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PubMed1997

Adenoid basal carcinoma of the uterine cervix: immunohistochemical study and literature review.

Adenoid basal carcinoma of the uterine cervix is rare and its cell origin is still obscure. We report a case of adenoid basal carcinoma of the uterine cervix discovered incidentally in a 69-year-old woman who had been hysterectomized due to endometrial adenocarcinoma of the uterine corpus. Histologically, small round-to-oval cancer cell nests with peripheral cell palisading were seen budding from the basal cell layer of the uterine cervix showing carcinoma in situ. Immunohistochemically, the basaloid cells of the adenoid basal carcinoma were positive for keratins 14, 17 and 19 and resembled reserve cells of the cervical epithelium. The results of this study clearly demonstrated that adenoid basal carcinoma shows a phenotype similar to reserve cells of the uterine cervix. A review of the literature indicated that this tumor has a favorable prognosis and should be clearly separated from adenoid cystic carcinoma, which has a much poorer outcome.

Aged↗
PubMed2002

Solid variant of mammary adenoid cystic carcinoma with basaloid features: a study of nine cases.

Adenoid cystic carcinoma of the breast is a rare neoplasm that represents <1% of breast carcinomas. The tumors are histologically indistinguishable from examples in other sites, and they have a generally favorable prognosis. Several studies have investigated the possible correlation between histologic grade in adenoid cystic carcinoma (largely determined by cytology and growth pattern) and prognosis. Some earlier reports concluded that a solid variant of mammary adenoid cystic carcinoma had a more aggressive clinical course, but others did not confirm this impression. This report describes nine patients with a solid variant of mammary adenoid cystic carcinoma that has a striking basaloid appearance. All were women ranging in age from 37 to 83 years. A solitary mass was evident in all patients. Tumor size was 1.1-15 cm (mean 3.7 cm). The tumors exhibited a predominantly solid architecture comprised of basaloid appearing cells with moderate to marked nuclear atypia. Five tumors had >5 mitotic figures per 10 high power microscopic fields. Intercalated ducts were found in all tumors, being well formed in six and poorly formed in three. Immunohistochemical stains for cytokeratins, basement membranes, and vimentin were consistently positive. Surgery was performed in all cases consisting of excision in seven and mastectomy in two. Axillary lymph node metastases were found in two of six axillary dissections and four had negative lymph nodes. The lymph nodes were not examined in three patients. Follow-up information was available for seven patients. Six women had no evidence of disease after follow-up of 2-88 months (mean 32 months), one patient died of unknown causes, and one patient was lost to follow-up. It is concluded that the solid variant of mammary carcinoma with basaloid features is a histologically distinct tumor that is capable of axillary metastases. Long-term follow-up of a larger series of cases will be needed to determine whether the prognosis of these patients differs significantly from that of women with conventional adenoid cystic carcinoma. Presently, these patients are candidates for axillary staging by sentinel lymph node mapping or low axillary dissection if there is no clinical evidence of axillary metastases. Systemic adjuvant treatment would be prudent when axillary nodal metastases are present. Breast-conserving surgery with radiation is an option if negative margins can be achieved because this appears to be a unicentric form of carcinoma.

Adult↗
PubMed1996

Adenoid cystic carcinoma of the submandibular gland with symptomatic ovarian metastases.

We report the clinical and pathologic features of an adenoid cystic carcinoma of the submandibular gland that metastasized to the ovaries 10 years after initial presentation. A 30-year-old woman underwent excision of a right submandibular adenoid cystic carcinoma followed by regional external beam radiation therapy. Three years later, she underwent extended hepatic resection and localized radiotherapy to the hepatic region for metastatic disease. The patient was without evidence of disease for 7 years when she developed pelvic pain and a pelvic mass was found. A solid and cystic 10-cm left ovarian mass and a single metastatic tumor nodule involving the right ovary were excised via the laparoscope. Histologically, the tumor was identical to the patient's initial salivary gland neoplasm. The neoplastic cells were CAM 5.2 positive, S100 positive, muscle-specific actin positive, and smooth muscle actin positive. Ultrastructurally, characteristic pseudocysts (pseudolumina) with abundant basal lamina and true glandular lumina lined by short microvilli were present. Other than a single anecdotal account of a parotid gland adenoid cystic carcinoma, this case represents the first documented report of an adenoid cystic carcinoma of salivary gland origin that was associated with symptomatic ovarian metastases. This case demonstrates that the ovary is a potential site for metastatic disease many years following the diagnosis and treatment for a primary neoplasm however uncommon or remote the site of origin. Since metastatic adenoid cystic carcinoma can rarely present as an ovarian mass, a clinical history of this neoplasm should be heavily weighed in the differential diagnosis of any unusual ovarian tumor with a predominant cribriform, trabecular, or tubular pattern.

