A patient who underwent canal wall up mastoidectomy for cholesteatoma 2 years ago returns with recurrent ear discharge. High-resolution CT shows a small soft tissue density in the epitympanum. Second-look surgery reveals a 2 mm pearl of cholesteatoma. This is best classified as:

• A Congenital cholesteatoma
• B Recurrent cholesteatoma
• C Iatrogenic cholesteatoma
• D Residual cholesteatoma ✓

Explanation

Residual cholesteatoma is cholesteatoma that was left behind at the time of primary surgery and is detected on second-look surgery, typically within 1-2 years. Recurrent cholesteatoma arises de novo after complete removal, often due to a new retraction pocket. The finding at 2 years in a canal wall up procedure is most consistent with residual disease that was missed initially.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.