A Comparative Evaluation of TRPS1 and GATA3 in adenoid cystic, secretory, and acinic cell carcinomas of the breast and salivary gland

GATA3 is the most used marker to determine tumors' breast origin, but its diagnostic value in triple-negative breast cancer (TNBC) is limited. The newly identified TRPS1 is highly sensitive and specific for breast carcinoma, especially TNBC. Here, we compared the utility of TRPS1 and GATA3 expression in a subset of salivary gland-type breast tumors (including adenoid cystic, acinic cell, and secretory carcinomas [AdCC, ACC, and SC, respectively]), and we compared TRPS1 and GATA3 expression of such tumors with head and neck (H&N) and AdCC of upper respiratory tumors. TRPS1 was strongly expressed in basaloid TNBC and AdCCs with solid components, including 100 % of mixed and solid breast AdCCs. However, TRPS1 was positive in only 50 % cribriform AdCCs. Expression patterns of TRPS1 in H&N and upper respiratory AdCC were similar. TRPS1 was positive in 30 % of H&N cribriform AdCCs but was strongly expressed in mixed AdCC (67 %) and solid AdCC (100 %). In the upper respiratory AdCCs, TRPS1 was positive in 58.4 % of cribriform AdCCs and positive in 100 % of AdCCs with solid components. On the contrary, GATA3 was negative in predominant AdCCs of the breast, H&N, and upper respiratory tract. These data show that GATA3 and TRPS1 expression varies AdCCs. In addition, TRPS1 and GATA3 expression patterns were similar SC and ACC of breast and H&N. Both markers were positive in SC and negative in ACC. Therefore, TRPS1 and GATA3 cannot be used to differentiate salivary gland-type carcinomas of breast origin from those of upper respiratory or H&N origin.

Inflammatory endotypes of adenoidal hypertrophy based on a cluster analysis of biomarkers

OBJECTIVE

To identify adenoid inflammatory endotypes based on inflammatory markers, match endotypes to phenotypes, and predict endotypes.

METHODS

This cross-sectional study included 72 children with adenoid hypertrophy. Thirteen inflammatory markers and total immunoglobulin E (TIgE) in adenoid tissue were analyzed using Luminex and enzyme-linked immunosorbent assay (ELISA) for performing cluster analysis. Correlation analysis was used to examine the characteristics of each cluster. Receiver operating characteristic (ROC) curve analysis was performed to screen for preoperative characteristic data with predictive value for adenoid inflammation endotype.

RESULTS

The patients were divided into four clusters. Cluster 1 exhibited non-type 2 signatures with low inflammatory marker concentrations, except for the highest expression of Th1-related cytokines. Cluster 2 showed a non-type 2 endotype with the highest concentration of interleukin (IL)-17A and IL-22. Cluster 3 exhibited moderate type 2 inflammation, with the highest concentration of neutrophil factors. Cluster 4 demonstrated significant type 2 inflammation and moderate neutrophil levels. The proportions of AR and serum TIgE levels increased from clusters 1 to 4, and there was a gradual increase in the prevalence of chronic sinusitis from low to high neutrophilic inflammation. The area under the ROC curve for serum TIgE was higher than those for combined or other separate preoperative characteristics for predicting non-type 2 and type 2 inflammation in the adenoid tissue.

CONCLUSIONS

The evaluation of cytokines in adenoid tissue revealed four endotypes. Serum TIgE level was an important indicator of the endotype of adenoid inflammation. Identification of adenoid inflammatory endotypes can facilitate targeted treatment decisions.

Novel Classification System of Adenoids Based on Appearance and Its Relationship with Drug Therapy

INTRODUCTION

Adenoidectomy is a common procedure in children who have adenoid hypertrophy (AH), but anesthesia risks should be considered. We proposed a novel classification system for adenoids based on their appearance. Additionally, we explored whether the novel classification of adenoids correlates with the response to therapy and thus might be helpful for further treatment recommendations.

METHODS

We used fiberoptic nasal endoscopy to determine the degree and appearance of AH. Obstructive Sleep Apnea Questionnaire (OSA-18) was used to assess the quality of life of children with AH. The adenoids were divided into three types: edematous type, common type, and fibrous type. In adenoid tissues, the eosinophils were counted. Immunohistochemistry and Western blot were done to determine the expression of CysLTR1, CysLTR2, CGR-α, and CGR-β in different types of adenoids.

RESULTS

70.67% (106/150) of AH patients presented with allergic rhinitis (AR), and of them, 68% (72/106) of adenoids were the edematous type. The expressions of CGR-α, CGR-β, and eosinophil count were higher in the edematous compared with the common and fibrous types. The expression of the leukotriene receptor was similar in all types. Upon montelukast combined with nasal glucocorticoid therapy, improvement of OSA-18 scores and AH grade was significantly compared to montelukast monotherapy for edematous type. There was not any statistically significant difference between the scores upon montelukast combined with nasal glucocorticoid and montelukast monotherapy for common and fibrous type. We observed a positive correlation between eosinophil count in the blood and in the adenoid tissue.

CONCLUSION

AR was the risk factor for the development of edematous AH. All subtypes of AH responded to montelukast, while there was an additional effect of nasal glucocorticoid in the edematous type. A combination therapy of nasal glucocorticoid with leukotriene receptor antagonist can be recommended for AH patients with AR, patients with edematous adenoids, and/or patients with increased eosinophils in blood routine.

[Research advances on signaling pathways affecting sweat gland development and their involvement in the reconstitution of sweat adenoid cells in vitro]

The damage of sweat glands in patients with extensive deep burns results in the loss of thermoregulation, which seriously affects the quality of life of patients. At present, there are many researches on the repair of sweat gland function, but the mechanism of human sweat gland development has not been fully clarified. More and more studies have shown that the cascaded pathways of Wnt/β-catenin, ecto- dysplasin A/ectodysplasin A receptor/nuclear factor-κB, sonic hedgehog, and forkhead box transcription factor jointly affect the development of sweat glands, and it has been reported that the cascaded signaling pathways can be used to achieve the reconstruction of sweat adenoid cells in vitro. This article reviews the signaling pathways that affect the development of sweat glands and their involvement in the reconstruction of sweat adenoid cells in vitro.

Vascular endothelial growth factor and transforming growth factor β in hypertrophic adenoids in children suffering from otitis media with effusion

OBJECTIVES

The study objective was to assess the levels of VEGF-A and TGF-β cytokines in the children with adenoid hypertrophy concomitant with exudative otitis media (OME) and in children with adenoid hypertrophy (HA) alone.

METHODS

The study material consisted of hypertrophic adenoids removed during adenoidectomy from 39 children (20 girls and 19 boys), aged 2-7 years suffering from OME. The reference group included 41 children (19 girls and 22 boys), aged from 3 to 9 years with adenoid hypertrophy. The levels of VEGF-A and TGF-β were determined in supernatants obtained from phytohemagglutinin-stimulated cell cultures of the adenoids using a commercial enzyme-linked immunosorbent assay kit.

RESULTS

The median VEGF-A and mean TGF-β concentrations in the study group were significantly higher than those in the reference group (503 pg/mL versus 201 pg/mL, P < 0.001 and 224 pg/mL versus 132 pg/mL, P < 0.001, respectively). ROC analysis revealed that the area under the curve (AUC) for VEGF-A was 0.952 with diagnostic sensitivity and specificity of 95%, whereas for TGF-β it was 0.902 with 60% sensitivity and the same specificity as for VEGF-A. There was no significant difference between the AUC for VEGF-A and TGF-β (P = 0.573).