Adult↗
PubMed2006

Human papilloma virus in hyperplastic tonsillar and adenoid tissues in children.

BACKGROUND: Human papillomavirus (HPV) in childhood causes skin and anogenital warts as well as the recurrent respiratory papillomatosis, a life-threatening cause of upper airway obstruction in children. To date, the information on HPV infection in tonsillar and adenoid hyperplasia in children is limited. PURPOSE: The purpose of this study was to investigate the presence of HPV DNA in children with benign tonsillar and/or adenoid hyperplasia. METHODS: One hundred six samples of paraffin-embedded adenoid and/or tonsillar tissues from 102 children, 57 girls and 45 boys (age range, 2-14 years), were tested for the presence of HPV DNA using polymerase chain reaction (PCR) with general primers GP5+/GP6+. HPV typing was performed by PCR with specific primers for HPV-16, -18, -33 and -11. RESULTS: HPV DNA was detected in 9 (8.5%) of the 106 collected specimens. The frequencies of HPV typing were 6 of 9 (66.7%) for HPV-16, 2 of 9 (22.2%) for HPV-11, zero of 9 (0%) for HPV-33 and HPV-18, whereas one HPV-positive sample remained untyped. No multiple HPV infection was detected. HPV was detected in 6 (9.4%) children with tonsillar hyperplasia and in 3 (7.1%) with adenoid hyperplasia. The mean age of children with HPV-positive specimens was lower than that of HPV-negative children (P = 0.006). No statistical correlation in the prevalence of HPV infection was observed according to children's sex, origin or residence (urban or rural). CONCLUSION: Although the significance of the presence of HPV DNA in tonsillar and adenoid hyperplasias remains obscure, the PCR detection of high-risk HPV DNA should be evaluated cautiously.

Adenoids↗
PubMed2005

Platelet endothelial cell adhesion molecule-1 is expressed in adenoidal crypt epithelial cells.

The adenoidal epithelial crypt is a potential site of antigen transport from pharyngeal lumen to adenoidal tissue. The base of the crypt is consistently infiltrated with leucocytes, forming a reticular lymphoepithelial structure. To evaluate mechanisms that possibly mediate leucocyte infiltration, expressions of leucocyte adhesion molecules, such as platelet endothelial cell adhesion molecule-1 (PECAM-1) (CD31), vascular cell adhesion molecule-1 (VCAM-1) (CD106) and intercellular adhesion molecule-1 (ICAM-1) (CD54), were studied in the adenoidal epithelial crypt. Epithelial cells in the outer opening of the adenoidal crypt were positive for VCAM-1, whereas epithelial cells at the base of the crypt were positive for PECAM-1. Isolated ICAM-1-expressing cells were found throughout the epithelial crypt. Double immunofluorescence staining revealed that the epithelial cells positive for PECAM-1 or VCAM-1 were positive for cytokeratin. The expression of PECAM-1 in the base and VCAM-1 at the orifice of the adenoidal epithelial crypt implies that the base and the orifice of the crypt have a distinct ability to recruit leucocytes. Epithelial cells expressing PECAM-1 may have a role in the formation of the reticular lymphoepithelial structure in the epithelial crypt.

Adenoids↗
PubMed1990

Lymphoid and non-lymphoid cells in the adenoid of children with otitis media with effusion: a comparative study.

