鼻内镜在鼻咽部疾病诊断中的价值

目的探讨鼻内镜在鼻咽部疾病诊断中的价值及作用。方法在表面麻醉下用鼻内镜对1416例门诊病人进行鼻咽部检查。对有新生物或怀疑为恶性肿瘤者在直视下咬取活检送病理。结果192例进行活检,其中发现鼻咽部淋巴组织增生,鼻咽囊肿,鼻咽纤维血管瘤,鼻咽部新生物等病变,确诊为恶性肿瘤107例(占58．75％);对鼻咽淋巴组织有怀疑者予以活检,结果皆为粘膜慢性炎症。结论鼻内镜对鼻咽部疾病的诊断具有较高价值。     

Localization of IgE synthesis in immediate-type allergy of the upper respiratory tract

The localization of allergen-specific IgE synthesis in allergic diseases of the upper respiratory tract is so far unknown. It has been suggested that the IgE production takes place in the nasal mucosa itself. The present immunohistochemical studies with anti-IgE and monoclonal markers for B lymphocytes, plasma cells, antigens of the major histocompatibility complex, T helper and T suppressor cells indicate that there are no IgE-producing plasma cells in the nasal mucosa of patients with seasonal allergic rhinitis. The IgE-associated cells have been defined as two different types of mast cells. Furthermore we found IgE-associated lymphoid follicles in palatine as well as in nasopharyngeal tonsils and in cervical lymph nodes from allergic patients. IgE-specific activated B lymphocytes and plasma cells were identified in direct contact with migratory mast cells in these lymphoid tissues. We therefore suggest that IgE synthesis takes place in the lymphoid tissues of Waldeyer's ring and in downstream cervical lymph nodes and that migratory mast cells transport specific IgE back to the nasal mucosa to mediate the allergic reaction.     

The influence of cigarette smoke on the pharyngeal mucosa

The influence of cigarette smoke on the pharyngeal mucosa was investigated in a clinical study and in an experiment on animals. Histologic reports were evaluated according to the Kambic-Lenart classification of hyperplastic aberrations of the throat mucosa. A close dependence of the degree of hyperplasia and the number of cigarettes smoked was revealed. The more cigarettes the patients smoked every day, the more evident were changes on the mucosa, more clearly manifested in male than in female smokers. It was observed that the changes related to the hyperplasia atypica were more evident the longer the patients smoked. They were also more intense the younger the smokers were when they started smoking. In the experiment on animals, a number of factors with additionally noxious influence on the pharyngeal mucosa were excluded. A great interdependence was observed between the number of daily inhaled cigaretes and the changes on the pharyngeal mucosa.     

Adenoidal hypertrophy as the presenting feature of HIV infection

A case of symptomatic recurrent adenoidal hypertrophy, as the presenting feature of HIV infection in a haemophiliac child, is reported. The incidence of non-malignant nasopharyngeal lymphoid hyperplasia in HIV infection is examined and the relevance of the histological appearance is discussed in relation to progression of disease.     

Adenotonsillar hypertrophy and Epstein-Barr virus in pediatric organ transplant recipients

OBJECTIVES/HYPOTHESIS: Epstein-Barr virus-related (EBV-related) lymphoid hyperplasia of the tonsils and adenoids is a precursor to post-transplantation lymphoproliferative disorder (PTLD). The incidence of post-transplantation adenotonsillar hypertrophy, a potential early sign of PTLD or EBV-related lymphoid hyperplasia, is not known. We sought to identify potential risk factors for adenotonsillar hypertrophy manifested as EBV-related hyperplasia and early PTLD in the pediatric solid organ transplant population. STUDY DESIGN: Cross-sectional analysis. METHODS: We developed a 65-point questionnaire concerning obstructive sleep disorder and upper respiratory tract infections and an 8-point focused physical examination, to identify prevalence of and risk factors for adenotonsillar hypertrophy in the pediatric transplant population. We evaluated 120 pediatric solid organ transplant recipients by parental questionnaire and focused adenotonsillar physical examination. RESULTS: Of the 120 patients, 62 had undergone liver transplantation and 58 had undergone kidney transplantation. Overall, the mean questionnaire score was 8.36 (range, 0-40) and the mean physical examination score was 3.86 (range, 1-8). Patients whose EBV serological test result was negative at the time of transplant had higher scores for both the questionnaire (mean score, 10.24) and the physical examination (mean score, 4.56) than those whose EBV serological test result was positive at the time of transplantation (scores of 7.38 and 3.30 for questionnaire and physical examination, respectively). The difference in examination scores was statistically significant (P <.003). CONCLUSIONS: Epstein-Barr virus seronegativity at the time of organ transplantation is a known risk factor for PTLD, with associated risk of developing EBV-related lymphoid hyperplasia. Our results indicate a higher incidence of symptoms and signs consistent with adenotonsillar hypertrophy in the EBV seronegative population. Adenotonsillar hypertrophy may be a precursor to EBV-related lymphoid hyperplasia and PTLD and must be identified in this patient population.     

