Discrimination of ‘Driver’ and ‘Passenger’ HPV in Tonsillar Carcinomas by the Polymerase Chain Reaction, Chromogenic In Situ Hybridization, and p16INK4a Immunohistochemistry

Human papillomavirus (HPV) positive tonsillar squamous cell carcinoma (TSCC) is associated with a favorable clinical outcome. However, the HPV detected in a given tumor may be causal (driver HPV) or an incidental bystander (passenger HPV). There is a need to discriminate these forms of HPV in TSCCs to understand their impact on HPV as a biomarker for use in TSCC patient management. This study has compared the polymerase chain reaction (PCR), chromogenic in situ hybridization (CISH), and p16^INK4a immunohistochemistry in the assessment of HPV status in TSCC. Archival specimens of TSCC from thirty patients were investigated. HPV was detected by PCR in 25/30 (83.3%) tumors; HPV16 (70.0%) and HPV52 (6.7%) were the most common types. HPV was corroborated by CISH in 22/25 (88.0%) specimens; integrated HPV was implicated by the presence of punctate signals in each of these cases. p16^INK4a staining was found in 20/22 (90.9%) HPV PCR positive samples; two PCR/CISH HPV positive cases were p16^INK4a negative and two HPV negative samples were p16^INK4a positive. These data suggest that a minority of HPV positive TSCCs are positive for passenger HPV and that two or more assays may be required for diagnosing driver HPV status. Further studies are required to exam whether oropharyngeal tumors positive for passenger HPV have a less favorable prognosis than tumors that are driver HPV positive. The clinical significance of TSCCs that test HPV negative/p16^INK4a positive, PCR and CISH HPV positive/p16 ^INK4a negative, or PCR HPV positive/p16 ^INK4a and CISH negative, also requires further investigation.     

Radiographic diagnosis of tonsillar cyst presenting as dysphagia

Tonsillar retention cysts are common and most often asymptomatic. The radiographic demonstration of a retention cyst in a symptomatic patient is reported. Emphasis should be placed on the oropharynx during barium swallow examinations in appropriately symptomatic patients. Tonsillar retention cysts should be included in the differential diagnosis of mass lesions in this area.     

Tonsillar carcinoma

Carcinoma of the tonsil is the second most common malignancy of the head and neck. Various studies have attempted to define the presentation, diagnosis, treatment, and prognosis of these tumors. This report reviews the currently available information on tonsillar carcinoma and discusses treatment options.     

Tonsillar focal infectious disease involving IgA nephropathy,pustulosis, and ossification

We report a rare case of IgA nephropathy (IgAN), that was considered as showing tonsillar focal infection, involving pulmoplantar pustulosis (PPP), and sternocostoclavicular hyperosteosis (SCCH). A 53-year-old man with a 3-year history of PPP had hematuria and proteinuria, and he sometimes had anterior chest pain. He was also diagnosed with IgAN and SCCH. We performed tonsillectomy as a treatment. The tonsillectomy was done with the patient under general anesthesia, and this treatment was followed by steroid therapy. Interestingly, all the symptoms of IgAN, PPP, and SCCH were alleviated 6 months after the tonsillectomy. Thus, tonsillectomy and steroid therapy may be effective and could be considered as treatment for these diseases.     

Frontal sinus dimensions can differ significantly between individuals within a monozygotic twin pair, indicating environmental influence on sinus sizes

Abstract Conclusion: The study showed that the size of the frontal sinus is not determined solely by genotype, but that other factors, e.g. environment, seem to affect the size as well. Environmental factors may include, for example diseases, trauma, allergies, acquired conditions, nutrition or medicine use. Objectives: The purpose of the study was to compare sinus dimensions between individuals within a monozygotic twin pair. Methods: Profile radiographs were obtained from 42 pairs of monozygotic twins, 18 male and 24 female pairs (aged 18-23 years) with no known skeletal deviations in the cranium or general diseases. For each individual the size of the frontal sinus was analyzed on a profile radiograph and compared with the sinus size of the corresponding twin. The variation between twins was estimated using a random effects model for each gender. Results: The sinus sizes varied considerably between twins. The standard deviation between female pairs was 2.98 mm and between male pairs 5.36 mm. The variations in sinus sizes between females and males within twin pairs were not significantly different (p = 0.86 for height and p = 0.83 for width, F test). Still, within one female twin pair and within two male twin pairs, sinus sizes varied significantly between the two individuals.     