We characterized on immuno- and enzymecytochemical level the lymphoid and non-lymphoid cells in the adenoid of children with upper respiratory tract infections (URI) and otitis media with effusion (OME) and compared these with the adenoid of children with URI without OME and with the adenoid of 'healthy' children and adults. Besides macrophages and dendritic cells we also showed the presence of MHC class II positive, ciliated, epithelial cells. These non-lymphoid cells were present in all adenoids. However, their number was less than 1% of all cells. We found no difference in lymphocyte subsets from children with URI + OME compared with those from children with URI alone. These two groups showed a significant decrease of CD8-positive (suppressor/cytotoxic) cells and a slight increase in CD22-positive B cells in comparison to 'healthy' children. No difference was found in percentages of CD4-positive (helper/inducer) cells. The localization of the lymphoid subsets in adenoids of children with URI and/or OME did not differ from those of 'healthy' children and adults.

Adenoids↗
PubMed1993

Adenoid tissue lymphocyte subpopulations--evaluation of a quantitative analysis with flow cytometry.

Secretory otitis media (SOM) is a common childhood disease without a completely clarified etiology. A chronic inflammatory condition in the nasopharynx, presumably caused by an increased bacterial load, is one factor of probable etiological importance. In the present study a flow cytometric method for analysis of adenoid lymphoid cell populations was developed to facilitate quantitative comparisons between children with SOM and children without ear disease. Adenoids removed from 18 children due to adenoid hyperplasia and obstructive symptoms were studied. Results of the flow cytometric analysis correlated well with the findings from immunohistological studies of five of the adenoids. PCA-1 and CD25 were found to be good markers of increased cellular activity after non-specific stimulation in cell culture. It is concluded that the flow cytometric method is suitable for further quantitative analysis of adenoid tissue.

Adenoidectomy↗
PubMed1996

B- and T-lymphocyte subpopulations in the adenoids of children with otitis media.

Adenoid hyperplasia is connected with the pathogenesis of otitis media in children, as implicated by the residence of pathogens causing otitis media in adenoids, and by the beneficial effect of adenoidectomy. We have quantitated the proportions of certain T- and B-lymphocyte subsets in the adenoids by three-color flow cytometry. Three groups were studied: 1) children with persistent effusion in the middle ear (pOME), 2) children with recurrent otitis media with no effusion in the middle ear at the time of surgery (rAOM), and 3) children with adenoid hyperplasia without otitis media (AH) presenting either with snoring or upper respiratory tract infections. B lymphocytes comprised on average 64, 66 and 58% of all mononuclear cells in the respective patient groups. The majority of the B lymphocytes were of the follicular mantle zone phenotype expressing surface IgD (on average 69, 67 and 70% of all B lymphocytes in the respective patient groups). Almost one third of the B lymphocytes were of the germinal center cell phenotype, expressing CD38 but negative for surface IgD (on average 29, 30 and 25% in the respective patient groups). CD3+ T lymphocytes comprised 33, 33 and 40%, respectively, of all mononuclear cells, and the average CD4+/CD8+ ratio was 5.2, 4.9 and 5.7, respectively. No statistically significant differences between the patient groups were seen in these T- and B-lymphocyte subpopulations. These results suggest that the relative sizes of the germinal center, follicular mantle and interfollicular compartments of the adenoids do not correlate with the disease status of the middle ear cavity.

Adenoidectomy↗
PubMed1999

Cervical adenoid cystic carcinoma coexisting with multiple human papillomavirus-associated genital lesions. A common etiology?

Adenoid cystic carcinoma of the uterine cervix is a rare tumor with unknown etiology. We report a case of adenoid cystic carcinoma occurring in a young woman, associated with multiple human papillomavirus (HPV)-related lesions including condyloma acuminata, vulvar intraepithelial neoplasm, cervical intraepithelial neoplasm and invasive basaloid squamous cell carcinoma. While adenoid cystic carcinoma has previously been found to coexist with squamous cell carcinoma or cervical intraepithelial neoplasia, its association with such a variety of HPV-related lesions in our case has not been previously reported, and raises the speculation that HPV may also be the causative factor for adenoid cystic carcinoma. However, in situ DNA hybridization and polymerase chain reaction in our current study failed to demonstrate the existence of HPV DNA in adenoid cystic carcinoma.

