[Expression of terminal deoxynucleotidyl transferase in the pharyngeal and palatine tonsils in local infectious and inflammatory diseases of the upper respiratory tract and pharynx in childhood]. / Ekspressiya terminal'noi dezoksinukleotidiltransferazy v glotochnoi i nebnykh mindalinakh pri mestnykh infektsionno-vospalitel'nykh zabolevaniyakh verkhnikh dykhatel'nykh putei i glotki v detskom vozraste.

Along with central immune organs, the peripheral lymphoepithelial organs of the pharynx are actively involved in protecting the body from infections. Adaptive, or induced, immunity occurs during the postnatal ontogenesis of immunocompetent lymphocytes, which includes the secondary somatic recombination of the V genes with the participation of recombination-activating gene (RAG) and terminal deoxynucleotidyl transferase (Tdt) proteins. This publication discusses the results of detection of Tdt-positive cells in the pharyngeal and palatine tonsils of children of different ages, who had been operated on for adenoid vegetations and chronic tonsillitis. Attention is drawn to the localization of Tdt+ cells, the level of Tdt expression, an attempt to clarify the phenotype, destination, and place in the diagnostic arrays of functional markers when an adaptive immunity is generated in children.

[Tumor-like amyloidosis of the upper respiratory tract]. / Opukholevidnyi amiloidoz verkhnikh dykhatel'nykh putei.

The paper describes 11 cases of local tumor-like amyloidosis (LTA) of the upper respiratory tract, among which laryngeal amyloidosis was most common. The clinical diagnosis of suspected local amyloidosis was made in only two cases. The diagnosis of local amyloidosis was established at a morphological examination of a distant neoplasm, by using special Congo red staining followed by polarizing microscopy. Attention is drawn to the localization and sequence of amyloid deposition and morphological changes related to the age of patients and the duration of the disease. The paper discusses the nature of local amyloidosis as stromal vascular proteinosis with the deposition of AL amyloid (immunoglobulin light chain amyloid) that are formed apparently by local immunocytes of the mucosa-associated lymphoid tissue (MALT) system. It emphasizes the need for the clinical monitoring of patients with LTA to rule out systemic amyloidosis.

[Solitary ganglioneuroma of the oropharynx]. / Solitarnaia ganglionevroma rotoglotki.

Mucosal neuromas, or ganglioneuromas, attract attention as a frequent component of multiple endocrine neoplasia (MEN) syndrome type 2B. The paper describes a clinical and morphological case of solitary oropharyngeal ganglioneuroma in a 60-year-old man, whose observation has not revealed its apparent association with the MEN syndrome.

[Human papillomavirus and Epstein-Barr virus in the pathogenesis of inverted papilloma and associated sinonasal carcinoma]. / Virusy papillomy cheloveka i Épshteina-Barr v patogeneze invertirovannoi papillomy i assotsiirovannoi s nei sinonazal'noi kartsinomy.

OBJECTIVE: To determine whether Epstein-Barr virus and human papillomavirus (HPV) types 6, 11, 16, 18, 35, and 43 DNA can be present in inverted papilloma (IP) and associated sinonasal carcinoma. MATERIAL AND METHODS: The investigation was carried out using tissue samples obtained during surgery from 76 cases of IP and 4 cases of sinonasal carcinoma that had developed in the presence of IP. PCR was performed in 41 cases of IP and in 4 cases of sinonasal carcinoma; immunohistochemistry was done in 15 cases of IP to identify HPV L1 capsid protein. RESULTS: HPV6 DNA was detected in 20 cases; three of them were simultaneously found to have also HPV11; 1 case had only HPV11. HPV types 16, 18, 35, and 45 and Epstein-Barr virus were not detected. PCR revealed HPV types 16 and 35 in one of the 4 cases of sinonasal carcinoma associated with IP. Immunohistochemical study identified HPV L1 capsid protein in the epitheliocytes and stromal infiltrating lymphocytes and macrophages in two cases of IP with the highest concentration of HPV DNA as evidenced by PCR, as well as in one case of sinonasal carcinoma. CONCLUSION: Taking into account the low HPV DNA concentration detected only for types 6 and 11, as well as the immunohistochemical detection of HPV L1 in the tumor stromal lymphocytes and macrophages and some basal epitheliocytes in individual cases, it can be assumed that HPV does not play a crucial role as an etiological factor for IP. PCR revealed oncogenic HPV types 16 and 35 in sinonasal carcinoma associated with IP only in one case, which makes it untimely to claim that this virus plays a very special role in the etiology of this carcinoma. Epstein-Barr virus was not found in any case.

