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[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.

Adenoids↗

[Lymphocyte subpopulations in the surface secretion on the adenoid].

The significance and protective efficacy of surface secretions on mucosal membranes in the upper airways are well recognized. The aim of our study was to reveal the role of the adenoids as a source of cellular components in the mucosal secretion. The adenoid removed because of its hypertrophy and the samples of surface secretions taken by "imprint method" described by Ebenfelt et al. from the group of 38 children were examined. By flow cytometry the lymphocyte subsets with following antigens: CD3, CD4, CD8, CD19, CD23, CD16+56, CD45RA, CD45RO, HLA-DR were analyzed. The results were compared between the groups of younger and older children and in the group of concomitant otitis media with effusion (OMS) and pure adenoid hypertrophy. The percentage of lymphocyte subsets in adenoid and secretion were similar, except for lymphocytes Th with memory phenotype which were more numerous in the adenoid and lymphocytes B CD23+ which were more numerous in the secretion. In the adenoid the percentage of T and Th lymphocytes increased with age and the percentage of B lymphocytes decreased. In the secretion the percentage of lymphocytes Th and B CD23+ was higher among older children. In cases of otitis media with effusion higher percentage of lymphocytes B (CD19+ and CD19+CD23+) and lower of lymphocytes Ts and Th with naive phenotype were observed in the secretion. In adenoid however lower percentage of lymphocytes B and higher of lymphocytes Ts was observed in cases of OMS.

Adenoidectomy↗

[Allergic origin of recurrent middle ear effusion and adenoids in young children].

Recurrent middle ear effusions and adenoids in children might be caused by mechanical obstruction, infection or allergy. From 1989 to 1990 we examined 35 infants with no history of allergic rhinitis but with recurrent adenoids and middle ear effusions. During operation a skin test was performed for common allergens. Afterwards we tried to identify these allergens by RAST tests on tissue homogenates from the removed adenoids, the middle ear effusion and serum samples. Additionally the IgE levels were determined and the adenoid tissue was examined for eosinophils. In 12 of our 35 children (34%) the skin tests showed an allergy, mostly to different kinds of pollen or house dust. From these positive patients the respective allergens could be determined by RAST tests in serum in 84%, in tissue homogenates from the adenoids in 41% and in the middle ear effusions in 50% of cases. 50% of the children with positive skin tests showed an eosinophilia in the adenoid tissue. We did not find any allergen in the RAST of the infants with negative skin tests. The data show a correlation of allergen specific IgE antibodies in the serum of our patients and in the middle ear and the nasopharynx. Together with an eosinophilia these results suggest an allergic genesis of recurrent middle ear effusions and adenoids in about 20% to 30% of our cases. Early diagnostic procedures to rule out allergy in children with appropriate clinical symptoms are useful, and in positive cases antiallergic treatment is recommended.

Adenoids↗

Fine needle aspiration of adenoid cystic carcinoma metastatic to the lung. Cytologic features and differential diagnosis.

Two examples of adenoid cystic carcinoma metastatic to the lung, one from a Bartholin's gland and the other from a submandibular gland, were sampled by fine needle aspiration. Although the cytologic features of adenoid cystic carcinoma have been well described, it is easy to confuse adenoid cystic carcinoma with other more common primary small-cell neoplasms of the lung; to determine distinguishing features, we compared the cytomorphology of adenoid cystic carcinoma with well-differentiated adenocarcinoma, small-cell undifferentiated carcinoma and carcinoid tumor of the lung. The differential features distinguishing adenoid cystic carcinoma from these other neoplasms include: (1) tight, globular, honey-comb arrangements of cells lacking true nuclear molding; (2) acellular chunks of basal lamina material, which alone may suggest adenoid carcinoma; and (3) the extension of a solid core of basal lamina material beyond a sievelike cellular meshwork. The morphologic expression of metastatic adenoid cystic carcinoma is so distinctive as to permit a definite diagnosis.