窄带成像内镜在鼻咽病变诊断中的应用初探

目的 探讨窄带成像(narrow band imaging,NBI)内镜在鼻咽病变诊断中的应用价值.方法自2009年12月至2010年4月对124例鼻咽病变患者使用具有普通白光与NBI两种观察模式的电子鼻咽喉镜进行检查,并行病理活检,评估NBI模式下鼻咽病变黏膜及黏膜表面血管的形态学特点.结果 本组病例经病理活检证实乳头状瘤1例,淋巴滤泡增生并慢性炎性反应87例,鼻咽囊肿11例,鼻咽癌25例.根据病变病理的不同,NBI模式下病变局部黏膜的颜色及黏膜表层血管形态明显不同,其中黏膜颜色深度可分为4级,分别记录为(+)～(++++),其中(+)为淡红色,(++)为暗红色,(+++)为紫红色,(++++)为蓝色或蓝黑色.NBI模式下乳头状瘤、鼻咽囊肿、淋巴滤泡增生并慢性炎性反应分别表现为(+)、(++)与(+++),未见异常血管增生;鼻咽癌表现为(+++)～(++++),异常血管增生明显.结论 NBI技术对于预测鼻咽病变的病理结果有着良好的临床应用价值.

Abstract：

Objective To evaluate the value of narrow band imaging (NBI) endoscopy in the diagnosis of nasopharyngeal lesions. Methods Between December 2009 and April 2010, a total of 124 patients with nasopharyngeal lesions were examined with electronic nasopharyngolaryngoscope equipped with the white light mode and NBI mode. The biopsies of nasopharyngeal lesions were done in all patients. The characteristics of morphologies of mucosa and mucosal superficial vessels of each lesion under NBI mode were evaluated. Results Of all cases, there were 1 of papilloma, 87 of lymphoid follicular hyperplasia and chronic inflammation, 11 of nasopharyngeal cysts, and 25 of nasopharyngeal carcinoma. According to the pathological results, the morphologies of nasopharyngeal lesions under NBI mode were quite different. The color depth of the mucosa could be divided iuto four types: light red ( + ), dark red ( + + ), prunosus ( + + + ), and blue or blue black ( + + + + ). Under NBI, the color depths were ( + ) in papilloma,( + + ) in nasopharyngeal cysts, and ( + + + ) in lymphoid follicular hyperplasia and chronic inflammation, without abnormal vessels. The color depths were ( + + + ) - ( + + + + ) in nasopharyngeal cancer, with abnormal vessels. Conclusion NBI has a potential ability to predict pathological results of nasopharyngeal lesions.     

Polypoid mucosa with eosinophilia and glandular hyperplasia in chronic sinusitis: a histopathological and immunohistochemical study

OBJECTIVE: To evaluate the histopathological and immunohistochemical characteristics of chronic sinusitis, with reference to the extent of sinus involvement. STUDY DESIGN: A nonrandomized, retrospective, controlled qualitative and quantitative study. METHODS: Twenty-nine adults with refractory chronic sinusitis underwent functional endoscopic sinus surgery. The score of computed tomography scans was used to determine the extent of disease. Six patients with normal sinus mucosae served as control subjects. Specimens underwent routine histological processing and hematoxylin-eosin and periodic acid-Schiff staining. Immunohistochemistry for T and B lymphocytes was applied. Low-magnification microscopy was designed to yield typical pathological features, and high magnification to count various inflammatory cells. RESULTS: Patients were divided into two groups according to their dominant pathological features: 16 had polypoid mucosa and eosinophilia, and 13 had glandular hyperplasia. The number of eosinophils, T and B lymphocytes in the lamina propria was significantly higher in patients with polypoid mucosa and eosinophilia, compared with those with glandular hyperplasia and with normal control subjects, whereas the difference between patients with glandular hyperplasia and control subjects was insignificant. Although the overall inflammatory reaction was relatively modest, nasal polyposis was more prevalent in patients with polypoid mucosa and eosinophilia; likewise, computed tomography revealed a significantly more extensive disease in these patients compared with the patients with glandular hyperplasia. CONCLUSION: Two pathophysiological pathways, inducing prolonged obstruction to the outflow of sinus secretion and ultimately causing chronic inflammation, are suggested: 1) swollen polypoid mucosa with activation of eosinophils that damage the epithelium and 2) continued increased mucus secretion originated from hyperplastic submucosal seromucous glands.     