Adult↗
PubMed2003

Increased levels of IL-2 and IL-4 in stimulated adenoidal lymphocytes of atopic children.

BACKGROUND: The adenoid is involved in the defence against airway pathogens and its surface is also exposed to airborne allergens. The knowledge about reactions taking place in the lymphatic tissue of this organ is, however, limited. To elucidate the influence of atopy we investigated the cellular and cytokine profile of in vitro-stimulated adenoid lymphocytes. METHODS: Adenoid tissue cells from 13 atopic and 8 non-atopic children were cultured and stimulated with ionomycin and 4beta-phorbol 12-myristate 13-acetate. Supernatants were collected after 4 and 20 h of stimulation and interleukin-2 (IL-2), IL-4 and interferon-gamma (IFN-gamma) were analysed by ELISA. Flow cytometry was used to quantify the leukocyte markers CD3, CD19, CD25 and HLA-DR. RESULTS: Increased levels of IL-2 and IL-4 but not IFN-gamma were detected in the supernatants of adenoid cell cultures from atopic children after 20 h of stimulation (p < 0.05) and a significant correlation with a positive regression between IL-2 and IL-4 was found. Atopy was also associated with a greater increase in the percentage of CD19-positive B cells after stimulation (p < 0.05). CONCLUSIONS: A difference in the reactivity of adenoidal lymphoid cells in children was observed between atopic and non-atopic subjects. Atopy was associated with an increased production of IL-2 and IL-4 as well as a more pronounced increase of B cells.

Adenoids↗
PubMed2006

Expression of Fas ligand and CTLA4 in adenoids has a predictive value for allergic rhinitis development in children.

BACKGROUND: The balance of CD28/CTLA4-derived signals and Fas-dependent apoptosis activity is determined by the peripheral defense mechanisms and might play a role in the pathogenesis of allergy. OBJECTIVES: The aim of the study was to investigate the expression of costimulatory and pro- and antiapoptotic molecules in adenoid T cells of children suffering from allergic rhinitis and to find out which of these molecules have a predictive value in the development of allergic rhinitis. METHODS: The adenoids of 60 children, removed because of nasal obstruction, chronic rhinitis and recurrent respiratory infection, were evaluated. Patients were divided into two groups: group 1, suffering from chronic allergic rhinitis, and group 2, suffering from chronic rhinitis, where no specific IgE was detected, including children with a positive family history of allergy (group 2a) and children with neither a personal nor a family history of allergy (group 2b). For immunohistochemical stainings anti-CD3, anti-CD19, anti-CD4, anti-CD8, anti-CD25, anti-CD28, anti-CTLA4 (CD152), anti-bcl-2, anti-Fas, and anti-FasL antibodies were used. The number of cells expressing these molecules was identified in adenoid interfollicular spaces. The results were then analyzed in allergic and nonallergic children. During a 24-month follow-up children were re-examined for allergy and results were compared to previous immunohistochemical evaluations. RESULTS: The expression of CD4, CD25, CD28, FasL, and CTLA4 was significantly increased in group 1 compared to group 2 (p < 0.05). However, the discriminant analysis confirmed that only CTLA4 and FasL expression fully discriminated allergic subjects from the others. During a 24-month period of observation 8 children from group 2a were also diagnosed with allergic rhinitis. All of them, especially those sensitized to mites, had an increased number of FasL+ and CTLA4+ in previously removed adenoids. CONCLUSION: An increased number of cells with intracellular expression of FasL and CTLA4, in interfollicular spaces of adenoids, seems to be a predictive factor of the development of allergic rhinitis.

Adenoids↗
PubMed2004

Effect of antimicrobial therapy with amoxicillin and cefprozil on bacterial interference and beta-lactamase production in the adenoids.