Adult↗

[Primary adenoid cystic carcinoma of the skin. Histologic and ultrastructural study of two cases localized in the external auditory canal].

Primary cutaneous adenoid cystic carcinoma is a rare tumor, even if its frequency has often be underestimated, its localization in the external auditory meatus being generally considered separately. The results of the histological and ultrastructural study of two cases of adenoid cystic carcinoma, arising in the external auditory meatus, are presented, confirming the essential morphological similarity of adenoid cystic carcinoma of the skin and salivary glands. In these two cases, the ultrastructural study revealed two types of unique intra luminal inclusions, composed respectively of parallel straight tubular arrays and paracrystalline quadrangular structures, probably corresponding to a peculiar organization of secretion products or cellular debris. The review of 126 published cases of adenoid cystic carcinoma of the skin, including 89 cases developed in the auditory canal, shows that 78% of the cases were located in areas containing numerous apocrine glands, supporting an apocrine gland origin for this tumor. Contrasting with the low (8%) metastatic potential of cutaneous adenoid cystic carcinomas of other locations, adenoid cystic carcinoma of the auditory meatus present a 30% metastatic risk, similar to those or adenoid cystic carcinoma of salivary glands.

Aged↗

Quality of life and health status in pediatric tonsil and adenoid disease.

OBJECTIVE: To assess the baseline global health status and quality of life (QOL) in children with tonsil and adenoid disease. DESIGN: Cross-sectional multicenter survey series. SETTINGS: A tertiary academic pediatric specialty hospital and a tertiary academic hospital in 2 different cities. PATIENTS AND OTHER PARTICIPANTS: Consecutive series of 55 parents of children who were seen for tonsil and adenoid disease. INTERVENTION AND METHOD: Cross-sectional survey of the health status of affected children to assess their QOL and its relationship to tonsil and adenoid disease. MAIN OUTCOME MEASURES: Quality-of-life subscale scores of affected children on the Child Health Questionnaire version PF28 (CHQ-PF28); comparisons of population data from healthy normal children and children with asthma and juvenile rheumatoid arthritis. RESULTS: The overall health status and QOL of children with tonsil and adenoid disease is significantly worse than those of healthy normal children, as demonstrated by lower mean scores on several CHQ-PF28 subscales, including general health, physical functioning, behavior, bodily pain, and parental impact (emotional). In addition, the general health perception of children with tonsil and adenoid disease is similar to the perceptions of children with asthma and juvenile rheumatoid arthritis, but several aspects of health status, as measured by CHQ-PF28 subscale scores, were significantly worse in children with tonsil and adenoid disease. CONCLUSION: The health status impact of tonsil and adenoid disease appears to be quite significant, particularly in aspects related to the parental impact of the child's disease.

Child↗

The human adenoid. A morphologic study.

OBJECTIVE: We examined the route by which antigen on the surface of the adenoid may be brought into contact with the lymphoid follicles in the submucosa of the adenoid. DESIGN: We studied under light and electron microscopy 13 adenoids from children undergoing elective surgery. Portions of all of the specimens were fixed in formalin and embedded in paraffin and plastic for hematoxylin-eosin and periodic acid-Schiff staining. Portions of four adenoids were fixed in glutaraldehyde for electron microscopy. RESULTS: Two major types of epithelium were evident by light microscopy: a ciliated or squamous epithelium containing few lymphocytes and a nonciliated-flat epithelium with a heavy infiltration of lymphocytes ("lymphoepithelium"). Scanning microscopy showed the surface of this lymphoepithelium to be composed largely of cells with multiple microfolds known as M-cells. Freeze-fracture technique showed many lymphocytes under the M-cells. Transmission electron microscopy showed the lymphocytes to be located in compartments formed by the epithelial cells. Light microscopy study of 50 serial sections embedded in plastic suggested that the compartments communicated to form intraepithelial channels for the lymphocytes. CONCLUSION: The epithelium of the adenoid has areas with ciliated epithelium adjacent to areas with epithelium containing M-cells and intraepithelial lymphatic channels. HYPOTHESIS: The lymphoepithelium of the adenoid is a mechanism for transporting antigen via the M-cells to the underlying lymphoid follicles.

