Lipoma Arising in the Eustachian Tube.

Lipomas are among the most common soft tissue tumors. Surgical removal of lipoma is considered if the patient has symptoms or cosmetic challenges. Lipomas that develop from any fat tissue in the body and involve the eustachian tube are extremely rare. Herein, we report the case of a patient with a lipoma arising in the eustachian tube. We also summarized the literature on tumors originating from the eustachian tubes. A 62-year-old female presented to our department with a five-year history of left nasal congestion. Nasal endoscopy revealed a tumor in the left eustachian tube. The tumor was considered a lipoma on computed tomography (CT) and magnetic resonance imaging (MRI) and was removed using a transnasal endoscopic approach. Nasal endoscopy and radiologic imaging can be used to detect tumors in the nasopharynx, including the eustachian tubes. Magnetic resonance imaging is particularly useful for the diagnosis of lipomas. A lipoma in the eustachian tube can cause nasal congestion and aural fullness, and the transnasal endoscopic approach is useful for tumor removal.

Recent changes in nasopharyngeal flora of children in Japan.

We investigated the relationship between nasopharyngeal flora of pediatric patients and antibiotic consumption in a local community in Japan between 2000 and 2009 retrospectively. There was a clear relationship between the lower annual consumption rate of cephalosporins and the lower annual prevalence of non-susceptible strains of Streptococcus pneumoniae (SP). High prevalence of BLNAR (ß-lactamase nonproducing ampicillin-resistant Haemophilus influenzae) has been one of the bacteriological features of Japan.

Up-regulation of ß1 integrin on tonsillar T cells and its induction by in vitro stimulation with α-streptococci in patients with pustulosis Palmaris et Plantaris.

Pustulosis palmaris et plantaris (PPP) is a tonsil-related disease that can be cured with tonsillectomy. Recent immunological studies have shown that hyperactivation of tonsillar T cells is caused by a hyperimmune response to α-streptococci; recruitment of the T cells to lesions may be involved in the pathogenesis of PPP. ß1 integrin, expressed on T cells, not only provides a costimulatory signal for T-cell activation but also facilitates the accumulation of T cells in inflammatory skin lesions. In this study, we found that expression of ß1 integrin on both tonsillar and peripheral blood CD4-positive T cells was higher in PPP patients than in non-PPP patients. In vitro stimulation with α-streptococcal antigen significantly enhanced ß1 integrin expression on tonsillar CD4-positive T cells in PPP patients, but not in non-PPP patients. The chemotactic response of tonsillar CD4-positive T cells to vascular cell adhesion molecule-1, the ß1 integrin ligand, was significantly better in PPP patients than in non-PPP patients. The percentage of ß1 integrin-positive peripheral blood CD4-positive T cells decreased after tonsillectomy in PPP patients. The numbers of ß1 integrin-positive T cells and the expression of vascular cell adhesion molecule-1 were more elevated in plantar PPP skin lesions than in normal skin. These results suggest that ß1 integrin may play a key role in the pathogenesis of PPP.

Laryngeal plexiform schwannoma as first symptom in a patient with neurofibromatosis type 2.

Neurofibromatosis type 2 (NF2) is an autosomal dominant disorder characterized by bilateral vestibular schwannomas. The initial symptoms of NF2 are usually hearing loss and tinnitus caused by vestibular schwannomas. Although other intracranial, spinal, or skin tumors also occur in NF2, laryngeal lesions are very rare. We report a rare case of NF2 with laryngeal plexiform schwannoma as first symptom. A 38-year-old man presented with a smooth-surfaced submucosal supraglottic mass. Two round masses in the left chest wall and left supraclavicular fossa were noted incidentally during investigation of the laryngeal mass. Magnetic resonance imaging (MRI) findings for these masses were identical to those of the laryngeal mass. No typical symptoms related to NF2 were identified. Histologically, the laryngeal tumor represented plexiform schwannoma. We thus considered that the two round masses in the left chest wall and left supraclavicular fossa might also represent plexiform schwannomas. NF2 was suspected, as a high incidence of multiple plexiform schwannomas has been suggested for patients with NF2. MRI of brain lesions demonstrated bilateral vestibular schwannomas and multiple meningiomas. Finally, NF2 with laryngeal plexiform schwannoma was diagnosed. Recognizing that multiple plexiform schwannomas could be associated with NF2 is important.

Increase in B-cell-activation factor (BAFF) and IFN-gamma productions by tonsillar mononuclear cells stimulated with deoxycytidyl-deoxyguanosine oligodeoxynucleotides (CpG-ODN) in patients with IgA nephropathy.