颈-颌-扁桃体联合径路手术治疗晚期扁桃体癌

目的：探讨晚期扁桃体高分化鳞癌有效的手术治疗方式及术后缺损的Ⅰ期修复。方法：对2例晚期扁桃体高分化鳞癌患者。行功能性颈清扫术，经颈-颌-扁桃体联合进路切除肿瘤，并采用胸大肌肌皮辩Ⅰ期修复。结果：术后分别随访2和3年，均健在，无肿瘤复发，功能恢复满意。结论：对晚期扁桃体高分化鳞癌手术治疗宜取颈-颌-扁桃体联合径路肿瘤切除术式，配合功能性颈淋巴结清扫术；胸大肌肌皮瓣具有取材方便，肌皮瓣成活率高，适合咽部缺损修复。     

康复新治疗成人急性化脓性扁桃体炎48例临床观察

目的观察康复新液治疗成人急性化脓性扁桃体炎的临床疗效,为化脓性扁桃体炎的治疗方法提供参考依据。方法选取2009年1月至2013年1月门诊及住院治疗化脓性扁桃体炎患者96例,随机分为治疗组和对照组,每组各48例,对所有入选病例均认真详细询问病史、全面体格检查,认真查找病灶,两组均给予抗生素抗感染治疗,治疗组同时予康复新液,每次10ml,3次/d,含5min后吞服,两组均以治疗3d为1个疗程.治疗1个疗程后观察临床疗效及退热时间、咽痛消失时间、治疗时间。结果治愈率治疗组为83.33%,对照组为56.25%,两组相差异有统计学意义（P〈0.05）。总有效率治疗组为93.75%,对照组为72.91%,两组相比较差异有统计学意义（P〈0.05）。退热时间、咽痛消失时间、治疗时间治疗组小于对照组,两组相比差异有统计学意义（P〈0.05）。结论康复新液治疗急性扁桃体炎有较好的临床疗效,可缩短退热时间、咽痛消失时间、治疗时间,值得临床应用。     

Virtopsy post-mortem multi-slice computed tomograhy (MSCT) and magnetic resonance imaging (MRI) demonstrating descending tonsillar herniation: comparison to clinical studies

Descending cerebellar tonsillar herniation is a serious and common complication of intracranial mass lesions. We documented three cases of fatal blunt head injury using post-mortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI). The results showed massive bone and soft-tissue injuries of the head and signs of high intracranial pressure with herniation of the cerebellar tonsils. The diagnosis of tonsillar herniation by post-mortem radiological examination was performed prior to autopsy. This paper describes the detailed retrospective evaluation of the position of the cerebellar tonsils in post-mortem imaging in comparison to clinical studies.Supported by a grant from the Gerbert Ruef Foundation, Switzerland.     

晚期扁桃体鳞状细胞癌的综合治疗及胸大肌肌皮瓣一期修复缺损

目的　探讨晚期扁桃体癌有效的治疗方法。方法　 1991年以来福建医科大学附属第一医院耳鼻咽喉科采用口腔下颌骨升支联合径路切除扁桃体癌 ,胸大肌肌皮瓣一期修复缺损 ,并加功能性颈淋巴结清扫术 ,配合术前化学治疗和术后放射治疗 ,治疗晚期扁桃体鳞状细胞癌 8例。结果　全部病例随访 3～ 9年 ,6例存活 3年以上 ,存活率 6 / 8;2例死亡 ,1例于术后 3个月死于放射性下颌骨骨髓炎大出血 ,1例术后 2年死于食管癌。并发症 :放射性下颌骨骨髓炎 2例 ,术后短暂食物返流入鼻腔 2例。结论　口腔下颌骨升支联合径路 ,可于直视下在肿瘤外 1 0cm的边界范围内安全地将肿瘤完整大块切除。配合功能性颈淋巴结清扫术、术前化学治疗和术后放射治疗 ,对减少肿瘤复发、提高疗效具有重要意义。胸大肌肌皮瓣具有取材方便 ,肌皮瓣成活率高 ,适合咽部缺损修复     

100例扁桃体癌放射治疗分析

1972年 5月至 1 988年 1 2月共收治疗 1 0 0例癌患者。全组均属病理证实 ,计未分化癌 31例 ( 31 % ) ,低分化癌 33例 ( 33% ) ,鳞癌 31例 ( 31 % ) ,腺癌 1例 ( 1 % ) ,乳头癌恶变 1例 ,未分类3例。临床分期 :( 1 987,UICC)Ⅰ期 4例 ( 4 % ) ,Ⅱ期 6例 ( 5 % ) ,Ⅲ期 2 1例 ( 2 1 % )及Ⅳ期 6 9例( 6 9% )。颈部淋巴结转移 :N0 1 8例 ( 1 8% ) ,N1～ 3 82例 ( 82 % )。远距离60 Co照射 5 0～ 70Gy/6～ 8周 ,占 88% ,1 2例患者照射量 <5 0Gy。随诊超过 5年者 93例。 1 ,3,5年生存率分别为 76 0 %( 70 /1 0 0 )、 5 3 0 % ( 5 3/1 0 0 )和 4 9 4 % ( 4 6 /93)。分期早者预后好 ,总剂量大于 6 0Gy为宜 ,年青患者生存率高 ,放疗结束时肿瘤消失者预后好。