Adenoids↗

Adenoid cystic carcinoma: use of cell proliferation, BCL-2 expression, histologic grade, and clinical stage as predictors of clinical outcome.

BACKGROUND: Although the three basic histologic growth patterns of adenoid cystic carcinomas (tubular, cribriform, and solid) provide some indication of clinical outcome, additional, perhaps superior, predictors of biologic activity are needed for patient management. METHODS: This series is composed of 31 adenoid cystic carcinomas that presented in Linköping between 1982 and 1997. The tumors were clinically staged and histologically graded. For each case, after immunohistochemical identification, the proportion of tumor cells expressing the cell cycle markers MIB-1 and bcl-2 (as an indicator of proliferation and apoptosis, respectively) were quantified. Statistical correlation was sought between tumor stage and grade and the two cell cycle markers. RESULTS: The proportions of cycling tumor cells in adenoid cystic carcinomas ranged from 0.3% to 55%. For patients with no evidence of disease and a follow-up of at least 5 years, the mean percent MIB-1 value was significantly lower than for those patients who were alive with local recurrence and/or metastasis or who had died from their adenoid cystic carcinoma (p =. 024). MIB-1 tumor cell positivity also correlated strongly with tumor grade (p =.053), but not with stage (p =.22). Neither clinical stage nor histologic grade correlated with the degree of bcl-2 tumor cell positivity (p =.97 and p =.49, respectively). CONCLUSIONS: Staging and grading continue to play a vital role in the management of patients with adenoid cystic carcinoma. Furthermore, in this series of patients with adenoid cystic carcinoma, a cycling tumor cell population as measured by the MIB-1 antibody greater than 10% indicates this group as biologically more aggressive and at an increased risk for a fatal course.

Adult↗

Primary pulmonary adenoid cystic carcinoma: report of a case diagnosed by fine-needle aspiration cytology.

Adenoid cystic carcinoma of the lower respiratory tract is an uncommon tumor that can arise in the mainstem bronchus and often presents as an endobronchial mass lesion causing bronchial obstruction with post obstructive atelectasis and pneumonia. Exfoliative cytology is seldom useful in the diagnosis of primary bronchial adenoid cystic carcinoma, because these neoplasms usually have a submucosal location with often intact mucosa. Since most endobronchial adenoid cystic carcinomas are endoscopically visible, bronchoscope-guided fine-needle aspiration constitutes an excellent approach to establish a pathologic diagnosis. The fine-needle aspiration cytology of primary pulmonary adenoid cystic carcinoma has been rarely described. We report a case of primary adenoid cystic carcinoma of the lung having characteristic cytologic features and correlate with computed tomography, bronchoscopic, and histological findings. Bronchoscope-guided aspiration cytology provided a conclusive diagnosis of adenoid cystic carcinoma, which was further corroborated by histology in the pneumonectomy specimen. Diagn. Cytopathol. 2004;30:51-56.

Adenoma, Pleomorphic↗

The role of acoustic rhinometry in the diagnosis of adenoidal hypertrophy in pre-school children.

