Ki-67 and P = .008 for p27), BES values (P < .001 for Ki-67 and P = .001 for p27), and recurrence rates (P < .001 for Ki-67 and P = .037 for p27). CONCLUSION This is the first paper assessing the cholesteatoma prognosis according to the differential Ki-67 and p27 staining properties of cholesteatoma and healthy skin tissues. Cellular proliferation rate in the cholesteatoma is important but insufficient by itself for predicting the prognosis of cholesteatoma patients. Patients having lower basal levels of cellular proliferation rate and higher cellular activity in the cholesteatoma tissue are prone to worse prognosis with increased stage, recurrence rates, and degree of bone erosion.

Bu yazıda, çocukluk çağında literatürdesıklıkla bildirilmeyen, rekürren romatizmal kardit ve buna ikincil sol atriyaldilatasyona bağlı Ortner sendromu gelişen hasta sunuldu. Sydenham koresi tanısıolan ve penisilin profilaksisini kullanmayan 15 yaşındaki kız çocuğutekrarlayan romatizmal kardit atağı ile başvurdu. Hasta yatırıldı ve oralsteroid tedavisi ile intramüsküler benzatin profilaksisi başladı. Ayrıcahastanın yatışı sonrası başlayan ses kısıklığı, sıvı gıda alımı sonrası öksürükve hematez yakınmaları vardı. Yapılan laringoskopik muayenede sol vokal kordparalizisi saptandı. Hastaya vokal kord enjeksiyonu yapıldı ve sıvı alımısonrası öksürüğü geriledi, ancak ses kısıklığı devam etti. Sol atriyal basıncıazaltmak ve kalıcı laringeal sinir hasarı gelişimini önlemek için mitral veaort kapak replasmanı yapıldı. Ortner sendromu nadir görülebilmesine rağmen,ses kısıklığı nedeniyle başvuran çocuklarda da akılda tutulmalıdır., In this report, the patient who developedOrtner syndrome secondary to recurrent rheumatic carditis and left atrialdilatation was presented which was not commonly reported in the literature inchildhood. A 15-year-old girl with Sydenham’s chorea who did not use penicillinprophylaxis was presented with recurrent rheumatic carditis attack. She washospitalized and oral steroid therapy and intramuscular benzathine prophylaxiswas initiated immediately. She also had the complaints of hoarseness, coughafter liquid, and hematemesis after the hospitalization. In the laryngoscopicexamination left vocal cord paralysis was detected. Vocal cord injection wasperformed and her cough after liquid intake regressed, but hoarseness did not.Mitral and aortic valve replacement was performed in order to decrease leftatrial pressure and to prevent the development of permanent laryngeal nervedamage. Ortner syndromealthough seen rarely should be kept in mind also in children who have beenadmitted because of hoarseness.

Carcinoma ex pleomorphic adenoma (CEPA) is the malignant salivary gland tumor originating from primary (de novo) or recurrent pleomorphic adenoma. Although parotid gland is the most common site, it can also be seen in submandibular gland or minor salivary glands. It can be seen rarely in head and neck region, such as oral cavity, trachea, nasal cavity and lacrimal gland. Although pleomorphic adenoma cases originating from ectopic salivary gland tissue in the neck region are present in the English literature, there is no published pleomorphic adenoma ex carcinoma case. In this case report we presented a CEPA as a 7.5 cm long neck mass in a 72-year-old woman originating from the submandibular region apart from submandibular gland. Difficulties in diagnosis and way to appropriate treatment are discussed with current literature.