CONCLUSIONS

The changes in the levels of VEGF-A and TGF-β may indicate bacterial pathogen as one of the causes of exudative otitis media in children. Determination of VEGF-A and TGF-β could be used as additional and objective tests to confirm the clinical diagnosis.

Expression and subcellular localisation of AID and APOBEC3 in adenoid and palatine tonsils

Activation-induced cytidine deaminase (AID) and apolipoprotein B mRNA-editing catalytic polypeptide 3 (A3) family are cytidine deaminases that play critical roles in B-cell maturation, antiviral immunity and carcinogenesis. Adenoids and palatine tonsils are secondary lymphoid immune organs, in which AID and A3s are thought to have several physiological or pathological roles. However, the expression of AID or A3s in these organs has not been investigated. Therefore, we investigated the expression profiles of AID and A3s, using 67 samples of adenoids and palatine tonsils from patients, with reverse transcription quantitative polymerase chain reaction (RT-qPCR) and immunohistochemical analyses. AID and A3s expression levels in the adenoids and the palatine tonsils of the same individual significantly correlated with each other. Of note, AID expression level in the adenoids negatively correlated with the age (r = -0.373, P = 0.003). The younger group with adenoid vegetation and tonsillar hypertrophy showed more abundant AID expression than the older group with recurrent tonsillitis and peritonsillar abscesses (P = 0.026). Moreover, immunohistochemical analysis revealed the distribution of AID and A3s in the epithelial cells as well as germinal centres. The localisation of AID expression and its relation to age may contribute to adenoid vegetation and inflammation.

Detection of Intracytoplasmic Cytokines by Flow Cytometry in Adenoids and Peripheral Blood Lymphocytes of Children

Cytokine flow cytometry at the single-cell level has never been utilized in the study of adenoidal lymphocytes. We describe the multiparameter capability of flow cytometry to simultaneously detect an antigen on the surface of the adenoidal and peripheral blood lymphocytes and detect Th1 and Th2 cytokines within the cytoplasm of these lymphocytes. The data suggest that the percentage of cells producing interferon (IFN)-γ are decreased in adenoidal as compared to peripheral blood lymphocytes, confirming our previous studies. The new findings show that the CD8 subset of adenoidal lymphocytes produces lower amounts of IFN-γ as compared to peripheral blood CD8 cells. The intracytoplasmic synthesis of interleukin (IL)–2, however, appears to be similar in both adenoidal and peripheral blood lymphocytes. The CD4 subset of lymphocytes in the adenoid produces more IL-2, whereas the CD8 subset produces more IFN-γ. Finally, as shown in our previous studies, the Th2 cytokines appear to be produced in similar quantities in both adenoidal and peripheral blood lymphocytes.

Lymphocyte Subpopulations and Cytokines in Nasal Polyps: Is there a Local Immune System in the Nasal Polyp?

PURPOSE: The pathogenesis of chronic hyperplastic rhinosinusitis with massive nasal polyposis is still not entirely known. The present study evaluates the lymphocyte subpopulations and their production of cytokines using a technique for detection of intracytoplasmic cytokines by flow cytometry. This information may allow us to determine whether the source of these lymphocytes is from peripheral blood, the common mucosal immune system, or both.

METHODS: Detection of intracytoplasmic cytokines by flow cytometry was performed using a fluoresceinated monoclonal antibody directed against CD4+ and CD8+ lymphocytes and a rhodaminelabeled intracytoplasmic monoclonal antibody directed against four cytokines. In this way, the percentage of lymphocytes synthesizing TH1 and TH2 cytokines were identified in nasal polyp lymphocytes and the corresponding peripheral blood lymphocytes of 13 patients.

RESULTS: Lymphocytes producing interferongamma and IL-2, as well as IL-4 and IL-5, were found in the nasal polyps, suggesting that the nasal polyp possesses both TH1 and TH2 cytokine expression. There are also significant differences between the percentage of lymphocytes producing these cytokines between nasal polyps and peripheral blood, suggesting that nasal polyp lymphocytes derive from at least another source than only peripheral blood lymphocytes. Statistical analysis of four groups of patients demonstrated that no statistically significant difference in the lymphocyte subpopulations in atopic versus non-atopic patients, nor aspirin-intolerant versus aspirin-tolerant patients. In general, CD8 cells always produce more interferon-gamma than IL-2 in both peripheral blood and nasal polyps. In contrast with this data, CD4 cells produce more IL-2 in the peripheral blood than in nasal polyps.

CONCLUSIONS: Data support the concept that nasal polyp lymphocyte subpopulations may be derived from both the local mucosal immune system as well as from random migration of peripheral blood lymphocytes secondary to adhesion molecules and chemokines, which are known to be present in nasal polyps.

[The correlation studies between recurrent otitis media and adenoid hypertrophy in children]

OBJECTIVE

To investigate the relationship between the immune status of adenoids and secretory otitis media (SOM).

METHOD

The adenoids tissue samples of 30 cases of recurrent secretory otitis media (SOM), 17 cases of non-recurrent secretory otitis media and 20 cases of the adenoids hypertrophy without SOM were studied by immunohistochemical method.

RESULT

The expression of PCNA, BCL-2, CD4+, CD8+ cells and CD4+/CD8+ in recurrent SOM tissue were 30.85 +/- 1.73, 21.27 +/- 1.25, 41.90 +/- 9.07; 20.45 +/- 7.08 and 2.10 +/- 0.17, respectively, which was remarkably higher than those of non-recurrent SOM, (25.50 +/- 1.66, 14.23 +/- 1.06, 17.40 +/- 6.85, 13.02 +/- 5.88, 1.33 +/- 0.11, respectively) and those of simple adenoid hypertrophy (25.25 +/- 1.75, 14.05 +/- 1.02, 16.30 +/- 8.21, 11.15 +/- 5.71 and 1.39 +/- 0.15, respectively) (P < 0.01); the difference of the expression of PCNA, BCL-2, CD4+, CD8+ and CD4+/CD8+ between the latter two groups was not significant. Differences of the gender or the size were not significant (P > 0.05). In group of simple adenoid hypertrophy, PCNA in the subgroup of the age 3 to 6 was significantly higher than those in the other groups (P < 0.05).

CONCLUSION

In adenoid tissues of recurrent SOM patients, the activities of T-lymphocyte subsets cells in hypertrophic status increase, the adenoids enlarge and local immunity enhances. The age and gender have nothing to do with the SOM, but low age is one of the influencing factors of adenoid hypertrophy. Therefore, adenoidectomy for recurrent SOM patients with adenoid hypertrophy should be carried out as early as possible.

[Research on the relationship of IgE between adenoid and middle ear effusion in children otitis media with effusion cases]

OBJECTIVE

To study the expression of IgE in recur repeatedly children otitis media with effusion (OME), and the relativity of IgE between adenoid and middle ear effusion.

METHOD

Thirty-five cases diagnosed of OME in our department, were enrolled in the research. Thirty-one adenoidal hypertrophy cases were selected as control group. Obtained middle ear effusion and adenoid samples from experimental group, and obtained adenoid samples from control group. All adenoid samples were taken for tissue homogenate. Determination all samples of concentration of IgE by ELISA. SPSS 18.0 statistical software was used for all relevant data processing and analysis.

