Takeshi Akisada

Malignant peripheral nerve sheath tumor arising in benign ancient schwannoma: A case report with an immunohistochemical study

A rare example of malignant transformation in an ancient schwannoma arisng in the right side of the neck of a 51‐year‐old man without any clinical manifestations suggesting neurofibromatosis is described. The tumor, approximately 4 cm at its largest dimension, was well circumscribed and had a direct connection with the sympathetic nerve. Microscopically, the central portion of the tumor showed features of ancient schwannoma characterized by extensive hyalinization with cystic degeneration, scattered spindle cells with hyperchromatic and tapered nuclei, and some symplastic changes. However, predominantly in the outer portion, a proliferation of spindle‐shaped cells with enlarged nuclei was present. The nuclei of these cells showed irregular contours, coarse granular chromatin texture, and conspicuous nucleoli. Mitotic figures and small necrotic foci with scattered apoptotic bodies were also seen. Immunohistochemically, S‐100 protein was almost negative in areas consisting of overtly atypical cells where the mitotic index evaluated with MIB‐1 antibody was 30.5%. In contrast, S‐100‐positive bland spindle cells were scattered in an extensively hyalinized area with a labeling index less than 3%. P53 protein was strongly positive in atypical spindle cells. Although it is a very uncommon event, definite nuclear atypia, frequent mitotic figures, and the existence of small necrotic foci should be recognized as indicating a diagnosis of malignant degeneration of benign schwannoma. Immunohistochemistry would be useful as an ancillary technique in such a setting.

Detection of varicella-zoster virus DNA in peripheral mononuclear cells from patients with Ramsay Hunt syndrome or zoster sine herpete.

On the basis of alterations in varicella‐zoster virus (VZV) antibody titers, it appears that Bells palsy in some patients could be associated with VZV reactivation, that is, zoster sine herpete. To obtain stronger evidence of this association, polymerase chain reaction (PCR) was used to detect VZV DNA in auricular lesions or peripheral blood mononuclear cells (PBMCs) from Bells palsy or Ramsay Hunt syndrome patients. VZV DNA was detected in the auricular lesions of Ramsay Hunt syndrome, in PBMCs from 2 Ramsay Hunt syndrome patients, and in 4 of 17 samples from 16 Bells palsy patients. Three of these four positive patients were thought to have zoster sine herpete because of hearing difficulty, vertigo, and pain. VZV IgM antibodies were positive in 1 of the 2 patients with Ramsay Hunt syndrome, and in 2 of the 17 samples from the Bells palsy patients. VZV IgG antibody titers during the acute phase were significantly higher in the patients positive for the PCR or VZV IgM antibody than in those negative for them. These findings provide evidence that Bells palsy in some patients could be associated with VZV reactivation. J. Med. Virol. 56:359–363, 1998.

Anti-HER2-antibody enhances irradiation-induced growth inhibition in head and neck carcinoma.

To explore the antiproliferative effects of rhumAbHER2 on head and neck squamous carcinoma cell (HNSCC) lines and breast cancer cell lines (BCCLs) and to evaluate the combined effects with irradiation, 2 human HNSCC lines and 2 BCCLs were exposed to rhumAbHER2 with or without irradiation. The results showed that combined treatment enhanced the growth and colonization inhibitory effects of rhumAbHER2 or irradiation. Interestingly, the apoptotic cell fraction produced by irradiation disappeared on combined treatment. This disappearance was associated with repression of p53 and Bax upregulation induced by irradiation, but conservation of the upregulation of p27. Based on these results, rhumAbHER2 and irradiation may be a new strategy for treating HNSCC and breast cancers. In addition, the upregulation of cyclin‐dependent kinase inhibitors by rhumAbHER2 may occur upstream of irradiation‐induced p53 upregulation.

Uptake of microparticles into the epithelium of human nasopharyngeal lymphoid tissue

The M cells of nasopharyngeal lymphoid tissue (NALT) have been considered to play an important role for vaccine delivery systems in humans. A number of investigations have reported particle uptake data in NALT of rodents. However, there have been no reports indicating any involvement of the nasopharyngeal lymphoid tissue in human vaccination. In the present study, we investigated whether the epithelium of human adenoid tissues might incorporate fluorescent microparticles using electron and fluorescent microscopy. The dissected adenoid tissues were incubated with various sizes and concentrations of fluorescent microparticles for 120 min at 37°C. Furthermore, the effect of surface coatings of microparticles with cations on the uptake into the epithelium of adenoid tissues was investigated. Transmission electron microscopy revealed that microparticles were taken up by the M cells of human nasopharyngeal lymphoid tissues. The NALT-M cells showed greater uptake of the smallest particles, 0.2 µm in diameter, than those of 0.5, 1.0, or 2.0 µm diameter. It was also revealed that surface coatings with poly-l-lysin or chitosan resulted in efficient uptake into the NALT. These results indicate that nasal administration of antigenic microparticles, which were coated with cationic materials, probably leads to a useful method of transnasal vaccination against respiratory and intestinal infections in humans.