Search for Herpesvirus 1 and 2 by in situ hybridization in tonsils and adenoids

OBJECTIVE: Herpes simplex virus (HSV) has been described as cause of acute tonsillitis. It has also been found in nasopharyngeal florid lymphoid infiltrate, mostly composed of CD4+, CD56+ T-cells, simulating lymphoma. In spite of its widespread prevalence in latent form, to the best of our knowledge no study is available on in situ detection of HSV in chronically hyperplastic nasopharyngeal lymphoid tissue. The purpose of the present study was to search for the presence of HSV 1 and 2 in 21 adenoids and 15 tonsils from children (2-12 years of age) in which these organs had been surgically removed due to hypertrophy. METHODS: Paraffin wax-embedded sections from the 36 cases were submitted to the in situ hybridization technique, using the biotinilated probe to Herpes simplex virus 1 and 2 (Pan Path, Amsterdam) and the Rembrandt Universal DISH & HRP Detection Kit (Pan Path, Amsterdam). Positive control consisted of a previously tested Herpes infected lung. RESULTS: In none of the 36 cases studied were positive nuclei detected in adenoid and tonsils, either in lymphoid, in stroma or in epithelial cells, as those seen in the positive control. CONCLUSION: HSV does not seem to be implied in tonsil or adenoid chronic lymphoid hyperplasia. These organs do not seem to harbor the virus latently, or the amount of virus is too low to be detected without amplification methods.     

吸烟对鼻气道阻力影响的初步探讨

目的：探讨吸烟对鼻气道阻力（ＮＡＲ）的影响,方法：采用前鼻测压法,对４０例正常不吸烟者（对照组）,４１例轻度吸烟者（轻度吸烟组）、４２例重度吸烟者（重度吸咽组）的单侧及总鼻腔ＮＡＲ进行测定,比较。结果：重度吸烟组鼻粘膜减充血前单侧及总鼻腔（ＮＡＲ）与对照组比较有显著性差异（Ｐ〈０．０５）,鼻粘膜减充血后则针显著性差异（Ｐ〉０．０５）;轻度吸烟鼻粘膜减充血前后均无显著性差异（Ｐ〉０．０５）。结论：长     

Benign nasopharyngeal masses and human immunodeficiency virus infection

Manifestations of the acquired immunodeficiency syndrome are common in the head and neck and are becoming well known to the otolaryngologist. We present a series of seven patients who complained of nasal obstruction and hearing loss and were found, on examination, to have large obstructing nasopharyngeal masses and otitis media with effusion. Biopsy revealed benign lymphoid proliferation. Because of a suspicion of human immunodeficiency virus infection by history, antibody titers were obtained and were found to be positive in all cases. With the known increased rate of aggressive extranodal B-cell lymphomas in human immunodeficiency virus-infected patients, its existence in the nasopharynx should be ruled out histologically in symptomatic patients. Nasal obstruction and hearing loss secondary to nasopharyngeal lymphoid proliferation in high-risk patients can be an early sign of human immunodeficiency virus infection. Patients presenting with this clinical entity should be advised to have serologic testing and further treatment and counseling if necessary.     

鼻咽粘膜异常与鼻咽癌相关的前瞻性观察

在鼻咽癌高发区对３０～６４岁４３５４１健康人群进行了六年ＥＢ病毒血清学和鼻咽检查的前瞻性观察，对其中ＶＣＡ－ＩｇＡ阳性者及高滴度≥１：４０所对应的阴性对照者或有鼻咽粘膜异常者作为观察对象，共３７３７人。结果提示：①鼻咽粘膜异常多见于青壮年；部位以顶后壁最多；常呈滤泡增生和膨隆。②鼻咽粘膜异常组与无鼻咽粘膜异常组，ＶＣＡ－ＩｇＡ（壳抗原抗体ＩｇＡ）阳性率与几何平均滴度均无差异；粘膜异常患者百分率并不随ＶＣＡ－ＩｇＡ滴度升高而增大，且ＶＣＡ－ＩｇＡ滴度的变化与粘膜异常的变化无相关。③经六年前瞻性观察，两组的鼻咽癌出癌率在去除性别及年龄因素影响后显示有差异。目前，这种粘膜异常在病理组织学上尚未能证实为癌前病变。     