RESULT

Compared the IgE content between experimental group and control group with adenoid samples, IgE content increased significantly in experimental group (P < 0.05), and IgE in experimental group of middle ear effusion samples were also increased (P < 0.05). The content of IgE in the experimental group of middle ear effusion and adenoid assumed straight-line correlation, in negative correlation (r = 0.580, P < 0.05).

CONCLUSION

The occurrence of OME is related to immune factors. Adenoidal hypertrophy may lead to local immunity enhancement, may cause middle ear cavity immune system abnormality, give rise to recur repeatedly with OME and procrastinate does not recover.

Epithelial barrier and antigen uptake in lymphoepithelium of human adenoids

Invasion of antigens through the mucosal surface can be prevented by the common mucosal immune system, including Peyer's patches (PPs) and nasopharyngeal-associated lymphoreticular tissue (NALT). The adenoids (nasopharyngeal tonsils) comprise one of the NALTs and constitute the major part of Waldeyer's lymphoid ring in humans. However, the role of the lymphoepithelium, including M cells and dendritic cells (DCs), in the adenoids is unknown compared with the epithelium of PPs. NALTs also have unique functions such as the barrier of epithelial cells and uptake of antigens by M cells and DCs, and may play a crucial role in airway mucosal immune responses. The lymphoepithelium of adenoids has well-developed tight junctions that play an important role in the barrier function, the same as nasal epithelium but not palatine tonsillar epithelium. Tight junction molecules are expressed in both M cells and DCs as well as epithelial cells, and various antigens may be sampled, transported, and released to lymphocytes through the cells while they maintain the integrity of the epithelial barrier. This review summarizes the recent progress in our understanding of how M cells and DCs control the epithelial barrier in the adenoids.

[The histoarchitectonics of the pharyngeal tonsil in age aspect: morphometric and immunohistochemical study]

To assess immune responsiveness in children requires basic knowledge of the morphofunctional organization of the immune system that involves lymphoepithelial organs of Waldeyer's ring. Among them, the pharyngeal tonsil is the first to respond to both respiratory tract infection and local vaccination, which determines the need for investigations of its immune responsiveness when a child's immune system is developed. The morphometry of the histological structures of the pharyngeal tonsil and the cell immunophenotyping of this organ in age aspect are used to solve this task. The basic findings are needed to assess and compare different therapeutic approaches (vaccination and immunotherapy).

[Expression of PCNA, BCL-2, CD4+, CD8+ in the adenoid tissues from children with secretory otitis media]

OBJECTIVE

To investigate the relationship between immune status of adenoids and secretory otitis media (SOM).

METHOD

The adenoid tissue samples of 72 cases with SOM and 30 cases with adenoid hypertrophy without SOM were studied by immunohistochemical method.

RESULT

The PCNA, BCL-2, CD4+, CD8+ and CD4+ / CD8+ in SOM tissue samples were 30.85 +/- 1.73, 21.27 +/- 1.25, 41.90 +/- 9.07, 20.45 +/- 7.08 and 2.10 +/- 0.17, respectively, which were much more than that of tissue samples without SOM (25.25 +/- 1.75, 14.05 +/- 1.02, 16.30 +/- 8.21, 11.15 +/- 5.71, 1.39 +/- 0.15 respectively) (P < 0.01). The expression of CD4+ in T-lymphocyte was obviously higher than that of CD8+.

CONCLUSION

In adenoid tissues of SOM patients, the activity of T-lymphocyte subsets are increased,the adenoids are enlarged and local immunity are enhanced. Therefore,adenoidectomy should be applied in SOM patients as early as possible.

[The prolipherative and proapoptotic activity of limfoid nodules cells in the hypertrophic pharyngeal tonsil]

The human immune system recognize and eliminate strange antigens by present of lymphoid cell clones, which to come into being in consequence of clonal proliferation inducted by contact with the antigen. The cell clones to be due to the somatic mutations and recognize antigens incorrectly are eliminate by apoptosis.

THE AIM OF THE STUDY

To estimation of expression of chosen proliferative and proapoptotic proteins in lymphoid follicles and extra-follicular region of pharyngeal tonsil.

MATERIAL AND METHODS

Histochemical examination of chosen proapoptotic (p53, Bax) and proliferative (Ki-67, PCNA) proteins in adenoidectomised pharyngeal tonsil was done.

RESULTS

The most greater proliferation activity was in the germinal centers of lymphoid follicles, much less in the mantle zone and in the extrafollicular region. Similarly, maximal expression of proapoptotic proteins was in germinal centers of tonsil lymphoid follicles, the least in the mantle zone.

CONCLUSIONS

The high proliferative and proapoptotic activity of lymphoid follicles germinal centers to bear evidence of clonal selection of undistinguished lymphoid cells to come into being by somatic mutations.

Neurotrophins and their receptors in human lingual tonsil: an immunohistochemical analysis

Lymphoid organs are supplied by many nerve endings associated with different kinds of cells and macrophages. The role of this innervation on the release of locally active molecules is still unclear. Lingual tonsils belong to Waldeyer's Ring, in close association with palatine tonsils and nasopharyngeal (adenoids) tonsils, thus constituting part of NALT (nasal-associated lymphoid tissue) together with the tubal tonsils and lateral pharyngeal bands. In this study, we focused our attention on the expression of some neurotrophins (NTs) and their high- and low-affinity receptors in human lingual tonsils. Light immunohistochemistry showed that human tonsillar samples were generally positive for all the NTs investigated (NGF, BDNF, NT-3, NT-4) and their receptors (TrKA, TrKB, TrKC and p75) with some different expression levels. NGF and TrKC were strongly expressed in macrophages, but weakly in lymphocytes. However, BDNF and TrKB was highly expressed in lymphocytes and weaker in macrophages. The low-affinity receptor for NGF, p75, was mainly moderately expressed in the analysed samples. These results suggest the presence of a pattern of neurotrophin innervation in the human lingual tonsil which may play a role in sustaining inflammatory conditions and in modulating a close interaction between the nervous system and the different immune cellular subtypes.

Expression of tight junction proteins in epithelium including Ck20-positive M-like cells of human adenoids in vivo and in vitro

The human adenoid epithelium forms a continuous barrier against a wide variety of exogenous antigens. In this study, to elucidate the structures of the epithelial barrier in the human adenoid, including M-cells, we identified M-cells using an anti-cytokeratin 20 (Ck20) antibody and investigated expression of tight junction proteins in human adenoid epithelium in vivo and in vitro. In human adenoid epithelium and primary cultures, mRNAs of occludin, junctional adhesion molecule-A, ZO-1, and claudin-1, -4, -7, and -8 were detected by reverse transcription-polymerase chain reaction, whereas claudin-2 and -9 were expressed in vitro. In the epithelium in vivo, some Ck20-positive cells were randomly observed and indicated pocket-like structures, whereas Ck7 was positive in almost cells. Transmission electron microscopy revealed that Ck20-associated gold particles could be identified in M-like cells which had short microvilli and harboured the lymphocyte in the pocket-like structure. In primary cultures in vitro, Ck20-positive cells were also detected and had a function to take up fluorescent microparticles. In Ck20-positive cells in vivo and in vitro, expression of occludin, ZO-1, claudin-1 and -7 were observed at cell borders. These results indicate that the epithelial barrier of the human adenoid is stably maintained by expression of tight junction proteins in the epithelium including Ck20-positive M-like cells.

Mucin gene expression in hypertrophic adenoids

CONCLUSION

Membrane-bound mucin MUC4 represents the predominant mucin expressed in the adenoid epithelium followed by MUC5AC (gel-forming mucin). This may suggest that membrane-bound mucins could be involved in pathogen binding and immunological stimulation.