UNLABELLED: Adenoidal hypertrophy is a common problem in pre-school children and diagnosis depends mostly on evaluation of clinical symptoms and signs. Investigative techniques to assess adenoidal size often do not add to this information. Recent reports have suggested a role for acoustic rhinometry in this situation. A total of 49 children consecutively referred to the Department of Otorhinolaryngology, University of Mainz, with evidence of adenoidal enlargement underwent acoustic rhinometry pre- and post-operatively and were compared to an age-matched control group from a local kindergarten school. Adenoidal size was visually estimated at surgery and questionnaires were completed by parents of symptomatic children. Acoustic rhinometry was not able to differentiate controls (mean nasopharyngeal cross-sectional area 1.34+/-0.47 cm2, n = 35) from symptomatic children admitted for adenoidectomy (mean nasopharyngeal cross-sectional area 1.66 +/- 0.83 cm2, n = 42, P = 0.53). Acoustic rhinometry was advantageous for patients with adenoidal hypertrophy in two situations. Firstly a sub-group of patients with complete nasopharyngeal obstruction could be identified (P = 0.03) and secondly all patients with a postnasal space less than 1.2 cm2 clinically benefited from adenoidectomy. CONCLUSIONS: Acoustic rhinometry, in general, is not suitable for assessing adenoidal size in pre-school children. Physical limitations of currently available acoustic rhinometers are likely to explain the limited clinical value of this investigative technique.

Acoustics↗

Spontaneous immunoglobulin production by adenoidal and tonsillar lymphocytes in relation to age and otitis media with effusion.

Spontaneous immunoglobulin (Ig) production by autologous adenoidal and tonsillar lymphocytes cultured without any mitogen was measured by an enzyme-linked immunosorbent assay (ELISA) in 18 children with or without otitis media with effusion (OME). Both IgG and IgA levels synthesized by adenoidal or tonsillar lymphocytes significantly increased with age. The average concentrations of IgG and IgA produced by adenoidal lymphocytes from children with OME were significantly lower than those from children without OME. Adenoidal lymphocytes produced IgG and IgM at significantly lower levels than autologous tonsillar lymphocytes did in children with OME. In contrast, no significant difference between adenoidal and tonsillar lymphocytes was seen on Ig production for any isotypes in children without OME. These results may indicate immunological impairment of the adenoids associated with OME.

Adenoids↗

Specific immune response of the adenoids to a respiratory antigen.

The specific antibody response of the adenoids to a respiratory antigen was investigated, both in vitro and in vivo. The in vitro immunoglobulin (Ig) production of adenoidal and tonsillar lymphocytes in the same patient in 18 cases was measured by an enzyme-linked immunosorbent assay. Adenoidal lymphocytes produced more IgM than IgG or IgA under culture conditions without any mitogens, whereas IgG was the major Ig produced by tonsillar lymphocytes. The same results were obtained when cultured with pokeweed mitogen. Under culture conditions with Dermatophagoides farinae (mite) antigen, adenoidal lymphocytes produced only specific IgM class antibody, and at a level significantly greater than tonsillar lymphocytes. Through an in vivo study, we established experimental adenoidal tissue in the guinea pig by long-term exposure to an ovalbumin aerosol. Infiltration of cells producing the specific antibody against an ovalbumin was demonstrated in the epipharyngeal mucosa using immunofluorescent staining. Our results confirm that the adenoids play a role in specific immune responses to respiratory antigens.

Adenoids↗

Measuring the correlation between adenoidal-nasopharyngeal ratio (AN ratio) and tympanogram in children.

OBJECTIVE: To evaluate the correlation between adenoidal-nasopharyngeal ratio (AN ratio) and tympanogram in children. STUDY DESIGN: A prospective clinical study from June 2002 to May 2003. METHOD: A total of 64 children, aged 6-9 years who presented with nasal obstruction, snoring, mouth breathing, and hyponasal speech were examined and AN ratio was calculated by using the lateral neck radiograms and compared with the tympanometric values. The relationship between AN ratio and middle-ear pressure was evaluated, regarding the AN ratio of 0.71. The chi-square test was used to analyze the correlation between AN ratio and middle ear pressures and Wilcoxon test was used to compare the changes between the mean AN ratio values, and mean middle ear pressures (including A and C type tympanograms) before and after medical therapy. RESULTS: Middle-ear effusions and C type tympanograms in impedance audiometry were both related to eustachian tube dysfunction resulting from enlargement of the adenoids with AN ratios higher than 0.71. Middle ear pressures were found lower in children with AN ratio greater than 0.71 than in children AN ratio less than 0.71 and the difference was highly significant (p<0.001). Although medical treatment of large adenoids was rather effective to shrink the adenoid tissue (p<0.001), it did not cause a statistically significant change in tympanometric values (p>0.05). CONCLUSIONS: Antibiotherapy is effective in reducing adenoid size without signs and symptoms of infection. The reduction of the adenoids in size after 3 weeks of antibiotherapy has an positive effect on recovery of eustachian tube function but is not sufficient in patients with middle ear effusion. Early ventilation tube insertion may be an alternative therapy for the middle ear effusions not improving by 3 weeks medical therapy.

