Immunopathologic study of chronic sinusitis: a proposal for atopic and non-atopic IgE-activated mast cell allergic inflammation.

Paranasal sinus mucosa was examined in this study for mast cell membrane-bound IgE. The study material was from 54 patients identified in hospital records as having one of the following diagnoses: chronic sinusitis, chronic sinusitis with asthma, or chronic sinusitis with associated nasal polyps. Formalin-fixed tissue samples taken during endoscopic sinus surgery were routinely processed and examined with hematoxylin and eosin stains. Additional sectioned tissue was analyzed by fluorescence microscopy for mast cells after the use of anti-IgE and anti-tryptase antisera; 45% of the cases of chronic sinusitis, 50% of the cases of chronic sinusitis with polyposis, and 69% of the cases of chronic sinusitis with asthma exhibited 10 or more IgE-positive mast cells in the sinus mucosa. Significant numbers of individuals with chronic sinusitis have coexistent allergic disorders. Some individuals in this study who were not allergic by hospital record review also manifested IgE-positive mast cells in the sinus mucosa; a basis for this finding is proposed.

Fine needle aspiration cytology of a cerebral ganglioglioma. Report of a case.

The fine needle aspiration (FNA) cytology of a rare central nervous system tumor, ganglioglioma, is described. The FNA cytologic diagnosis confirmed a radiologic suspicion of ganglioglioma detected by computerized tomography and intraoperative sonography, thus sparing the patient from a superior temporal gyrus resection, with attendant speech impairment. The cytologic distinction of this lesion from high-grade astrocytoma is important because of the more favorable prognosis in ganglioglioma.

The role of immunoglobulins in allergic disease: IgE and IgG4 immunofluorescent study of adenoid tissue.

Upper airway allergy is a common problem in children. The most frequent tissue removed from children is adenoid tissue. Although conventional stains offer little help in characterization of the allergic response in this tissue, immunohistologic assessment does offer the opportunity to reveal immunoreactants present. Adenoid tissue from 91 allergic and nonallergic children was examined by a dual immunofluorescent method to detect mast cell membrane bound IgE and IgG4. Positive mast cell membrane staining was seen with IgE (FIEMC) but not with IgG4 in adenoid tissue from allergic children. Numerous IgG4 plasma cells were often seen in close relationship to FIEMC in adenoid stroma where blocking function of IgG4 may take place. False-positive FIEMC patients may represent transient or infrequent encounters with allergens. Disparate clinical allergy and tissue FIEMC status may also reflect different genetic control of IgE regulation and antigen (allergen) recognition.

Detection of allergic disease in adenoid tissue.

Allergic adenoiditis is defined as the presence of numerous brightly fluorescent IgE mast cells (FIEMC) demonstrated in formalin-fixed adenoid tissue by the trypsin-immunofluorescent method. A prospective study of 606 routinely accessioned cases seen during a 39-month period revealed 98 positive cases. Correlation with clinical and other allergic diagnostic testing revealed a sensitivity of 58% and a specificity of 89%. The pathogenetic role of allergy in chronic otitis media with effusion appears to be related to an exaggerated immediate hypersensitivity response to an allergen and/or infectious agent leading to dysfunction of the eustachian tube. The proximity and shared mucosa of adenoid tissue and eustachian tube allow the recognition of this inflammatory event.