[Nasal glial heterotopia: Clinical and morphological characteristics]. / Kliniko-morfologicheskaia kharakteristika nazal'noi glial'noi geterotopii.

The paper describes a case of nasal glial heterotopia in a 10-month-old girl with a mixed (intranasal and subcutaneous) localization, which is accompanied by the divergence of the nasal bones. Histological examination supplemented by immunohistochemical reactions with antibodies to vimentin, S100 protein, neuron-specific enolase, as well as Ki-67 and smooth muscle actin confirmed the neural nature of the tumor. Fields of mature astrocytic glia including individual cells with neuronal differentiation were found among the fibrous and fibrovascular tissues. The paper provides a brief overview of the discussed pathology.

[The morphology of vocal fold polyps and mucosa in Reinke's edema].

OBJECTIVE: To investigate the morphogenesis of vocal fold polyps and Reinke's edema on the basis of clinical and morphological analyses of the histological and immunohistochemical data characterizing the state of the local microcirculatory bed and the mechanisms of its permeability impairment. SUBJECTS AND METHODS: Polyps of the vocal folds and their mucosal tissue samples in Reinke's edema mucosa, which had been obtained after microsurgical treatment of 31 patients (13 men and 18 women) aged 23 to 75 years, were studied using a wide panel of peroxidase-labeled monoclonal and polyclonal antibodies (DAB chromogen), including T and B cell differentiation markers, Toll-like receptors (TLR2, TLR4, and TLR9), the costimulatory molecule CD80 (B7- 1), and markers for angiogenesis (CD34), vascular and tissue permeability (matrix metalloproteinases (MMP-1 and MMP-9)), and vascular cell adhesion molecule-1 (VCAM-1). Results. All types of the examined polypoid hyperplasia were ascertained to realize through the impaired permeability of the wall of microcirculatory vessels in the membranous vocal fold portion called Reinke's space. The expression of molecules, such as CD34, VCAM-1, MMP-1 and MMP-9, as well as TLR4 and TLR9 was revealed on the endothelial cells of microcirculatory vessels. The epithelial lining cells simultaneously expressed the above-mentioned Toll-like receptors and the costimulatory molecule CD80 (B7-1) that modulated T cell lymphocyte activity (through CD28) or attenuation (through CTLA-4), ensuring the interaction of structures of innate and adaptive immunity. CONCLUSION: The morphogenesis of polypoid hyperplasia of the vocal folds is a result of an epithelial stromal interaction under poor etiological factors, such as high vocal loads, exogenic intoxications, and viral infections. The integumentary lining cells carrying Toll-like receptors initiate reactive alterations in Reinke's space.

[The morphological study of the Perfoost demineralized bone alloimplant applied for the plastic reconstruction of the posterior wall of the external auditory canal].

The objective of the present study was to enhance the effectiveness of the surgical treatment of chronic suppurative otitis media (CSOM) by means of the application of the Perfoost demineralized bone alloimplant for the plastic reconstruction of the posterior wall of the external auditory canal. This aim was attained by the elucidation of morphological features the Perfoost alloimpalnt at the site of surgical intervention one year after the operation. The study included 12 patients presenting with CSOM (epi- and epimesotympanitis) who had underwent "closed-type" sanation surgery of the middle ear. A Perfoost demineralized bone implant (DBI) plate was used for plastic reconstruction of the posterior wall of the external auditory canal. The secondary intervention within one year after the implantation was used to obtain 5×5 mm biopsy specimens containing a fragment of Perfoost DBI together with the adjacent cicatrical tissue bordering the "living" bone. The biopsies were subjected to standard histological treatment. It was shown that the fragment of the transplanted bone tissue underwent resorption accompanied by neo-osteogenesis. The source of formation of the new bone was fibroblastic elements of connective tissue of the recipient undergoing transformation into osteoblasts under the influence of resorbable components of the alloimplant. The presence of pre-existing bone canals and perforation holes in the implant provides the favourable conditions for its invasion by connective tissue that ensures its strong immobilization and gradual replacement by the newly formed bone tissue which corresponds by "carcass" regeneration. The results of the present study give evidence of the high clinical effectiveness of reconstructive surgery for the treatment of CSOM with the application of the Perfoost demineralized bone alloimplant used for the plastic correction of the posterior wall of the external auditory canal.