To compare the effects on the bacterial flora of the adenoids of antimicrobial therapy with amoxicillin or cefprozil, we enrolled in a prospective randomized study 60 children scheduled for elective adenoidectomy because of recurrent otitis media. They were randomized before surgery into 3 groups of 20 patients each: a no-therapy group, and groups with 10 days of either amoxicillin or cefprozil therapy. Core adenoid materials were quantitatively cultured for aerobic and facultative bacteria. The in vitro ability of alpha-hemolytic streptococci (AHS) to inhibit the growth of non-type B Haemophilus influenzae and Streptococcus pneumoniae was determined. The number of organisms in adenoids obtained from patients treated with either antibiotic was reduced as compared to that in adenoids from controls. However, in patients treated with amoxicillin, a significant decline in the number of AHS, and an increase (in Staphylococcus aureus) or no change in the number of other beta-lactamase-producing bacteria (BLPB) was noted. In contrast, in those treated with cefprozil, no change was noted in the frequency of recovery of AHS, and the number of BLPB decreased. Interfering AHS were more often recovered in patients treated with cefprozil. We conclude that the adenoids contain more interfering AHS after therapy with a second-generation oral cephalosporin (cefprozil) than after amoxicillin therapy. This study suggests a potential beneficial effect of using an antimicrobial that selectively spares interfering AHS while inhibiting BLPB.

Adenoids↗
PubMedDate not supplied

Adenoid cystic carcinoma of the subglottic region.

Adenoid cystic carcinoma is one of the most common malignancies of the minor salivary glands in the head and neck. However, adenoid cystic carcinoma of the larynx is very rare, with less than 75 cases reported in the literature. We present three cases of adenoid cystic carcinoma of the subglottic region with 6-year, 9-year, and 18-year follow-up, respectively. The literature on adenoid cystic carcinoma of the subglottic area is reviewed. Symptoms of long duration, slow progressive growth with tendency for local recurrence, and eventual development of pulmonary metastasis is common. Five-year survival statistics do not appear as relevant as 10- and 20-year survival rates in this entity because of the often slow but pernicious nature of adenoid cystic carcinoma of the subglottic area. Despite aggressive therapy, the disease often leads to the eventual death of the patient. In our series one patient died, and two patients are alive and free of disease. The evaluation, treatment, and clinical course of this disease is discussed.

Adult↗
PubMedDate not supplied

Radiographic evaluation of the symptom-producing adenoid.

Adenoid hypertrophy has several variable symptoms. In this study, symptoms were divided into minor and major. A lateral radiograph of the nasopharynx was performed in 114 patients to study the superior and antroadenoid diameters. With proper statistical analysis, a correlation was made between the various clinical groups (scores) and the adenoid measurements. Our results support Hibbert's findings that the antroadenoid width is a better indicator of the symptom-producing adenoid than adenoid mass measurements with their loosely defined norms. A thorough history and physical examination remain paramount in the diagnosis and management of adenoid hypertrophy.

Adenoids↗
PubMed2002

High mobility group box chromosomal protein 1 (HMGB1) is an antibacterial factor produced by the human adenoid.

Antibacterial factors were purified from human adenoid glands by tissue extraction and consecutive steps of reversed-phase chromatography and assayed for bactericidal activity against the airway pathogen Moraxella catarrhalis and also Escherichia coli and Bacillus megaterium. One of the most active components isolated from adenoids was identified by N-terminal sequence analysis and mass spectrometry as high mobility group box chromosomal protein 1 (HMGB1). This novel finding was further substantiated by Western blot analysis, demonstrating a protein of expected size reactive with HMGB1 antiserum. Local synthesis was confirmed by reverse-transcriptase PCR and in situ hybridization. Adenoid-derived HMGB1 and recombinant HMGB1 revealed comparable antibacterial activity at high rate. More than 95% of bacteria were eradicated within 5 min by HMGB1 in the cultures. Secretion from the adenoid gland surface was also demonstrated to contain antibacterial activity, mainly mediated by alpha-defensins, but not by HMGB1. We conclude that HMGB1, produced and stored intracellularly in the adenoid gland, contributes to the local antibacterial barrier defense system in the upper respiratory tract.

Adenoids↗
PubMed1994

Intraepithelial lymphocyte subpopulations and dendritic accessory cells in normal and hypertrophic adenoids.