A case of bilateral eosinophilic granuloma in the temporal bone

We present a case of bilateral eosinophilic granuloma in the temporal bone in a 47-year-old woman, who visited our hospital with a headache and a feeling of occlusion in her left ear. Her left tympanic membrane was slightly turbid and pure tone audiometry revealed mild left sensorineural deafness. CT disclosed a shadow of soft tissue in the left mastoid antrum and mastoid cells, which was indicative of marked destruction of the bone. Because MRI findings led us to suspect otitis media cholesteatoma, a mastoidectomy was performed. The mastoid antrum and mastoid cells were filled with easily bleeding granulation, and there was a wide range of bone deficit in the posterior cranial fossa. Histopathologically, the granulation tissue was an eosinophilic granuloma. Her postoperative clinical progress was good and she was discharged. However 2 months after discharge, she had a feeling of occlusion in the right ear and CT revealed a shadow in the right mastoid antrum and cells. Therefore, right tympanoplasty was performed and the same findings as in the left ear were obtained. A histopathological diagnosis of eosinophilic granuloma was made again. To date, there has been no recurrence.

Arterial embolization for control of bleeding in advanced head and neck malignancy

BackgroundThis study was undertaken to assess the efficacy and suitability of an arterial embolization technique for the control of bleeding in advanced head and neck malignancies.MethodsEmbolization was performed on 6 patients with advanced head and neck malignancy using various embolic materials for the control of bleeding. The primary tumors were located in the nasopharynx, hypopharynx (n=2), oral base, face, and external auditory canal. All of these patients had severe anemia and 5 had massive regional hemorrhages.All bleeding was well controlled by the arterial embolization; 2 patients were cured of hypovolemic shock. None of the patients died as a direct result of tumor bleeding, and there were no massive rebleeding cases in our series.ConclusionArterial embolization offers an effective, safe, and fast method for controlling bleeding from advanced head and neck malignancies. A good working relationship between the surgeon and the interventional radiologist provides the greatest chance for sucess in such cases.

Nitric Oxide Synthase in the Nasal Mucosa

Objective: The amount of nitric oxide (NO) in the nasal cavity is significantly higher in allergic rhinitis patients than in healthy individuals. The purpose of this study was to identify NO synthase (NOS) isoforms (NOS-1, NOS-2, and NOS-3) and examine their localization, gene expression, and protein expression in allergic rhinitis model mice. Method: Male BALB/c mice were intraperitoneally administered Cryptomeria japonica 1 (Cryj1) and adjuvant (primary immunization) 3 times; thereafter, Cryj1 was administered daily into the nasal cavity (secondary immunization). The expression of NOS-1, NOS-2, and NOS-3 in the nasal mucosa was investigated using real-time polymerase chain reaction, and Western blot analysis. Results: The expression of NOS-1 mRNA was significantly decreased, and NOS-2 and NOS-3 mRNA levels were significantly increased in the allergy group compared to the control group. Protein expression of NOS-1 was significantly decreased and that of NOS-2 was significantly increased in the allergy group compared with the control group, but no significant difference was noted in the levels of NOS-3 protein. Conclusion: This study shows that not only NOS-2 but also NOS-1 and NOS-3 are involved in the pathogenesis of allergic rhinitis.

A Case of Cat Scratch Disease

We present a case of cat scratch disease. The patient was an 18 year-old female with no history of cat scratches, although she kept five cats. She noticed lymph node swelling in the right subparotid region. A malignant lymphoma was suspected, so the mass was surgically removed. Histopathologically, focal granulomatous lesions with necrosis were found in the subparotid lymph node. The necrosis was surrounded by a layer of epithelioid cells. The diagnosis of cat scratch disease was made on the basis of the clinical and histopathological features.

Congenital Cytomegalovirus Infection and Sensorineural Hearing Loss

Cytomegalovirus (CMV) is the most common cause of congenital viral infection with a reported incidence of 0.29-0.42% of live births. Bilateral and unilateral sensorineural hearing loss of varying degrees has been reported in children with symotomatic and asymptomatic congenital CMV infections. In this paper, case studies from three infants with hearing impairments diagnosed by pediatricians as symptomatic congenital CMV infections are reported. The follow-up hearing assessments were performed by ABR and pure tone audiography. According to their ABR thresholds, the three cases had severe, severe and moderate bilateral sensorineural hearing impairment, respectively. We administered acyclovir and anti-CMV r-globlin, and the ABR thresholds of all three cases improved. However, in two cases, delayed progressive hearing loss and vestibular impairment were found.

Parapharyngeal Space Tumors; A Clinical Study of 7 Cases.

A 67-year-old man was admitted to our hospital because of general fatigue and pancytopenia. The patient had a past history of total laryngectomy for cancer of the larynx at age 64. Following that operation Tegaful 642.0g was administered for about three years. Hematological examinations revealed a hemoglobin of 7.6 g/dl, a white cell count of 2300/μl, and a platelet count of 34000/μl. A diagnosis of myelodysplastic syndrome (RAEB-t) was made from bone marrow, which contained myeloblasts and atypical cells, and peripheral blood cells (65%). A chromosomal banding study of the bone marrow cells was normal. We speculated that the preceding adjuvant chemotherapy was probably related to the occurrence of myelodysplastic syndrome.