[Chromogenic in situ hybridization in diagnostics of Epstein-Barr-virus infection in chronic tonsillitis].

In the issue we demonstrate results of Epstein-Barr virus (EBV) detection by chromogenic in situ hybridization (CISH) in epithelial and lymphoid cells of the palatine tonsil in patients with chronic tonsillitis. Virus genome detections were performed using RNA-probes with digoxigenin-labeled oligonucleotides which target EBV RNA, notably RNA-transcripts of virus genomic DNA. The obtained data confirm the virus lymphotropism and also tropism to epithelial cells of both surface and cryptal epithelium of the palatine tonsil. CISH method in combination with immunohistochemical identification of virus protein products opens new possibilities for clinicopathological monitoring of the different clinical forms of the chronic tonsillitis, as well as new horizon for understanding intrinsic role of EBV in tonsillar pathology.

[Lymphoepithelial organs of the pharynx in children after local immunomodulatory therapy].

The immunomorphology of adenoids and hypertrophied palatine tonsils in frequently ill children after treatment with herbal and microbial immunomodulators reflects the functional tension and interaction of both innate and adaptive immunity cells. The increase in the count of BCL-2-expressing cells is considered as possible dysregulation of the physiological processes of positive and negative selection via apoptosis.

[The histoarchitectonics of the pharyngeal tonsil in age aspect: morphometric and immunohistochemical study].

To assess immune responsiveness in children requires basic knowledge of the morphofunctional organization of the immune system that involves lymphoepithelial organs of Waldeyer's ring. Among them, the pharyngeal tonsil is the first to respond to both respiratory tract infection and local vaccination, which determines the need for investigations of its immune responsiveness when a child's immune system is developed. The morphometry of the histological structures of the pharyngeal tonsil and the cell immunophenotyping of this organ in age aspect are used to solve this task. The basic findings are needed to assess and compare different therapeutic approaches (vaccination and immunotherapy).

[The rare case of laryngeal lesion in idiopathic Kaposi's sarcoma].

The case report of laryngeal Kaposi's sarcoma (KS) in 59 year old HIV-negative man infected by herpes virus 8 (HHV-8) is in the paper. The primary onset of KS was on the legs. Lesion of laryngeal mucosa was developed sequentially, resulted in laryngeal stenosis and led to application of tracheostome. The skin and laryngeal mucosa lesions had homotypic histological structure and corresponded to early manifestation of KS preceded tumor node appearance.

[Morphofunctional organization of lymphoepithelial organs of the human pharynx]. / Morfofunktsional'naia organizatsiia limfoépitelial'nykh organov glotki cheloveka.

We present the current concepts of morphofunctional organization of the lymphoepithelial organs in the human pharynx based on the published data and authors' results. Functional compartmentation of palatine and pharyngeal tonsils is considered, which reflects cooperative cell interactions in the immune response; B- and T-areas have been structurally isolated and functionally substantiated. A special attention is paid to the fine structure of cryptal epithelium and its interactions with lymphoid cells infiltrating the epithelial sheet: lymphoepithelial symbiosis. Attention is also paid to structural homology of the lymphoepithelial compartment of palatine tonsils and thymus. The problem concerns the place of lymphoepithelial organs in hierarchy of the immune system as secondary organs with their own immunoregulatory area and having the functions of a regional center controlling the mucosal immunity.

[Clinical and morphological analysis of adenoid vegetations in children]. / Kliniko-morfologicheskii analiz adenoidnykh vegetatsii u detei.

The paper outlines the authors' clinical and morphological experience in clinically rehabilitating children with adenoid vegetations and sinusitis. Retrospective morphological and immunohistological studies have revealed that the structure of adenoids corresponds to the morphology of humoral and cellular immune responses. This enables adenoid vegetations to be regarded as an actively functioning secondary immunity organ that requires maximum sparing in young children.

