Yuko Saito

Immunohistochemical Interpretation of Early Epithelial Disorders of Pyriform Sinus

Expression of cytokeratins (CKs) was investigated immunohistochemically by use of monospecific monoclonal anti-CK antibodies in normal epithelia of pyriform sinus and epithelial lesions such as simple hyperplasia, different degrees of dysplasia, in situ carcinoma, and invasive carcinoma. In normal epithelium, strong expression of CK-19 was consistently observed only in the basal layer as basic CK, while expression of CK-13 showed a completely reverse pattern, being expressed only in suprabasal layers as stratification-related CK. Characteristic changes in expression pattern of these two CKs were observed in accordance with the degree of epithelial disorders and differentiation of carcinoma. Cytokeratin 1, as keratinization-associated CK, was observed only in keratinized cells of hyperplastic epithelia and well-differentiated carcinomas. These findings may be useful in evaluating epithelial disorders and classifying carcinomas more objectively, and may assist earlier detection of carcinoma when used with standard histologic techniques.

A Case of Olfactory Neuroblastoma

A case of olfactory neuroblastoma is reported. A 71-year-old man visited our hospital exhibiting left nasal obstruction and purulent choanal drip on May 13 1998. Examination showed a large tumor in his left nasal cavity; the surface of it was smooth and bled easily. The patient did not have any visual acuity difficulties and the cervical lymphnodes were not swollen. The patient had undergone surgery for an olfactory neuroblastoma in 1979 in another hospital. CT scan revealed a large tumor in his left nasal cavity and maxillary sinus but which did not extend into the cranial space or eye socket. There was no bone defect. Based on the pathological findings, we made a diagnosis of recurrent olfactory neuroblastoma.The patient was treated using combined therapy; preoperatively, chemotherapy (CBDA+CPA+VP-6) and radiation therapy were performed. Since 19 years previously, 40 Gy radiation therapy was used, we added a further 30 Gy radiation. Subsequently, the tumor was removed completely left lateral rhinotomy approach.The patient is being followed up periodically and to date no recurrence of tumor has been observed. In conclusion, we suggest that long-term follow up is important since it has been previously reported that olfactory neuroblastoma can recur even after a long interval as in this case.

Sudden Sensorineural Deafness of both Sides with Diabetes Mellitus(DM); A Report of Different Results on Each Side.

We have an interesting case of sudden sensorineural deafness of both sides with DM. The hearing loss of the left side and diabetic control were progressively aggravated by steroid therapy. We suspected that this was a case related to viral infection. Anti-parainfluenza 3 virus titer increased by anti-virus titer examination. Therefore, we changed from steroid to γ-globulin therapy and performed intensified conventional insulin treatment. Diabetic control was improved and the right side showed excellent recovery. However, the left side experienced deafness. In general, DM produces individual immune dysfunction. Thus, we consider that the hearing loss in both sides was progressively aggravated because of steroid therapy, which induced excessive individual immune dysfunction and viral activation.

Cerebellar Infarction with Occlusion of the Right Vertebral Artery; A Case Report.

A 61-year old male complained of rotatory vertigo with hearing disturbance, nausea, and vomiting. Although the symptoms suggested peripheral vestibular dysfunction, a diagnosis of cerebellar infarction was made from the MRI findings. The patient first showed deviation toward the right while walking, secondary rotatory vertigo, nausea, vomiting, and spontaneous horizontal and rotatory nystagmus toward the left. The nystagmus changed to gaze nystagmus during the clinical course. Vertebral angiography showed occlusion of the right vertebral artery near the foramen magnum and collateral branches from the left vertebral artery. It is considered that circulatory insufficiency of the inner ear caused the vertigo attacks, but signs or symptoms of cerebellar dysfunction were not apparent because of the presence of collateral branches. We conclude that MRI and MRA are useful in the early diagnosis of cerebellar infarction.