Shinichi Kawabori

Histological and immunological studies on eosinophilic granuloma of soft tissue, so‐called Kimura's disease

Increase of serum IgE with frequent localization of IgE in the germinal centres, mast cell hyperplasia in lymph nodes and changes of specific granules in the infiltrated eosinophils, such as roughness of the matrix and appearance of tubular structures together with fusing and disappearance of the core, were demonstrated in eosinophilic granuloma of the soft tissue, so‐called Kimuras disease, in association with increase of anti‐Candida IgE antibody.

Preoperative Computed Tomography Diagnosis of Non‐Recurrent Inferior Laryngeal Nerve

Objective The non‐recurrent inferior laryngeal nerve (NRILN) is a nerve anomaly that is associated with the developmentally aberrant subclavian artery. Thus, it is possible to predict NRILN by preoperative diagnosis of an aberrant subclavian artery. Preoperative recognition of the NRILN should be advantageous in the prevention of intraoperative nerve damage. The purpose of this study was to assess the possibility of diagnosis of an aberrant subclavian artery by computed tomography (CT) of the neck, which is often performed before thyroid surgery.

Proliferative activity of mast cells in allergic nasal mucosa

The proliferative activity of mast cells in the nasal mucosae of allergic (n= 14) and non‐allergic (n= 18) rhinopathic patients was studied by a sequential double immuno‐histochemistry using anti‐proliferating cell nuclear antigen (PCNA) and anti‐tryptase antibodies. Two hundred to 300 tryptase‐positive cells (mast cells) were studied in each allergic nasal epithelium. In case of non‐allergic nasal mucosa, only a few mast cells existed in the epithelial layer. The total number of mast cells which we could detect in all patients was 168 cells. One of these cells contained PCNA. Three hundred to 500 mast cells were studied in each subepithelial layer and deep layer of lamina propria of both diseases. PCNA‐positive mast cells were observed in the nasal epithelia of 10 allergic patients. In the subepithelial layer, PCNA‐positive mast cells were observed eight allergic patients and four non‐allergic patients, respectively, In the deep lamina propria, PCNA‐positive mast cells were observed in a few patients with both diseases. The percentage of PCNA‐positive mast cells of all mast cells each area ranged from 0 to 1.7%. The incidence of PCNA‐positive mast cells was statistically higher in the allergic epithelium and subepithelial layer than in the deep layer of lamina propria. Moreover, that of PCNA‐positive mast cells in the subepithelial layer was higher in allergic than in non‐allergic nasal mucosa. Our results suggest that mast cell proliferation may contribute to the number of mast cells in the nasal epithelium and subepithelial layer of allergic patients.

Spindle Cell Lipoma within the Larynx: A Case Report with Correlated Light and Electron Microscopy

A spindle cell lipoma was removed surgically from the right intralaryngeal lesion of a 68-year-old man. Laryngoscopy demonstrated a spherical protrusion with intact mucosa near the vestibular fold. CT scan examination showed a low-density mass just medial to the thyroid cartilage. Light microscopy revealed that the circumscribed tumor consisted of mature lipocytes and spindle cells. Electron microscopy revealed that the spindle cells lacked a typical basal lamina. Such tumors are more frequent in the posterior aspect of the neck and shoulder regions. To our knowledge, this is the first reported case of a spindle cell lipoma within the larynx.

Mast cells in allergic nasal epithelium and lamina propria before and after provocation. An electron microscopic study

A study of mast cells in subjects with nasal allergy was made by electron microscopy before and after provocation in three areas; the nasal epithelium, the subepithelial layer and the deep layer of the nasal lamina propria. The ration of degranulation of the mast cells in the nasal epithelium and subepithelial layer increased after provocation. The main features of exchanged granules of the mast cells in these areas were (1) swelling of lower electron density of the area enclosed by perigranular membrane, (2) lower electron density of the total area of granular substance with fibrillar and reticular changes, and (3) the disappearance of granular substance. It was, therefore, judged that the mast cells in the nasal epithelium and in the subepithelial layer play a more important part in the onset of a nasal allergic reaction than do those in the deep layer of the nasal lamina propria.