OBJECTIVES

The aim of this study was to investigate mucin expression in hypertrophic adenoids.

MATERIALS AND METHODS

Adenoidal samples were obtained from 12 children. The expression of eight mucin genes, MUC1-4, MUC5AC, 5B, 6 and 7 was studied by in situ hybridization utilizing digoxigenin-labelled oligonucleotide probes.

RESULTS

The dominant mucin genes were MUC4, 3 and 5AC, while MUC1, 2, 5B and 7 were sparsely expressed and MUC6 was not expressed. Expression patterns were very different from those in the upper airways. Most samples expressed two membrane-bound mucins (MUC4 and 3) and one secretory mucin (MUC5AC).

A phenotypic and functional characterization of NK cells in adenoids

Adenoids are part of the MALT. In the present study, we analyzed cell surface markers and cytolytic activity of adenoidal NK (A-NK) cells and compared them with NK cells derived from blood of the same donors (B-NK). NK cells comprised 0.67% (0.4-1.2%) of the total lymphoid population isolated from adenoids. The majority (median=92%) of the A-NK cells was CD56(bright)CD16(-). A-NK cells were characterized by the increased expression of activation-induced receptors. NKp44 was detected on >60%, CD25 on >40%, and HLA-DR on >50% of freshly isolated A-NK cells. Functional assays indicated that the cytotoxic machinery of A-NK is intact, and sensitive target cells are killed via natural cytotoxicity receptors, such as NKG2D. Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1; CD66) expression was up-regulated in 23% (median) of the A-NK cells by IL-2 activation but unchanged in B-NK cells. CEACAM1 inhibited the A-NK killing of target cells. CXCR4 was expressed on more than 40% A-NK cells prior to activation. Its ligand, CXCL12, was found in endothelial cells of the capillaries within the adenoid and in cells of the epithelial lining. In addition, A-NK cells migrated in vitro toward a gradient of CXCL12 in a dose-responsive manner, suggesting a role for this chemokine in A-NK cell recruitment and trafficking. We conclude that the A-NK cells are unique in that they display an activated-like phenotype and are different from their CD16(-) B-NK cell counterparts. This phenotype presumably reflects the chronic interaction of A-NK cells with antigens penetrating the body through the nasal route.

[Glucocorticoid receptor subunit expression in adenoid tissue of children with obstructive sleep apnea hypopnea syndrome]

OBJECTIVE

The expression of glucocorticoid receptor (GR) expression in obstructive sleep apnea hypopnea syndrome (OSAHS) in children is currently unknown. The aim of this study was to determine the GR-alpha and GR-beta status in the adenoidal tissues in children with OSAHS.

METHODS

Thirty-four pediatric patients (aged 3-14 years, median 7.8 years) had sleep study with polysomnography before adenoidectomy. According to the criteria of apnea hypopnea index (AHI) > or = 5 /h or/and apnea index (AI) > or = 1/h, they were divided into OSAHS and non-OSAHS sub groups. The study was based on fluorescent quantitative PCR (FQ-RT-PCR) for the mRNA expression of GR-alpha and GR-beta in the adenoidal tissues in children.

RESULTS

GR isoforms mRNA encoding for expression of both GR-alpha and GR-beta were detected in the adenoids of all children. GR-alpha mRNA level [(9.40 +/- 3.06) x 10(5) cDNA copies/microg total RNA] in the adenoidal tissues in OSAHS was lower than those in the non-OSAHS [(1.60 +/- 0.26) x 10(6) cDNA copies/microg total RNA] (F = 40.285, P < 0.001), whereas no differences found for GR-beta [(1.57 +/- 0.35) x 10(4) cDNA copies/microg total RNA, (1.52 +/- 0.18) x 10(4) cDNA copies/microg total RNA]. GR-alpha/GR-beta ratio was 62.3 +/- 20. 3 in OSAHS and 107.4 +/- 24.4 in non-OSAHS. AHI or AI was not related to the mRNA levels of GR-alpha and GR-beta in OSAHS or non-OSAHS.

CONCLUSIONS

GR-alpha and GR-beta were detectable in the adenoidal tissues in children. These data indicated that the relationship between the expressions of GR and the clinical significance in OSAHS need further and profound investigation.

Calcitonin expression of high endothelial venules during lymphocyte migration in human pharyngeal tonsil

The migration routes of lymphocytes through high endothelial venules (HEVs) of control and hypertrophic pharyngeal tonsil (HPT) tissue sections were investigated by immunohistochemistry using the expression of a hormone [calcitonin (CT)] and two calcium-dependent endothelial adhesion molecules (E-selectin and P-selectin), as well as electron microscopy. A marked increase in CT-specific staining was observed in the endothelial cells of HEV in the HPT group compared to the control group. Expressions of E-selectin and P-selectin on HEVs of control group were faint, when compared to the strong expression of these selectins on HEVs of HPT. Electron microscopically, we demonstrated that lymphocytes transmigrated through HEV and observed the close membranous contact between endothelial cells and lymphocytes during this process. We speculate that increasing CT during inflammation may be important for lymphocyte migration through the HEVs via controlling the expression of E-selectin and P-selectin.

Is Helicobacter pylori really present in the adenoids of children?

Adenoid hyperplasia is a common cause of nasal obstruction in the pediatric age group. Recently, the adenoids were shown to harbor Helicobacter pylori (HP) based only on the rapid urease test (RUT). We conducted this pilot study to identify the presence of HP in the adenoids histologically and assess the reliability of both the RUT and histology in detecting HP in an extragastric location, using nested (two-steps) polymerase chain reaction (nPCR). Consecutive patients undergoing adenoidectomy for obstructive adenoid hyperplasia were enrolled. Adenoid specimens were subjected to the RUT. Histological sections stained with hematoxylin and eosin, Giemsa and Warthin-Starry were examined. We then used nPCR to detect the presence of HP in the studied specimens. Twenty-five patients (3-10 years; mean of 5.5 years) were enrolled. Twenty-one (84%) adenoids were positive by the RUT. Seventeen (68%) had bacteria on histological sections; four (16%) contained HP-like organisms. However, all specimens were negative by nPCR. No patient had a history of symptoms suggestive of laryngopharyngeal reflux within 6 months of the study. In conclusion, the children enrolled in this study did not have HP in their adenoids. High false positive results can occur with the RUT when used on adenoid tissues. It is not possible to rely solely on morphology to detect HP in an extragastric location. The nPCR remains the best way to identify HP accurately, but does not imply its presence in an active role.

Cytokines produced by T cells in adenoid surface secretion are mainly downregulatory or of Th1 type

CONCLUSIONS

T cells in adenoid surface secretion (AdSS) possess the property of cytokine production and are mainly downregulatory or of Th1 type. These results strengthen the hypothesis of an active immunological defense in AdSS.

OBJECTIVES

Recently, we demonstrated the presence of activated T cells in AdSS. The aims of this study were to elucidate the ability of these T cells to produce cytokines and to reveal their cytokine profile.

MATERIAL AND METHODS

Eight children subjected to adenoidectomy were enrolled. Samples of AdSS, adenoid tissue and peripheral blood were obtained, as well as a nasopharyngeal culture. T cells obtained from AdSS, adenoid tissue and peripheral blood were then cultured and stimulated with anti-CD3 and -CD28 for 5 days. The production of interferon (IFN)-gamma, tumor necrosis factor (TNF)-a and IL-2, -4, -5 and -10 was then analyzed using flow cytometry.