[Clinical and morphological aspects of benign tumor-like growths in the vocal cords]. / Kliniko-morfologicheskaia kharakteristika dobrokachestvennykh opukholepodobnykh obrazovanii golosovykh skladok.

The structure of the nasal septum was studied on 34 samples obtained from dead bodies of children aged 3 to 14. The septums were removed from the skull cavity. The morphometric studies consisted of measurements of the anteroposerior, superior-inferior, septum and its area, as well as composite anatomical structures. It is shown that the size and area of the septum and its anatomical structures undergo age-specific changes which are not regular. The data should be accounted for in correction of nasal septum structural defects in children of different age.

[Histological evaluation of the condition of the trepanation cavity coating after radical surgery on the middle ear]. / Sostoianie vystilki trepanatsionnoi polosti posle radikal'noi operatsii na srednem ukhe po dannym gistologicheskogo issledovaniia.

Tissue samples obtained intraoperatively from different parts of the middle ear in the course of the radical operation (35 cases) or reconstructive operations in patients with the history of surgical intervention on the ear (67 cases) were examined histologically. Fibrous-atrophic changes in the trepanation cavity coating correlated with the duration of the disease and the time since the radical operation. Pathomorphological and topographic profile of the changes in the operated ear coating copies relevant picture of otitis media purulenta chronica. The tympanomastoid cavity coating was characterized by increasing fibrous-atrophic changes reflecting regeneratory-plastic insufficiency of the epithelium and persistent tympanofibrosis in conditions of open trepanation cavity with disturbed anatomic relations in the middle ear.

[Morphofunctional organization of the palatine tonsils as a lymphoepithelial organ]. / Morfofunktsional'naia organizatsiia nebnykh mindalin kak limfoépitelial'nogo organa.

The paper considers compartment structure of the tonsils reflecting cooperative interactions of the cells in immune response. A special emphasis is laid on the lymphoepithelial relations at the level of criptal epithelium the area of which serves as an immunoregulatory compartment of the palatine tonsils. Similarity of the regions of lymphoepithelial symbiosis in the zone of the criptal epithelium and lymphoepithelial pattern in the thymus is discussed as well as the role of the palatine tonsils as a secondary organ of immunogenesis in the general hierarchy of the immune system.

[Choanal polyps: principles of current diagnosis and treatment]. / Sovremennye printsipy diagnostiki i lecheniia khoal'nykh polipov.

Computed tomography, endoscopic investigation, surgical endoscopic revision of the paranasal sinuses performed in 20 patients with choanal polyps (CP) showed that according to their growth origin, CP may be antrochoanal, sphenochoanal and ethmochoanal (11, 3 and 6 patients, respectively). Thorough preoperative examination prevents opening of unaffected paranasal sinuses. However, when several sinuses are involved, site of CP fixation may be detected at surgery. Endoscopic techniques presented as a good alternative to routine polypotomy and Caldwell-Luc operation. In atypical CP location a differential diagnosis with inverted papilloma must be made.

[The morphofunctional characteristics of the palatine and pharyngeal tonsils in children with chronic tonsillitis and adenoids]. / Morfofunktsional'naia kharakteristika nebnykh i glotochnoi mindalin u detei s khronicheskim tonzillitom i adenoidami.

22 palatine and 10 pharyngeal tonsils of 20 children, 4 to 15 years of age, with chronic tonsillitis and adenoids were studied histologically and immunohistochemically. The material was obtained at tonsillectomy, adenotomy and adenotonsillectomy. The expression of LCA, CD20, CD45 RO, CD45 RA, CD68 and HLA DR-antigen was determined immunohistochemically. Functional heterogeneity of the whole lymphoid population in the tonsil tissue is structured by dividing lymphoid tissue into T- and B-regions. However, this subdivision is relative. Interpenetration of T- and B-cells into structurally determined functional zones reflects cooperative cell relations in the immune response the obligatory participant of which are non-lymphoid cells of the microenvironment: antigen-representing macrophages of the follicle germinative centres and reticular epitheliocytes in the regions of lymphoepithelial symbiosis. HLA-DR-antigen expression of the reticulum epithelium cells and the presence of activated T-lymphocytes in the lymphoepithelial symbiosis zones allow one to consider these zones as an immunoregulatory compartment of the tonsils.