Dynamics of mast cell degranulation in human allergic nasal epithelium after provocation with allergen.

The histamine content in the nasal epithelial layer of twenty‐five patients with nasal allergy was measured before, 10 min after and 1 hr after nasal provocation with allergen. A decrease in histamine content was observed 10 min after provocation compared to the values obtained before provocation (P<0.05). There was a tendency for an increase in the histamine content of the nasal epithelium one hour after provocation when compared with the amounts present 10 min after provocation (P<0.1). Mast cells in the nasal epithelial layer of a further five patients were studied by electron microscopy 10 min and 1 hr after provocation. The rate of mast cell degranulation appeared to decrease 1 hr after provocation when compared with 10 min.

Existence of c-kit Receptor-Positive, Tryptase-Negative, IgE-Negative Cells in Human Allergic Nasal Mucosa: A Candidate for Mast Cell Progenitor

The accumulation of mast cells in the allergic nasal epithelium is well known, yet the mechanism remains unclear. We studied whether there is a candidate for mast cell progenitors in the allergic nasal mucosa tissue removed at the time of surgery. We first confirmed that most mast cells in nasal mucosae of 10 nasal allergic patients had c-kit receptor by immunohistochemistry using the mirror sectioning technique. We then investigated whether c-kit receptor+, tryptase-, IgE- cells existed in nasal mucosae of 15 nasal allergic patients and 15 nonallergic ones using sequential triple immunohistochemistry. We observed the area in which 1,000 to 1,100 tryptase-positive cells (mast cells) existed in both the subepithelial layer and the deep layer of each nasal lamina propria. The epithelial layer above this area was also examined. Some c-kit receptor+, tryptase- cells existed in the nasal mucosae of 11 patients with nasal allergy and of 5 patients with nonallergic rhinitis. From one to four of these cells in the nasal epithelium and subepithelial layer of the 4 allergic patients were IgE-negative. In contrast, no IgE-negative cells existed in the deep layer of allergic nasal mucosae or in any nonallergic nasal mucosae. Our results suggest that mast cell progenitors, hematopoietic progenitor cells or multipotential blood cells exist in the allergic nasal mucosa, and may contribute to the increase of mast cells in the epithelium and subepithelial layer of allergic nasal mucosa.

A Case of Hypopharyngeal Leiomyosarcoma

Squamous cell carcinoma is the most common malignant neoplasm in the hypopharynx. Other types of malignant neoplasm are rare. Leiomyosarcomas are commonly found in the alimentary tract and the uterus. Only 6 cases of hypopharyngeal leiomyosarcoma have been reported in the past. We report here the seventh case of this rare tumor, which arose from the piriform sinus in a 69-year-old man. The tumor was completely resected, and the pharynx and larynx were reconstructed. The patient remains free of recurrence 25 months postoperatively.

Angioleiomyoma of External Auditory Canal. A Case Report.

We report a rare case of angioleiomyoma of the external auditory canal. The patient was a 59-year-old female who complained of hearing loss and blocking in the left ear. A smooth mass protruding to the external auditory canal was found. Excision of the tumor was performed. The diagnosis was confirmed as an angioleiomyoma with microscopic studies. The postoperative course was uneventful, and no sign of recurrence had been noted six months after the operation. The clinical features of angioleiomyoma and other benign tumors of the external auditory canal are discussed.

Mixed Thyroid Tumor of Papillary and Medullary Carcinoma Arised in the Parapharyngeal Space. A Case Report.

We report a rare case of a mixed thyroid papillary and medullary carcinoma originating in the parapharyngeal space. The patient was a 57-year-old female with a swollen subparotid area and no swelling of the lymph node in her neck. A CT scan and MRI demonstrated a large mass in the left parapharyngeal space. The tumor was resected surgically using the push-up method. Microscopic studies revealed that the tumor was composed of papillary carcinoma tissue positive for thyroglobulin and medullary carcinoma tissue positive for Grimelius and chromoguranin stains, supporting the diagnosis of a mixed papillary and medullary carcinoma. Lymphoid tissue was not identified in the tumor tissue. There was neither primary nor metastatic sites in any organs, suggesting that the tumor may have originated in the parapharyngeal space.