Acoustic Impedance Tests↗

Frequency of pharyngeal reflux in children with adenoid hyperplasia.

OBJECTIVES: The purpose of the study is to investigate whether there is any association between pharyngeal reflux and adenoid hyperplasia by using 24-h esophageal pH monitoring with a dual probe in children. METHODS: The study group consisted of 30 children with adenoid hyperplasia, and the control group consisted of 12 healthy children, studied prospectively. All children underwent 24-h esophageal pH monitoring with a dual probe (distal and proximal esophageal pH monitoring). The results were evaluated by the Measurement and Analysis Software of Medical Measurement System program (Version: 7.2a). RESULTS: In the study group, the frequency of pharyngeal reflux was 46.7% and the gastroesophageal reflux (GER) was 64.5%, while, in the control group, they were 8.3% and 25%, respectively. There was a significant difference between study and control groups for frequencies of pharyngeal reflux and GER. Mean adenoid nasopharyngeal ratio (ANR) was 0.78+/-0.11 in children with adenoid hyperplasia. There was not a significant difference between positive pharyngeal reflux, positive GER and mean ANR (p>0.05). CONCLUSIONS: Children with adenoid hyperplasia had higher frequency of pharyngeal reflux than children at the same age healthy group. These results supported that pharyngeal reflux may play an important role in the etiology of adenoid hyperplasia.

Adenoids↗

Identification of adenoid biofilms in chronic rhinosinusitis.

OBJECTIVE: To compare the percent mucosal surface area of adenoids removed from children with chronic rhinosinusitis (CRS) and those with obstructive sleep apnea (OSA) infected with biofilms. DESIGN: Comparative micro-anatomic investigation of adenoid mucosa using scanning electron microscopy from patients with CRS and OSA. SUBJECTS: 4 females and 12 males ranging from 3 months to 10 years of age. RESULTS: Adenoids removed from patients with CRS had dense mature biofilms covering the mucosal surface. More specifically, adenoids removed from patients with CRS had an average of 94.9% of their mucosal surface covered with mature biofilms vs. an average of 1.9% coverage on the adenoids removed from patients with OSA. These differences were statistically significant at the p<0.001 level. CONCLUSIONS: It is well established that adenoidectomy is useful in the treatment of CRS resistant to antibiotics. Adenoids removed from patients with CRS had almost their entire mucosal surface covered with biofilms vs. scant coverage for patients with OSA (p<0.001). Decreased metabolic activity, decreased growth rate, and transmission of resistance genes all contribute to the antibiotic resistant nature of the biofilms. These metabolically sessile communities shed planktonic microorganisms on an intermittent basis. Therefore biofilms in the nasopharynx of children with CRS may act as a chronic reservoir for bacterial pathogens resistant to standard antibiotics. Also, the mechanical debridement of the nasopharyngeal biofilms may explain the observed clinical benefit associated with adenoidectomy in this subset of pediatric patients.

Adenoidectomy↗

Adenoid cystic breast cancer.