RESULTS

All children had T cells in AdSS capable of cytokine production. T cells in AdSS, adenoid tissue and peripheral blood samples from all children produced IFN-gamma. Of the cytokines analyzed, IFN-gamma was produced in the highest concentrations. In 6/8 children, T cells in AdSS also produced TNF-a and IL-10.

[Expression Bcl-2 protein of lymphocytes T and B in hypertrophied adenoid in children with otitis media with effusion]

INTRODUCTION

The quantity of lymphocytes in adenoid and their cooperation in immunological processes is dependent on proliferation process and their migration to the effectory places. The most important process provide for equilibrium between lymphocytes of tonsils is apopotosis. Special meaning in induction this process has Bcl-2 family proteins with can be divided into pro-apoptotic and anti-apoptotic. An investigation was executed in hypertrophied adenoids with or without otitis media with effusion.

MATERIAL AND METHODS

By flow cytometry percentage of lymphocytes CD4+, CD8+, CD19+ and percentage of these lymphocytes with expression Bcl-2 proteins in hypertrophied adenoid and hypertrophied adenoid and otitis media with effusion was analyzed.

RESULTS

The percentage of lymphocytes CD4+Bcl-2+, CD8+Bcl-2+, CD19+Bcl-2+ was lower in hypertrophied adenoid and otitis media with effusion compared to the control group.

CONCLUSIONS

Tendency to lowered percentage of lymphocytes T and B with expression Bcl -2 protein in adenoids reflects likely the local immunity alterations.

Oxidants and antioxidants in tonsillar and adenoidal tissue in chronic adenotonsillitis and adenotonsillar hypertrophy in children

OBJECTIVE

The aim of the study is to determine the possible role of oxidants and antioxidants in the pathogenesis of chronic adenotonsillitis and adenotonsillar hypertrophy in children.

PATIENTS AND METHODS

The children were divided into infection and hypertrophy groups, which were comparable according to age and gender distribution. The infection group was consisted of 20 children with the diagnosis of chronic adenotonsillitis and the hypertrophy group was made up of 19 children with adenotonsillar hypertrophy to whom adenotonsillectomy was performed. Preoperative blood levels of erythrocyte MDA, serum MDA, erythrocyte catalase and serum catalase, and adenoidal and tonsillar tissue levels of MDA and catalase were studied.

RESULTS

There were significant increase in tonsil MDA, adenoid MDA, tonsil catalase and adenoid catalase levels in infection group (p<0.05).

CONCLUSION

Oxidants and antioxidants are found to have an important role in the pathogenesis of adenotonsillar hypertrophy and chronic adenotonsillitis. These findings strengthen the hypothesis that indicates adenotonsillar hypertrophy and chronic adenotonsillitis are different diseases of the same tissues.

Cytokines locally produced by lymphocytes removed from the hypertrophic nasopharyngeal and palatine tonsils

OBJECTIVE

Human palatine tonsils and the nasopharyngheal tonsil are the largest components of the Waldeyer's ring. Subepithelial and intraepithelial lymphocytes of human adenoids and tonsils are responsible for the local and the systemic immune response. We studied the cytokine production by lymphoid cells isolated from 16 nasopharyngeal tonsils (adenoid) and 9 palatine tonsils surgically removed by from 25 children (aged from 4 to 15 years) suffering from tonsil hypertrophy.

METHODS

We evaluated (by the cytometry method, using BD Bioscience kits, San Diego, CA) the concentration of IL-2, IL-4, IL-5, IL-10, TNF(alpha) and IFN(gamma) released from human peripheral blood mononuclear cells (MC) (activated or not activated by phytohaemagglutinin (PHA)) cultured in vitro during 72 h. The fluorescence-activated cell sorter (FACS) analysis was also performed and the percentage of mononuclear cells (unstimulated or activated by phorbol acetate during 24 h) stained with the monoclonal antibodies anti-CD3 containing the intracellular cytokines was calculated.

RESULTS

The increased secretion of IL-2, IL-4, IL-5, TNF(alpha) and IFN(gamma) from PHA activated palatine origin immune cell cultures, as compared to adenoids, was revealed. The higher mobilization (Delta%) of CD3+ T-lymphocytes containing IL-12 in palatine cell cultures (798.5+/-276.29%), in comparison with to the adenoids (298.5+/-49.16%; p< or =0.05), was also noted.

CONCLUSION

In palatine tonsils, as compared to adenoids, the cellular immune (Th1) response dominates over humoral immune (Th2) reaction.

Structural and immunological characteristics of chronically inflamed adenotonsillar tissue in childhood

Recurrent or chronic adenotonsillar infections mainly affect children and frequently involve otherwise healthy subjects. Therefore, having excluded systemic immunological deficiencies, this disease may be due to a local dysfunction of the epithelial structures at either the rhino or oropharyngeal level. The aim of the present investigation was to analyze structural and immunological aspects of tonsils and adenoids in subjects who underwent adenotonsillectomy because of recurrent inflammatory episodes with fever. Histological studies and analyses of the cytokine patterns were carried out in palatine tonsils and adenoid samples from 105 patients who underwent adenoidectomy and bilateral extracapsular tonsillectomy for chronic inflammatory hypertrophy of these organs; 46 of the 105 cases examined presented hyperkeratosis of the crypt epithelium; in the remaining 59, the epithelium was hyperplastic with no signs of keratosis. Scanning electron microscopy revealed a continuous epithelial surface of polygon-shaped flattened cells with fissures towards the cryptic depressions. Titration of interleukin-1beta and tumor necrosis factor alpha in serum and tissues demonstrated higher concentrations in the adenotonsillar specimens, whereas the rise in interleukin-6 was more modest.

Expression of neurotransmitters and neurotrophins in human adenoid tissue

Mucosae-associated lymphoid tissues are richly innervated and the mucosae contain peptidergic nerve endings associated with different types of cells and macrophages. The lymphatic tissue is known to interact with the nervous system and several organs, implicated in the host response to a wide range of stressors, and is also richly innervated. We focussed our attention on the immune organs with particular regard to the human adenoid lymphatic tissues in order to investigate the neuroimmune links and the possible existence of relationships among different neurotransmitters and lymphocytes, macrophages, epithelial cells and nerve fibers by testing the expression of certain neurotransmitters and neurotrophins (NTs) with their own receptors.

Glucocorticoid receptor subunit expression in adenotonsillar tissue of children with obstructive sleep apnea

Tonsillectomy and adenoidectomy (T&A) is a frequent surgical procedure in children with obstructive sleep apnea (OSA). Many symptomatic children who do not fulfill the currently recommended criteria for T&A may benefit from topical intranasal steroid therapy. However, the expression of glucocorticoid receptor (GCR) expression in adenoid and tonsillar tissue is currently unknown. The objective of this study was to assess and compare expression patterns of the human GCR in children who undergo T&A for either recurrent throat infections (RI) or OSA. Adenotonsillar tissues from 36 children with OSA or RI were subjected to quantitative PCR using specific primers for GCR-alpha and GCR-beta and to immunohistochemistry and Western blotting for protein expression of GCR isoforms. mRNA encoding for expression of both GCR-alpha and GCR-beta was detected in the tonsils and adenoids of all children, with markedly higher relative abundance of the GCR-alpha. Furthermore, GCR-alpha mRNA expression was increased in OSA-derived adenoid and tonsil tissues compared with RI, whereas no differences emerged for GCR-beta. Immunoblots confirmed these findings for the protein transcripts of these genes, and immunohistochemistry showed a specific topographic pattern of distribution for both receptors in tonsillar tissue. GCR-alpha and GCR-beta are expressed in pediatric adenotonsillar tissue, are more abundant in OSA patients, and demonstrate a specific topographic pattern of expression. These findings along with the high GCR-alpha:GCR-beta ratio suggest a favorable profile for topical steroid therapy in snoring children with adenotonsillar hypertrophy.