鼻咽癌中VEGF的表达与树突状细胞含量的相关分析及临床意义

目的 探讨鼻咽癌组织中VEGF表达与树突状细胞含量的相关性。方法 选取鼻咽癌组织和鼻咽部淋巴组织各25例,采用ELISA方法检测组织中VEGF的表达,采用流式细胞仪检测组织中树突状细胞和调节性T细胞的含量并分析其相关性。结果 鼻咽癌组织中VEGF含量高于鼻咽部淋巴组织,组间差异具有统计学意义(t=12.324,P<0.01);鼻咽癌组织中CD4+淋巴细胞含量低于鼻咽部淋巴组织,组间差异具有统计学意义(t=14.304,P<0.01);而鼻咽癌组织中CD4+CD25+调节性T淋巴细胞含量高于鼻咽部淋巴组织,组间差异具有统计学意义(t=5.910,P<0.01);鼻咽癌组织中CD123+树突状细胞含量低于鼻咽部淋巴组织,组间差异具有统计学意义(t=7.866,P<0.01),鼻咽癌组织中CD11c+树突状细胞含量低于鼻咽部淋巴组织,组间差异具有统计学意义(t=3.411,P<0.01),鼻咽癌组织VEGF表达与CD4+CD25+淋巴细胞含量呈正相关(r=0.966 ,P<0.01),与CD123+树突状细胞含量呈负相关(r= -0.946,P<0.01),与CD11c+树突状细胞含量呈负相关(r= -0.954,P<0.01)。结论 鼻咽癌组织中VEGF表达与鼻咽癌组织中CD4+、CD25+调节性T细胞和树突状细胞的含量有关,可能参与鼻咽癌的免疫逃逸。     

Cystic lymphoid hyperplasia of the parotid in relation to acquired immunodeficiency syndrome (HIV+). Apropos of 2 cases

Cystic lymphoid hyperplasia of the parotid, a rare disease, was recently described in patients with acquired immunodeficiency syndrome. We reported here 2 new cases of this illness. The 2 HIV+ patients showed an enlargement of parotid gland. A superficial parotidectomy was performed. The histological and immunohistochemical studies were completed in one case by a histoenzymological and ultrastructural study. We could see numerous cystic cavities lined with a cylindrical or metaplastic malpighian epithelium and surrounded by a lymphoid tissue, similar to a true lymph node with germinal centers. In these lymphoid structures, we could find some epithelial remnants and numerous epimyoepithelial islands. Besides, anomalies similar to those described in persistent generalized lymphadenopathies were obvious: hyperplastic germinal centers with multiplication of B lymphocytes and thin mantle zone, perifollicular hypervascularization, numerous macrophages, plasmocytes and T lymphocytes with increase of T8 cytotoxic subset in interfollicular and paracortical areas. An early opportunist infection is suggested in the histogenesis of this disease.     

Immunopathology of polymorphic reticulosis of the larynx

We treated a 28-year-old woman with initial symptoms of hoarseness. At biopsy, atypical lymphoid cells infiltrate was observed in the submucosa of the larynx and polymorphic reticulosis was diagnosed. Immunohistochemical examination of the laryngeal material obtained at autopsy revealed a strong reaction of lymphoid cells to the monoclonal antibody to human T lymphocytes. The possibility that polymorphic reticulosis is a transitional form of peripheral T cell lymphoma was confirmed.     

不伴鼻息肉的慢性鼻及鼻窦炎黏膜重构的组织病理学研究

目的观察不伴鼻息肉的慢性鼻及鼻窦炎（chronic rhinosinusitis without nasal polyps, CRSsNP）黏膜是否具有相似的组织重构的特征。方法选取50例CRSsNP患者和20例对照组的钩突黏膜,分别进行HE染色、Masson2色胶原染色、VanGieson染色（VG染色）和阿辛蓝一过碘酸．希夫（alcian blue-periodic acid-Schiff,AB-PAS）染色,观察黏膜上皮损伤、基底膜厚度、黏膜下胶原和腺体增生等情况。结果所有CRSsNP组黏膜均存在上皮脱落、基底膜增厚、黏膜下胶原沉积和黏液腺细胞增生等组织病理学特征,且均较对照组严重。结论黏膜组织重构是CRSsNP的普遍现象。     

