This excisional biopsy
revealed a mass lined by moderately to severely hyperplastic
keratinizing stratified squamous epithelium
devoid of adnexal structures. There was marked thickening
of all layers of the epithelium, with a dense layer
of surface orthokeratosis. There was vacuolation and
dyskeratosis within the stratum spinosum (Figure 5).
A histopathologic diagnosis of cholesteatoma was
made. Decalcified sections from the bulla wall revealed
mild, multifocal, chronic myelofibrosis with mild,
locally extensive edema, which was interpreted as a
degenerative change associated with chronic otitis
media