[Expression of receptor CD23+ on B lymphocytes in hypertrophied adenoids of children with otitis media with effusion]

Tonsil pharyngeal is stimulated chronic by pathogens can be causes this hypertrophied; whose often is companions to otitis media with effusion. Subpopulation dominates in tonsil pharyngeal are lymphocytes B, and their markers activation are expression of antigen CD23+. The aim of this study was finding dependence between otitis media with effusion and coexistent hypertrophy adenoids, and percentage of lymphocytes CD19+ with expression of antigen CD23+ in hypertrophy adenoids. In the study showed higher significant percentage of lymphocytes CD19+ CD23+ at children in otitis media with effusion (20.08+/-2.93) with reference to comparative group, which was only hypertrophy adenoid (18.16+/-2.25). Percentage lymphocytes B (CD23+) were the highest (20.01+/-5.81) in children subgroup above 5 years old with otitis media with effusion, and lowest (17.36+/-2.78) in children comparative subgroup above 5 years old. As regards on different functions of antigen CD23+ the assessment of percentage lymphocytes B with expression of CD23+ can be additional marker in course immunological and inflammatory processes to occur in hypertrophy adenoids at children are sick otitis media with effusion.

T and IgA B lymphocytes of the pharyngeal and palatine tonsils: differential expression of adhesion molecules and chemokines

The pharyngeal (Ph) and palatine (Pa) tonsils, although located in different regions of the upper aero-digestive tract (UADT), are thought to protect the respiratory tract similarly against infections by inducing and disseminating T and surface IgA(+) (sIgA(+)) B cells. We investigated the factors controlling the migratory properties of T and sIgA(+) B lymphocytes in the UADT of pigs by comparing the expression of vascular addressins, homing receptors and chemokine transcripts in Ph/Pa tonsils, Peyer's patches (PP) and their draining lymph nodes (LN). The vascular addressin PNAd was detected on high endothelial venules in both tonsils, whereas mucosal addressin cell adhesion molecule-1, otherwise present in PP and mesenteric LN, was not detected. More importantly, the vascular cell adhesion molecule-1 (VCAM-1) addressin was present in Ph tonsil and LN but neither in Pa tonsil nor in PP vascular cells, whereas both T and sIgA(+) B lymphocytes displayed similar levels of alpha4beta1(high) integrin, the ligand of VCAM-1. Analysis of transcript levels for several lymphoid (CCL19, CXCL12 and CCL21) and epithelial chemokines also demonstrated opposite chemokine mRNA ratios for Ph tonsil (CCL28 > CCL25) and PP, with Pa tonsil expressing very low levels of CCL28. Collectively, these data indicate that the differential compartmentalization of sIgA(+) lymphocytes between Pa and Ph tonsils may partly result from the differential expression of VCAM-1 and CCL28. They also suggest that tonsillar addressins and epithelial chemokines, rather than the cells intravasating it, control the regionalization of sIgA(+) lymphocytes in the UADT.

Antibody production directed against pneumococci by immunocytes in the adenoid surface secretion

OBJECTIVE

In previous studies of the adenoid surface secretion we revealed the presence of activated T cells, granulocytes engaged in phagocytosis and immunocytes that produce IgG, IgA and IgM. In the present study the objective was to assess the ability of these immunocytes to produce antibodies directed at S. pneumoniae.

METHOD

Nine children subjected to adenoidectomy due to adenoid hypertrophy, secretory otitis media or recurrent otitis media were enrolled in the study. Samples of adenoid surface secretion were obtained by an imprint method and for comparison samples of adenoid tissue and peripheral blood were also obtained as well as a nasopharyngeal culture. Double-colour enzyme-linked immunospot (ELISPOT) assays were performed to detect total and pneumococci-specific IgG- and IgA-antibody secreting cells (ASC). In the adenoid tissue, the presence of H. influenzae type b specific ASC was also examined.

RESULTS

ASC were present in all nine samples of adenoid surface secretion with a dominance of IgG-ASC as compared to IgA-ASC. The proportion of ASC relative to the total number of lymphocytes was always greater in the secretion than in the corresponding adenoid tissue. The adenoid surface secretion samples from three of nine children contained IgG-ASC directed against S. pneumoniae. IgG-ASC directed against S. pneumoniae were detected in six of eight adenoids and IgA-ASC directed against S. pneumoniae were detected in two of eight adenoids. IgA-ASC directed against H. influenzae type b (Hib) were detected in one of seven adenoids.

CONCLUSION

The immunocytes in the adenoid surface secretion and the adenoid tissue itself hold the property to produce antibodies specific for known pathogens of the upper airways. These ASC are probably engaged in the immunologic defence of the nasopharyngeal mucosa and further studies are therefore called upon.

[Expression of the chosen proapoptotic and activation markers in adenoids in children with allergic rhinitis]

Naive T cells can become either tolerant or immune as a result of their first encounter with antigen. Apoptosis is the most important immunoregulatory mechanism leading to either regional tolerant or autoimmunity and allergy. The lymphatic structure closest to the nasal mucosa is the adenoid, the part of NALT - Nasal Associated Lymphoid Tissue. The objective of this study was to find evidence for our hypothesis that allergic sensitization can occur in adenoid. Of special interest the activity of proapoptotic markers of adenoids lymphocytes in interfollicular areas. In this study the number of cells presenting expression of chosen antigens in adenoids of 20 allergic and 20 non-allergic children were evaluated. The number of positive cell for CD3, CD4, CD8, CD25, CD28, CTLA4(CD152), Fas, FasL, bcl-2, bcl-x were determined using immunohistochemical staining techniques. The eosinophils in the interfollicular space showed a trend to be more numerous in the allergic group (p < 0.005). The number of CD4, CD28, FasL, CTLA-4 and bcl-x positive cells was higher in adenoids allergic than non-allergic children. The differences were statistically significant (p < 0.05; p < 0.001). The result of this study showed that the activity of pro-apoptotic and proliferation markers of the adenoid of allergic children was more intensive than in other children. These findings support that allergic sensitization either is related to or takes place in the adenoid.

Immunology of tonsils and adenoids: everything the ENT surgeon needs to know

The lymphoid tissue of Waldeyer's ring, and particularly the nasopharyngeal tonsil (adenoids), appears to be functionally comparable to nasal-associated lymphoid tissue in rodents. Antigen-stimulated lymphoid follicles give rise to: (a) clonal B-cell expansion; (b) B-cell receptor affinity maturation; (c) positive selection of B cells according to receptor affinity for antigen; (d) differentiation to B memory cells and plasma cells; and (e) variable induction of the joining (J)-chain gene. B-cell differentiation is also important to promote downstream isotype switching of the immunoglobulin (Ig) heavy chain constant genes. For tonsillar B cells, this process gives mainly rise to IgG and IgA plasma cells, partially associated with J-chain expression. Because the J chain is a key peptide in the polymer structure of secretory IgA, tonsils and adenoids may provide B cells for mucosal effector sites. Thus, several observations suggest that these lymphoid organs generate polymeric IgA (pIgA)-expressing B cells that migrate to the upper airway mucosa, lacrimal glands and salivary glands. Accordingly, the nasal route of vaccination induces secretory IgA-dependent regional mucosal immunity and will also enhance systemic immunity. Although the pIgA-producing capacity of tonsillar B cells is considerably decreased in children with recurrent tonsillitis, a conservative attitude towards adenotonsillectomy appears immunologically desirable, particularly in the young age group.