BACKGROUND: Adenoid cystic carcinoma is a rare type of breast cancer that is generally reported in individual case reports or as series from major referral centers. To characterize early diagnostic criteria for adenoid cystic carcinoma and to determine whether breast-preserving surgery with radiotherapy is as effective as mastectomy for eradicating the disease, we reviewed clinical records of a large series of patients treated for adenoid cystic carcinoma of the breast at a large health maintenance organization (HMO) that includes primary care facilities and referral centers. METHODS: Using the data bank of the Northern California Cancer Registry of the Kaiser Permanente Northern California Region (KPNCR), we retrospectively reviewed medical records of patients treated for adenoid cystic carcinoma of the breast. Follow-up also was done for these patients. RESULTS: Adenoid cystic carcinoma of the breast was diagnosed in 22 of 27,970 patients treated for breast cancer at KPNCR from 1960 through 2000. All 22 patients were female and were available for follow-up. Mean age of patients at diagnosis was 61 years (range, 37 to 94 years). In 17 (77%) of the women, a lump in the breast led to initial suspicion of a tumor; in 4 (23%) of the 22 patients, mammography led to suspicion of a tumor. Median tumor size was 20 mm. Pain was a prominent symptom. Surgical management evolved from radical and modified radical mastectomy to simple mastectomy or lumpectomy during the study period, during which time 1 patient died of previous ordinary ductal carcinoma of the contralateral breast, and 7 died of unrelated disease. At follow-up, 12 of the 13 remaining patients were free of disease; 1 patient died of the disease; and 1 patient remained alive despite late occurrence of lymph node and pulmonary metastases. CONCLUSIONS: Whether breast-preserving surgery with radiotherapy is as effective as mastectomy for treating adenoid cystic carcinoma of the breast has not been determined.

Adult↗

How should adenoidal enlargement be measured? A radiological study based on interobserver agreement.

Clinical assessment of adenoidal size is difficult, and an objective measurement is desirable. To establish the best radiological method, lateral cephalometric radiographs were taken of 38 children three days before their adenoids were removed. Two radiologists each made five measurements related to adenoidal size on ech radiograph, and the correlations between the radiological measurements and between the measurements and the volume of tissue removed at operation were calculated. Linear measurement of the palatal airway at the narrowest point between the outlines of the adenoid and soft palate is the simplest method to use and shows good correlation between observers. It is recommended for clinical use. Measurement of the nasopharyngeal soft tissue area show equally good observer correlation and better correlation with the volume of adenoid removed at operation. This method appears more suitable for longitudinal studies of adenoidal size.

Adenoids↗

Resistant bacteria in the adenoid tissues of children with otitis media with effusion.

OBJECTIVE: To investigate the relationship between the resistant bacteria in the adenoid tissue and the middle ear effusion of children who underwent myringotomy and adenoidectomy with the diagnosis of otitis media with effusion (OME). METHODS: This study was performed in the ENT Clinic, Firat University between January 2001 and June 2001. Forty-one subjects who were enrolled in the study were diagnosed as OME, their age ranged from 1 to 11 years, and they underwent a myringotomy together with an adenoidectomy because of adenoid hyperthrophy. Bacteriological cultures were performed on the samples obtained from adenoid tissues and middle ear fluids, in the bacteria that were cultured; the resistance to oxacilline sodium and beta-lactamase were investigated. The resistance of penicillin was confirmed by MIC test. The control group composed of individuals who did not have OME but who underwent adenotonsillectomy due to adenotonsillary hyperthrophy. RESULTS: In the adenoid tissue cultures; Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis species were isolated from the 70% (29/41) of the study group and 40% (20/41) of the control group (P<0.01). In the isolated bacteria, the resistance rates for oxacilline or beta-lactamase were found to be 48% (20/41) in the study group and 16% (4/25) in the control group (P<0.05). We observed that bacterial growth in 29% (9/31) of the middle ear cultures of the study group and resistant bacteria were isolated in 77% (7/9) of them. The same pathogens which have grown in the middle ear cultures were also present in the adenoid tissue cultures. CONCLUSION: The isolation of resistant bacteria in most of the adenoid tissue samples of the children with OME, makes us to consider the possible role of these bacteria in the development of OME.

Adenoidectomy↗