IgA nephropathy (IgAN), the most common form of primary glomerulonephritis, is recognized as a tonsil-related diseases since it often gets worse after and/or during acute tonsillitis and the disease progression is often prevented by tonsillectomy. Although several reports showed an increase in IgA production of tonsillar mononuclear cells (TMCs), its mechanism has not yet been fully clarified. Recently, B-cell-activation factor (BAFF), which stimulates B-cell proliferation and immunoglobulin production, was identified. Unmethylated deoxycytidyl-deoxyguanosine oligodeoxynucleotide (CpG-ODN), which is able to mimic the immunostimulatory activity of microbial DNA, is known to be involved in the production of immunoglobulins and some cytokines. In this study, we focused on roles of BAFF and IFN-gamma in IgA production of TMCs stimulated with CpG-ODN in IgAN patients. Two-color flow cytometric analysis revealed that the intercellular expression of IFN-gamma on the T-cells freshly isolated from tonsils was significantly higher in IgAN patients than in non-IgAN patients (p=0.032). The spontaneous productions of IgA and IFN-gamma of TMCs were significantly higher in IgAN patients than in non-IgAN patients (p=0.023 and p=0.02). Under stimulation with CpG-ODN, the productions of IgA, BAFF and IFN-gamma of TMCs were significantly higher in IgAN patients than in non-IgAN patients (p=0.013, p=0.005 and p=0.039). The IgA production of TMCs stimulated by CpG-ODN was inhibited by the treatment with anti-BAFF antibody and/or anti-IFN-gamma antibody. Under stimulation with IFN-gamma, the BAFF expression on the CD1c cells and the BAFF production of TMCs were significantly higher in IgAN patients than in non-IgAN patients (p=0.004 and p=0.042). These data suggest that hyper-immune response to microbial DNA may be present in IgAN patients and may lead to hyperproduction of BAFF up-regulated by IFN-gamma, resulting in hyperproduction of IgA in IgAN patients.

[Therapeutic effects and prognostic factors in tonsillectomy patients with IgA nephropathy].

INTRODUCTION: Because upper respiratory tract infections, particularly tonsillitis, often precede IgA nephropathy (IgAN), IgAN is now recognized as a tonsil-related disease, and reports have shown that tonsillectomy is effective in preventing disease progression in IgAN patients. IgA may thus play an important role in IgAN pathogenesis and development. B cell activation factor belonging to the TNF family (BAFF) is expressed by monocytes, macrophages, and dendritic cells, and may be the mechanism by which macrophages and dendritic cells directly regulate human B-cell activation. BAFF acts as a potent B-cell growth factor and costimulator of immunoglobulin production, including IgA. We studied therapeutic effects and serum BAFF levels as prognostic factors. PATIENTS AND METHODS: Subjects were 41 patients undergoing tonsillectomy and followed up for at least 1 year. Serum samples were obtained from 38 with IgAN and 29 with recurrent tonsillitis as a properative control groups. The remission group consisted of patients with normal renal function without hematuria and proteinuria. Serum BAFF levels were measured by ELISA kits at our laboratory. RESULTS: Overall remission was 39.0%. The disappearance of hematuria increased for long-term follow-up groups, but proteinuria was unchanged. Serum BAFF levels among the two groups did not differ significantly. Among IgAN patients, higher BAFF levels were associated with higher serum IgA/C3 levels. The correlation was weak (p =0.026, r = 0.407). Using 3.2 ng / ml as a cut off point, we compared cumulative improvement in those with high pretreatment BAFF levels to those with low pretreatment levels. Those with high pretreatment BAFF levels had inferior cumulative improvement in hematuria. CONCLUSION: Tonsillectomy was effective in improving hematuria. BAFF appears to be a key factor in tonsillectomy among [gAN patients.

[Endoscopic endonasal sinus surgery for post-operative maxillary cysts].

Surgical treatment for postoperative maxillary cysts uses a Caldwell-Luc or endonasal approach. Endoscopic endonasal surgery has become the treatment of choice in postoperative maxillary cyst, and many postoperative maxillary cysts have been classified. Due to the importance of cyst medial wall sites, we classified cysts into 4 types by location. Those whose, medial wall was close to the middle meatus, inferior meatus, or nasal lateral wall, we termed middle meatus, inferior meatus, and nasal lateral wall types. When the lateral cyst was not close to the nasal cavity but to another cyst, we termed the cyst continuous. We opened all nasal cavity cysts as far as possible. For continuous types, we determined location of the lateral cyst 3-dimensionally before surgery. We first opened medial cysts and opened the lateral cyst through the medial cyst. The tube was placed the lateral cyst to the nasal cavity. We opened all 45 cysts in 29 patients to the nasal cavity. As of this writing, no cysts connected to the nasal cavity have recurred.

[Study of allergic fungal sinusitis in 40 surgical cases of chronic paranasal sinusitis].

Allergic fungal sinusitis is chronic and paranasal, related to fungal allergy. Many papers on allergic fungal sinusitis have been reported in the United State, and the incidence is 5% to 10% among patients with chronic paranasal sinusitis. Although cases of allergic fungal sinusitis have been reported in Japan, the incidence is unclear. We studied allergic fungal sinusitis in 40 consecutive patients--26 men and 14 women--undergoing endoscopic sinus surgery at Keiyukai Sapporo Hospital December 2000 to July 2001. We checked for allergic rhinitis and asthma, a history of surgery for nasal polyps and chronic sinusitis, the presence of nasal polyps, grading of sinusitis via computed tomography, nonspecific IgE and allergen-specific IgE for fungi in serum, eosinophilia in nasal smears, paranasal eosinophilic mucin, and histology and fungal culture of paranasal sinus mucus. None had typical allergic fungal sinusitis, but 1 had eosinophilic paranasal mucin, high IgE, and false-positive IgE for fungi. We studied clinical data and histology of fungi and paranasal mucosa in 9 cases with fungal maxillary sinusitis, but none had allergy or eosinophilic mucin. This suggested that few patients with allergic fungal sinusitis exist among those with chronic paranasal sinusitis.