The Bcl-2 protein expression in germinal centers of hypertrophied adenoids in children

The aim of this study was to evaluate Bcl-2 expression in the germinal centers of adenoid in children on the assumption that it can be treated as a marker of adenoidal tissue function. The study involved 95 children. The patients were divided into three age groups: aged up to 5, 5-10 and above 10 years. The analysed material were adenoids removed on the grounds of hypertrophy. Immunohistochemical analyses were carried out using monoclonal antibodies (DAKO/Bcl-2, No. M0887) directed against human Bcl-2 protein. The presence of Bcl-2 positive lymphocytes within the lymphoid follicles and Bcl-2 immunostaining were scored. The immunohistochemical staining showed Bcl-2 positive lymphocytes in the examined sections of adenoidal tissue and their characteristic location, mainly within the mantle zone. Bcl-2 reactivity was widespread in hyperplastic lymphoid tissue, including germinal centers surroundings, scattered cells within the germinal centers and the T-cell areas in general. We have not found statistically significant correlation between Bcl-2 expression and clinical status and change in Bcl-2 expression level according to age. The apoptosis presence within the germinal centers and its lack in mantle zone, the manifestation of which is Bcl-2 expression, is a sign of a proper lymphocytes maturation within lymphoid follicles. It seems that these processes are not influenced by age, so the adenoid involution is probably associated with the changes in the number of lymphoid follicles rather than change or inhibition of the processes that take place in them.

Superoxide dismutase in pediatric palatine tonsils and adenoids and its related clinical parameters

PURPOSE

The objective of this study was to investigate a protective system of pediatric palatine tonsils and adenoids against superoxide radicals (O(2)(-)) and to evaluate the clinical factors including otitis media with effusion that are related to both the expression and activities of copper zinc superoxide dismutases (CuZnSODs).

DESIGN

CuZnSODs in the palatine tonsils and adenoids were studied using immunohistochemistry and reverse-transcription polymerase chain reaction.

RESULTS

Immunohistochemistry showed that CuZnSODs distribute in the crypt epithelium, mucous membrane, mantle zone, and extrafollicular area of the pediatric adenoids as well as in the palatine tonsils. Otitis media with effusion and paranasal sinusitis were related to CuZnSODs expression in the pediatric adenoids. In addition, the frequency of tonsillitis and presence of recent tonsillitis were significantly related to CuZnSODs expression in the pediatric tonsils (P <.05).

CONCLUSIONS

In both the pediatric palatine tonsils and adenoids, the mechanism of tissue protection against infection and frequent inflammatory reactions may be closely related to CuZnSODs expression. There may be close relationship between the increased level of O(2)(-) that leads to an increase in CuZnSODs in the pediatric adenoid tissue and the development of otitis media.

[Histopathological and immunological analysis of hyperplastic palatine tonsils and adenoids in children with coexisting atopic dermatitis]

Allergic sensitisation of the airways occurs in the mucosa of the shock organ, or in the lymphatic stations draining these structures. The lymphatic structure closest to the nasal mucosa in humans is the adenoid and tonsils. Research done in respect to Waldeyer's ring on people dealing at the same time with allergy, is seldom the subject of dissertation in polish as well as world wide medical literature. In the enclosed dissertation, writers present the results of histopathological and immunohistochemical analysis of hyperplastic tonsils and adenoid, taken from children with coexisting atopy. The authors describe an immunohistochemical analyses of the hyperplastic human palatine tonsil. They present the expression of antigen CD3, CD20, CD45, CD68, EMA, SMA, Vimentin, Desmin, S-100, von Willebrand Factor, p35, Bcl-2, melanin, cytokeratin, estrogen receptor, progesteron receptor, kolagen IV and NSE in every region of pallatine tonsil. It is worthwhile to remark, that many of these cases, the presence of eosinophilia and subepithelial oedema was observed. Our immunohistochemical findings support the hypothesis that allergic sensitization takes place in the adenoid and tonsils. Furthermore, this study confirms that dendritic cells ad macrophages are involved and important in allergic disease.

Activated T cells in the surface secretion on the adenoid--a flow cytometric study

We previously demonstrated the presence of leucocytes in the adenoid surface secretion with the ability of immunoglobulin A (IgA), IgM and IgG production as well as production of cells with phagocytic capacity. In the present study, we investigated the presence of activated T cells in the secretion. Adenoid surface secretion from 12 children subjected to adenoidectomy was obtained with an imprint method. From six children, peripheral blood was also obtained. By flow cytometry, the number of lymphocytes, granulocytes, epithelial cells and red blood cells was analysed as well as the expression on lymphocyte subsets of the following antigens: CD3, CD4, CD8, CD19, CD25, CD38, CD45RO, CD45RA, HLA-DR, TcRgd, CD161 and l-selectin. The majority of T cells were activated and to a significantly higher degree were CD45RO+, CD161+ and l-selectin-, as compared with the corresponding peripheral blood. The median percentage of B cells and T cells in the secretion were 81 and 13%, respectively. In conclusion, the proportion of B and T cells in the adenoid surface secretion is significantly different as compared with the peripheral blood. The T cells in the adenoid surface secretion are to a high degree activated. The results suggest that the leucocytes in the surface secretion are part of the mucosal defence.

Phagocytosis in the nasopharyngeal secretion by cells from the adenoid

The aim of this study was to elucidate whether granulocytes and macrophages in surface secretion on the adenoid emanate from the adenoid and whether these cells participate in the control of the nasopharyngeal bacterial flora. Samples of the adenoid and its surface secretion were obtained during adenoidectomy from 12 children with recurrent acute otitis media, secretory otitis media or enlarged adenoids causing obstruction. Immunochemistry was used to examine the location of granulocytes and macrophages in the adenoid as well as the presence of IgA, IgM, IgG and plasma cells in the secretion. Phagocytosis in the secretion was examined in imprints stained with May Grünwald Giemsa. Acridine Orange and Gram staining were used to demonstrate the presence and location of bacteria in the secretion and mucosa. As a control, surface secretions were obtained from 12 children without any history of recurrent airway problems. Granulocytes and macrophages were observed in the epithelium of the adenoid and some of these cells penetrated the epithelial surface. Positive staining for IgA, IgM and IgG was observed in all secretions. In 10 of 12 children plasma cells were present in the secretion. Bacteria were observed in all imprints. With the exception of I child in each group phagocytosis of bacteria in the surface secretion was demonstrated from imprints in all children. We conclude that granulocytes and macrophages leave the adenoid and enter the surface secretion, where constant phagocytic activity takes place. The spatial relations between mononuclear and polymorphonuclear cells imply a possible cooperation between these cells in the overall control of the nasopharyngeal bacterial flora.

[Morphological changes in adenotonsillar tissue as early manifestation of asymptomatic HIV patient]

The HIV virus induces in the host several changes in your immunological system, which heads to the AIDS. We report two cases diagnosed by pathological studies after adenotonsilectomy for adenotonsilar hypertrophy. The diagnosis of HIV patients is suspected by epidemiologic (risk groups) or clinical features (opportunist diseases). But, it exists a early diagnosis, the histological findings in the extranodal lymphoid tissues, unusual on the literature. These phenomenons re-enforce the contamination way by means of the superior aerodigestive tract mucosis.