The adenoids have been studied by immunocytochemistry and electron microscopy in children with and without adenoidal enlargement. Compared with normal adenoids, the enlarged ones showed a marked increase in the number of intraepithelial gamma-delta TCR+ lymphocytes and a slight increase in the number of intraepithelial CD8+ lymphocytes. This was accompanied by large amounts of dendritic human lymphocyte antigen (D related) (HLA-DR+) S-100+ accessory cells in the lymphoid tissue underlying the epithelium. By electron microscopy, dead epithelial cells apposed to intraepithelial lymphocytes, and clefts of the epithelial lamina, could be seen frequently in the enlarged adenoids, whereas, in the normal ones, they could not. Based on these findings, the hypothesis is drawn that imbalance of the system of the intraepithelial cytotoxic lymphocytes may lead to increased killing of epithelial cells and uncontrolled penetration of exogenous agents, and hence be involved in the pathogenesis of adenoidal hypertrophy.

Adenoids↗
PubMed1998

Assessment of adenoidal obstruction in children: clinical signs versus roentgenographic findings.

OBJECTIVE: As part of a comprehensive study of indications for tonsillectomy and adenoidectomy, we investigated the reliability of standardized clinical assessments and standardized roentgenographic assessments of adenoidal obstruction of the nasopharynx, and the degree of correlation between clinical assessments and roentgenographic assessments. METHODS: We rated the degree of patients' mouth breathing and patients' speech hyponasality on a 4-point scale (none = 1; mild = 2; moderate = 3; marked = 4), we averaged the ratings for each child to obtain a Nasal Obstruction Index, and we determined levels of interobserver agreement concerning the ratings. We classified lateral soft-tissue roentgenograms of the nasopharynx, based on assessments of adenoid size and of nasopharyngeal airway patency, as showing either no obstruction, borderline obstruction, or obstruction, and we determined levels of inter- and intraobserver agreement concerning the classifications. Finally, we determined correlations in individual patients between clinical ratings and roentgenographic ratings of nasal/nasopharyngeal obstruction, and calculated the predictive values of clinical ratings based on roentgenographic ratings as the gold standard. RESULTS: In sets of paired examinations, weighted kappa values for interobserver agreement concerning mouth breathing (total, 235 children) and speech hyponasality (total, 648 children) ranged from 0.84 to 0.91. The value for interobserver agreement concerning roentgenographic assessment of nasopharyngeal airway status (207 children) was 0.92, and for intraobserver agreement (191 children) 0.88. The Kendall's tau b value for concordance between Nasal Obstruction Index values and roentgenographic ratings (1033 children) was 0.51. Nasal Obstruction Index values at the lower and upper extremes--i.e., 1.0 and > or = 3.5, respectively--were highly predictive of concordant roentgenographic ratings. CONCLUSIONS: We conclude that standardized clinical ratings of the degree of children's mouth breathing and speech hyponasality provide reliable and reasonably valid assessments of the presence and degree of adenoidal obstruction of the nasopharyngeal airway. These clinical assessments are particularly valid at the extremes of either marked obstruction or no obstruction. Clinical assessment alone may be insufficient to establish the presence of adenoidal obstruction, but clinical assessment alone when findings are unequivocally negative can suffice to rule out adenoidal obstruction with a high degree of confidence.

Adenoidectomy↗
PubMed2006

Growth of the nasopharynx and adenoidal development in Brazilian subjects.

The purpose of this research was to study the growth of the nasopharynx and adenoid development. Lateral cephalometric radiographs obtained from 320 white Brazilian subjects between 4 and 16 years of age were used. All the participants were nose breathers and none of them had previously undergone adenoidectomy. Tracings were made from the radiographs and cephalometric measurements were performed. The results showed that adenoid sagital thickness is larger in the age group 4 - 5 years and decreases progressively. There is a slight increase in the age group 10 - 11 years, but afterwards the decrease continues. However, the nasopharyngeal free airway space does not decrease in the age group 10 - 11 years, despite the increasing thickness of the adenoid. This is attributable to the downward displacement of the hard palate, resulting in an increase of the free airway space due to growth. Although the nasopharynx follows a growth pattern similar to that of the rest of the body, adenoid tissue does not. Adenoidal development seems to differ from that of other lymphatic tissues, showing a peculiar pattern that can be revealed when hypertrophy due to infections and allergies is eliminated.

Adenoids↗