Masakazu Goda

Perivascular epithelioid cell tumor of the nasal cavity with TFE3 expression

To the Editor: In this article, we report the first case of nasal perivascular epithelioid cell tumor (PEComa) showing TFE3 protein expression. A 79-year-old Japanese man presented with left nasal bleeding, and a pedunculated elastic hard polypoid lesion was observed in the nasal cavity. Histologically, the squamous epithelium without atypia lined the surface of the polyp, and neoplastic cells with clear to eosinophilic granular cytoplasm proliferated with epithelioid growth in the lamina propria (Fig. 1). Some tumorous cells with voluminous clear cytoplasm proliferated in hyalinized stroma. Cell groups of granular cell tumor-like or rhabdomyoma-like neoplastic cells were focally identified. On immunohistochemistry the neoplastic cells were diffusely positive for a-smooth muscle actin (a-SMA; 1A4; 1:100; DAKO, Glostrup, Denmark) and TFE3 (polyclonal, 1:300, Santa Cruz Biotechnology, Santa Cruz, CA, USA; Fig. 2a; specimens of alveolar soft part sarcoma and renal cell carcinoma were used as positive and negative controls and we considered that the reaction for TFE3 akin to alveolar soft-part sarcoma was positive), and focally positive for melanosome (HMB45, prediluted, DAKO; Fig. 2b) and S-100 protein (polyclonal; 1:400, DAKO). On a-SMA immunostaining the close relationship between neoplastic cells and vascular wall was observed. Neoplastic cells were negative for MiTF (D5; prediluted, Lab Vision, Fremont, CA, USA). Seven cases of mucocutaneous angiomyolipoma (AML) and PEComa arising in the nasal cavity have been previously reported and are summarized in Table 1. Mucocutaneous AML arising in nasal cavity generally do not express melanosome and seem to be completely different from those of renal and hepatic AML. There is only one case of nasal PEComa having an epithelioid appearance and expressing melanosome. Recently, nine PEComas expressing TFE3 expression have been reported. The genetics of the translocation of TFE3 gene, however, was not analyzed for these PEComas. Therefore, the translocation study should be performed in PEComas expressing TFE3 protein in the near future. TFE3 protein is expressed in PEComa, alveolar soft part sarcoma and renal carcinoma associated with Xp11.2

Hybrid peripheral nerve sheath tumor of the nasal cavity showing schwannomatous, neurofibromatous, and perineuriomatous areas.

Soft tissue hybrid peripheral nerve sheath tumors (PNST), including schwannoma-perineurioma or neurofibroma-perineurioma, have recently been described. However, there are no reports on hybrid PNST arising in the nasopharyngeal area. In this article, we report such a case. A 58-year-old Japanese man presented with nasal obstruction and was found to have bilateral polypoid lesions in the middle meatus of the nose. Subsequently, nasal polypectomy was performed. Histologically, the tumor consisted of three components including schwannoma, neurofibroma, and perineurioma. Immunohistochemically, schwannoma, neurofibroma, and perineurioma components were positive for S-100 protein, CD34, and epithelial membrane antigen, respectively. In conclusion, this is the first case of hybrid PNST reported to occur in the nasopharyngeal area. Pathologists should be aware of the possibility that hybrid PNST may present outside soft tissue.

Effects of chemotherapy on gene expression of lingual taste receptors in patients with head and neck cancer.

We aimed to test the hypothesis that chemotherapy changes the gene expression of taste receptors in the tongue to induce dysgeusia in patients with head and neck cancer.

effects of aural stimulation with capsaicin ointment on swallowing function in elderly patients with non-obstructive dysphagia

Objective In the present study, an attempt was made to examine the effects of aural stimulation with ointment containing capsaicin on swallowing function in order to develop a novel and safe treatment for non-obstructive dysphagia in elderly patients. Design A prospective pilot, non-blinded, non-controlled study with case series evaluating a new treatment. Setting Secondary hospitals. Patients and methods The present study included 26 elderly patients with non-obstructive dysphagia. Ointment containing 0.025% capsaicin (0.5 g) was applied to the external auditory canal with a cotton swab under otoscope only once or once a day for 7 days before swallowing of a bolus of colored water (3 mL), which was recorded by transnasal videoendoscopy and evaluated according to the endoscopic swallowing score. Results After a single application of 0.025% capsaicin ointment to the right external auditory canal, the endoscopic swallowing score was significantly decreased, and this effect lasted for 60 minutes. After repeated applications of the ointment to each external auditory canal alternatively once a day for 7 days, the endoscopic swallowing score decreased significantly in patients with more severe non-obstructive dysphagia. Of the eight tube-fed patients of this group, three began direct swallowing exercises using jelly, which subsequently restored their oral food intake. Conclusion These findings suggest that stimulation of the external auditory canal with ointment containing capsaicin improves swallowing function in elderly patients with non-obstructive dysphagia. By the same mechanism used by angiotensin-converting enzyme inhibitors to induce cough reflex, which has been shown to prevent aspiration pneumonia, aural stimulation with capsaicin may reduce the incidence of aspiration pneumonia in dysphagia patients via Arnold’s ear-cough reflex stimulation.

Efficacy of percutaneous endoscopic gastrostomy on unplanned treatment interruption and nutritional status in patients undergoing chemoradiotherapy for advanced head and neck cancer

OBJECTIVE Efficacy of percutaneous endoscopic gastrostomy (PEG) on unplanned treatment interruption and nutritional status was examined in patients undergoing chemoradiotherapy (CRT) for advanced head and neck cancer. METHODS We retrospectively reviewed hospital charts of 44 patients with advanced head and neck cancer who were treated with CRT. RESULTS CRT-induced mucositis of grade 3 or worse and inadequate oral intake of less than one third of their usual intake developed in 33 patients who were recommended PEG placement, but not in 11 patients. Thirteen patients accepted PEG placement and then completed CRT (compliant group). However, among 20 patients who refused both PEG and nasogastoric tube (NGT) placements (non-compliant group), 10 required unplanned interruptions of CRT at a radiation dose around 30-40 Gy (UI-CRT group) while 10 others could complete CRT without interruption (C-CRT group) CRT. Total serum protein levels were significantly decreased after CRT in all patients. DISCUSSION It is suggested that therapeutic PEG placement is useful for preventing unplanned interruption of CRT in patients with advanced head and neck cancer. After severe mucositis and inadequate oral intake have developed during CRT, PEG placement should be considered before the radiation therapy dose of 30 Gy.

A Case of Dissociated Taste Impairment after Injury of the Major Petrosus Nerve

We report the case of a 16-year-old female patient with taste impairment of the soft palate. After receiving a skull fracture due to a traffic accident, she experienced the taste of bitter chocolate. CT showed the fracture around the right temporal bone. Electrogustometry showed that the decreased sensation of taste was restricted to the right soft palate. Shirmer test showed that lacrimal secretion of the right eye was decreased. These findings indicated that the selective injury of the major petrosus nerve on the right side due to the fracture caused taste impairment of the soft palate. It has been reported that the sensation of a sweet taste is more sensitive in the soft palate of young women. Therefore, it is suggested that the taste impairment of the soft palate caused the dissociated impairment of a sweet taste, resulting in the taste of bitter chocolate in the present case.