Incidence of pharyngeal hypophysis in neonates a histologic study

The presence of adenohypophysial tissue in the nasopharynx is no longer disputed. This study was performed in 50 neonatal cadavers subjected to medical autopsy within 6 hours of death. The aim was to study the incidence of extrasellar pituitary tissue in the nasopharynx and its various histologic cell types. The transpalatal approach was used to obtain the specimens. The specimens were stained with hematoxylin and eosin and periodic acid-Schiff-orange G for selective demonstration of adenohypophysial cells. Histopathologic evaluation led to the detection of pituitary tissue in 16% of the examined specimens. Selective staining demonstrated a 6% positive incidence of adenohypophysial cells. The pharyngeal hypophysis exists in 2 forms: a typical adenohypophysial collection of cells and an atypical subepithelial cluster. The incidence of hypophysial tissue was higher in the older neonates, perhaps because of hormonal stimulation of the caudal remnant of Rathke's pouch.

[Clinical and morphological analysis of adenoid vegetations in children]

The paper outlines the authors' clinical and morphological experience in clinically rehabilitating children with adenoid vegetations and sinusitis. Retrospective morphological and immunohistological studies have revealed that the structure of adenoids corresponds to the morphology of humoral and cellular immune responses. This enables adenoid vegetations to be regarded as an actively functioning secondary immunity organ that requires maximum sparing in young children.

HIV-associated multinucleated giant cells in lymphoid tissue of the Waldeyer's ring: a detailed study

Hyperplastic lymphoid tissues of the Waldeyer's ring in human immunodeficiency virus (HIV)-infected patients may occasionally contain multinucleated giant cells (MGCs). These cells, which are unrelated to any opportunistic infection, previously have been demonstrated to harbor significant amounts of HIV. Studies undertaken to characterize these MGCs have generated conflicting results: some reports suggested a macrophage origin, whereas others supported a dendritic cell lineage. This study was performed to determine the occurrence of MGCs in a series of adenoid/tonsil specimens from HIV-seropositive patients showing no histological evidence of opportunistic infection in order to further characterize the phenotype of these cells and to investigate the role of a viral infection in their pathogenesis. Adenoid/tonsil tissue specimens from 21 HIV-seropositive patients with no documented opportunistic infection were scrutinized for the presence of MGCs and evaluated immunohistochemically on paraffin sections by antibodies directed against various macrophage and DC antigens. These antigens included CD68, the macrophage marker 3A5, major histocompatibility complex Class II, S-100 protein, CD1a, and CD83. Additional immunostainings directed at CD21 and CD35 as well as at the HIV-associated p24 antigen were also performed. Finally, the presence of Epstein-Barr virus and human herpesvirus 8 viral sequences was investigated by in situ hybridization and by polymerase chain reaction analysis, respectively. MGCs were found in 14 patients (66.7%), regardless of gender, age, method of viral transmission, CD4 cell count, viral load, or ethnic group. These cells were mostly localized at the lymphoepithelium layer of the tonsillar crypts and, to a lesser extent, in the interfollicular areas of the underlying lymphoid tissue, which consistently exhibited features of follicular hyperplasia. Phenotypically, MGCs were found to be CD68+, 3A5+, major histocompatibility complex Class II+, S-100 protein+/-, CD1a-, CD21-, CD35-, and CD83-. Although the HIV-associated p24 protein was consistently present in the cytoplasm of these cells, no sign of Epstein-Barr virus or human herpesvirus 8 infection could be demonstrated. Consequently, our study didn't show any conclusive evidence to support that MGCs in hyperplastic lymphoid tissues of the Waldeyer's ring from HIV-seropositive patients originated from dendritic cells. The definite nature of these cells has yet to be elucidated, but it is plausible that they simply represent activated macrophages that are infected with HIV present in the oropharyngeal secretions during the circulation of their precursor through the lymphoepithelium area of adenoids and tonsils.

Analysis of epsilon germline transcripts and IL-4 mRNA expression in the adenoids suggests local IgE switching

BACKGROUND

We have previously observed more frequent occurrence of IgE+ and FcepsilonRI+ cells in adenoids of atopic than nonatopic children. To investigate the hypothesis that the adenoids are involved in IgE production, we analyzed the levels of epsilon germline (epsilonGL), IL-4, and IFN-gamma transcripts in the adenoids in relation to atopy and presence of ear disease.

METHODS

Adenoidectomy was performed on 19 atopic and 18 nonatopic children (median age 5 years, range 2-12 years) suffering from otitis media with effusion (OME) (n = 16) or obstructive adenoids hyperplasia (AH) (n = 21). The levels of epsilonGL transcripts, IL-4, and IFN-gamma mRNA were analyzed by competitive reverse transcriptase-PCR.

RESULTS

EpsilonGL transcript levels in the adenoids were found to be dependent on IL-4 mRNA expression (P < 0.01) and serum IgE levels (P < 0.05) (R2 = 0.32, n = 37). IL-4 mRNA expression was associated with epsilonGL transcript levels (rs = 0.32, P = 0.05, n = 37), especially among patients with AH (rs = 0.53, P = 0.01, n = 21). No significant differences in IL-4 and IFN-gamma mRNA levels were observed between the groups.

CONCLUSIONS

This study supports an IL-4-induced class switch to IgE production in the adenoids that might be of importance for inflammatory reactions in the upper respiratory tract.

Production of interferon-gamma by tonsillar mononuclear cells in IgA nephropathy patients

Much evidence, both in vivo and in vitro, suggests that patients with IgA nephropathy (IgAN) have enhanced IgA production. We hypothesized that Haemophilus parainfluenzae (HP) in the tonsil plays an important role in the IgA production of IgAN patients. In this study, we focused on interferon-gamma (IFN-gamma) and IgA production by tonsillar mononuclear cells (TMC) in patients with IgAN. Tonsillectomies were performed in patients with IgAN and chronic tonsillitis (CT). The induction of IFN-gamma and IgA in vitro by TMC from IgAN patients was compared with that from CT patients. In addition, we investigated whether stimulation with the outer membranes of HP (OMHP) enhanced IFN-gamma and IgA induction by TMC from patients with IgAN. Spontaneous IFN-gamma production and spontaneous total IgA production by TMC were higher in IgAN patients than in those patients with CT (p < 0.05). IFN-gamma induction by OMHP stimulation was also higher in IgAN patients than in CT patients. The stimulation of OMHP enhanced HP-specific IgA in IgAN but had no influence on the production of IFN-gamma in patients with either IgAN or CT compared with spontaneous IFN-gamma production. IFN-gamma production was positively correlated with total IgA values in both IgAN and CT patients, but not with HP-specific IgA. These results suggest that increased IFN-gamma production in patients with IgAN is not associated with HP infection but may play a role in the pathogenesis of IgAN.

[Adrenergic innervation of nasal polyps and pharyngeal tonsil in children]

Vegetative nervous structures in adenoids and nasal polyps were studied histochemically. Functional parameters of the vegetative nervous system were evaluated in children with hyperplasia of the pharyngeal tonsil. Polyps are shown to have adrenergic nervous structures. 80% of tonsillar hyperplasia children exhibited vegetative dystonia. Adrenergic innervation of adenoids removed surgically is described.