喉癌前病变100例分析

对１００例喉癌前病变进行临床及病理学分析。发现喉癌前病变的发病和过度使用嗓音及长期大量吸烟有密切关系。其病理表现为上皮典型增生及轻、中、重度非典型增生（亦称异型）。扫描电镜观察到随喉粘膜上皮细胞异型程度的增加，细胞表面形状、大小、边缘、细胞间连接等有显著不同。１００例中有２０例转为恶性。其中，慢性肥厚性喉炎的恶变率为１１．６％，喉角化症为１９％，喉乳头状瘤为３６％。临床表现及病理均证明为喉息肉的病例也有恶性变者，故临床上应加以警惕。     

Recurrent lingual tonsil hyperplasia

Clinically significant lingual tonsil hypertrophy is a rare entity in children. We describe a child, status postadenotonsillectomy, with recurrent hypertrophy of the lingual tonsil after carbon dioxide laser ablation. Workup was negative for immunodeficiency, cystic fibrosis, and allergies. The findings of examination of multiple biopsy specimens of the tissue suggested follicular hyperplasia, and cytometery showed no evidence of a lymphoproliferative disorder. Empiric treatment with a histamine2-receptor blocker after the sixth carbon dioxide laser ablation prevented lingual tonsil hypertrophy.     

Acute Sinusitis in the Rabbit Model: Histologic Analysis

Objectives: Characterize the histology of the rhinogenic model of sinusitis and compare this with existing models of sinusitis. Study Design: Prospective controlled trial in animals. Methods: New Zealand white rabbits were implanted with a synthetic sponge, which was then impregnated with Streptococcus pneumoniae bacteria. After a specified time the animals were sacrificed, and whole-mount sectioning of both the infected and noninfected sinuses was performed. The sinuses were carefully examined for evidence of inflammatory changes. Results: This model produced a sinus infection that is characterized by luminal exudates of neutrophils and eosinophils, mucosal infiltration with lymphocytes and plasma cells, and epithelial degeneration. In addition, discrete lymphoid follicles were identified in both the implanted and nonimplanted sides that in the implanted sides appear to hypertrophy and liberate leukocytes into the sinus lumen. Other areas were observed where luminal exudates seem to act on and degrade mucosa that has little or no underlying inflammation. In severely infected sinuses submucosal vacuole formation with overlying granulation tissue was observed. Conclusions: The rhinogenic model of sinusitis demonstrates features typical of other known models of sinusitis. In addition, there appear to be unique features of this model, specifically the identification of discrete lymphoid aggregates, which suggest that this model has the potential to be valuable for the study of the immune response of the sinuses.     

Nasopharyngeal epignathus causing nasal airway blocking in a 4-year old child

Congenital oral teratoma or epignathus is a very rare lesion, especially in older children. We report on a 4-year old female infant presenting with nasal blocking, little watery discharge and recurrent otitis. First adenoids were suspected. An endoscopic examination of the nose and nasopharynx demonstrated an irregular mass in the nasopharynx, covered partly by mucosa. A MRI-scan (T1-weighted) showed fat-intensity. Histological examination revealed a teratomatous malformation. Although rare, teratoma should be included in the differential diagnosis of a nasopharyngeal mass in the paediatric age group.     

不伴鼻息肉的慢性鼻-鼻窦炎鼻黏膜组织重塑研究

目的：观察慢性鼻-鼻窦炎不伴鼻息肉（cRssNP）黏膜组织重塑的特点。方法：收集30例CRSsNP患者和10例对照组的钩突黏膜组织,分别进行苏木精一伊红染色、Masson三色胶原染色、阿辛蓝-过典酸-希夫染色及苦味酸-天狼星红染色,观察黏膜上皮损伤、杯状细胞化生、基膜增厚、细胞外基质胶原沉积、腺体增生及胶原组成等情况。结果：①CRSsNP组上皮细胞损伤1级、2级和3级均比对照组明显增多（P〈0．01或P〈0．05）,而损伤0级比对照组明显减少（P〈0．01）。②黏膜下固有层黏液腺增生明显,分泌旺盛,上皮层杯状细胞计数较对照组明显增多（P〈0．01）。③黏膜细胞外基质胶原沉积较对照组明显增多,基膜明显增厚（P〈0．01）。④胶原沉积以Ⅰ型胶原为主,Ⅲ型、Ⅳ型胶原较少。结论：CRSsNP存在明显的鼻黏膜组织重塑,表现为上皮细胞损伤,细胞外基质胶原沉积、基膜增厚、杯状细胞和黏液腺增生。