Bone erosion is considered a typical characteristic of advanced or complicated cholesteatoma (CHO), although it is still a matter of debate if bone erosion is due to osteoclast action, being the specific literature controversial. The purpose of this study was to apply a novel scanning characterization approach, the BSE 3D image analysis, to study the pathological erosion on the surface of human incus bone involved by CHO, in order to definitely assess the eventual osteoclastic resorptive action. To do this, a comparison of BSE 3D image of resorption lacunae (resorption pits) from osteoporotic human femur neck (indubitably of osteoclastic origin) with that of the incus was performed. Surface parameters (area, mean depth, and volume) were calculated by the software Hitachi MountainsMap© from BSE 3D-reconstructed images; results were then statistically analyzed by SPSS statistical software. Our findings showed that no significant differences exist between the two groups. This quantitative approach implements the morphological characterization, allowing us to state that surface erosion of the incus is due to osteoclast action. Moreover, our observation and processing image workflow are the first in the literature showing the presence not only of bone erosion but also of matrix vesicles releasing their content on collagen bundles and self-immuring osteocytes, all markers of new bone formation on incus bone surface. On the basis of recent literature, it has been hypothesized that inflammatory environment induced by CHO may trigger the osteoclast activity, eliciting bone erosion. The observed new bone formation probably takes place at a slower rate in respect to the normal bone turnover, and the process is uncoupled (as recently demonstrated for several inflammatory diseases that promote bone loss) thus resulting in an overall bone loss. Novel scanning characterization approaches used in this study allowed for the first time the 3D imaging of incus bone erosion and its quantitative measurement, opening a new era of quantitative SEM morphology.

中文翻译：

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受胆脂瘤影响的人类砧骨的 SEM BSE 3D 图像分析将骨质侵蚀归因于破骨细胞，VpSEM dEDX 分析揭示了新骨形成

骨侵蚀被认为是晚期或复杂性胆脂瘤（CHO）的典型特征，尽管骨侵蚀是否是由破骨细胞作用引起的仍然存在争议，具体文献存在争议。本研究的目的是应用一种新颖的扫描表征方法（BSE 3D 图像分析）来研究 CHO 涉及的人类砧骨表面的病理侵蚀，以便明确评估最终的破骨细胞再吸收作用。为此，我们对骨质疏松人类股骨颈（无疑是破骨细胞来源）吸收陷窝（吸收凹坑）的 BSE 3D 图像与砧骨的吸收凹坑进行了比较。表面参数（面积、平均深度和体积）由 Hitachi MountainsMap© 软件根据 BSE 3D 重建图像计算得出；然后通过SPSS统计软件对结果进行统计分析。我们的研究结果表明，两组之间不存在显着差异。这种定量方法实现了形态学表征，使我们能够指出砧骨的表面侵蚀是由于破骨细胞的作用所致。此外，我们的观察和处理图像工作流程是文献中首次显示不仅存在骨侵蚀，而且还存在基质囊泡释放其内容物在胶原束和自我免疫骨细胞上，所有这些都是砧骨表面新骨形成的标志。根据最近的文献，推测 CHO 诱导的炎症环境可能触发破骨细胞活性，引起骨侵蚀。观察到的新骨形成可能以比正常骨转换更慢的速度发生，并且该过程是解耦的（正如最近在几种促进骨质流失的炎症性疾病中所证明的那样），从而导致整体骨质流失。本研究中使用的新型扫描表征方法首次实现了砧骨侵蚀的 3D 成像及其定量测量，开启了定量 SEM 形态的新时代。