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Streptococcus pyogenes is the main causative pathogen of recurrent tonsillitis. Histologically, lesions of recurrent tonsillitis contain numerous plasma cells. Strep A is an antigenic carbohydrate molecule on the cell wall of S. pyogenes. As expected, plasma cells in subjects with recurrent tonsillitis secrete antibodies against Strep A. The enzyme‐labeled antigen method is a novel histochemical technique that visualizes specific antibody‐producing cells in tissue sections by employing a biotin‐labeled antigen as a probe. The purpose of the present study was to visualize plasma cells producing antibodies reactive with Strep A in recurrent tonsillitis. Firstly, the lymph nodes of rats immunized with boiled S. pyogenes were paraformaldehyde‐fixed and specific plasma cells localized in frozen sections with biotinylated Strep A. Secondly, an enzyme‐labeled antigen method was used on human tonsil surgically removed from 12 patients with recurrent tonsillitis. S. pyogenes genomes were PCR‐detected in all 12 specimens. The emm genotypes belonged to emm12 in nine specimens and emm1 in three. Plasma cells producing anti‐Strep A antibodies were demonstrated in prefixed frozen sections of rat lymph nodes, 8/12 human specimens from patients with recurrent tonsillitis but not in two control tonsils. In human tonsils, Strep A‐reactive plasma cells were observed within the reticular squamous mucosa and just below the mucosa, and the specific antibodies belonged to either IgA or IgG classes. Our technique is effective in visualizing immunocytes producing specific antibodies against the bacterial carbohydrate antigen, and is thus a novel histochemical tool for analyzing immune reactions in infectious disorders.

口腔底類皮嚢胞は比較的まれな疾患であり，顎舌骨筋と嚢胞との位置関係により舌下型，オトガイ下型，舌下―オトガイ下型の3種類に分類される。術前診断の際には他の頸部嚢胞性疾患との鑑別が必要であり，主に超音波検査，CT，MRIが用いられる。しかしながら，舌骨近傍に発生した場合は正中頸嚢胞などとの鑑別が困難となることがある。症例は19歳男性で3か月前からのオトガイ下腫脹を主訴に受診した。画像診断で類皮嚢胞に典型的な所見を呈さず，確定診断に至らなかった。頸部外切開法にて腫瘤を摘出し，病理検査および術中所見から舌下型類皮嚢胞と診断した。口腔底周囲に発生する頸部嚢胞性疾患の画像診断的特徴についての考察を加え報告する。

The focus of human papilloma virus (HPV), particulary HPV 16 is on the role of carcinogenic and prognostic factors on oropharyngeal squamous carcinoma (OSCC). However, it remains unclear why patients with HPV-positive tumors have better outcomes than those with HPV-negative tumors. Thymidylate synthase (TS) is one of the initial key enzymes in the 5-fluouracil (5-FU) metabolic pathway. Clinical studies showed that intratumoural TS level was related to the response to 5-FU-based chemotherapy in patients with several types of cancer such as gastroenterological and head and neck cancers. We investigated the prevalence of HPV infection and TS expression in the patients with OSCC and evaluated the prognostic implications according to the HPV status and TS expression. We evaluated for high-risk HPV types (HPV 16, 18, 31, 33, 51, 52, 58) using a real-time polymerase chain reaction (RT-PCR) assay on archival biopsies from 54 patients with OSCC. Immunohistochemical assessments for TS were also performed. HPV was positive in 22 (40.7%) of 54 samples. Of these positive cases, 21 (95%) carried HPV 16 and only 1 (5%) HPV58 sequences. TS was overexpressed in 25 (46.3%) of 54 samples. Of these, 19 (76.0%) had an HPV-negative status and 21 (84.0%) were heavy smokers. TS over-expression was associated with the patients with HPV-negative tumors (P = 0.02) and heavy smokers (p = 0.012). Univariate analysis revealed that HPV positive status (77.3% vs. 29.0%; p = 0.006) significantly improved overall survival. Conversely, no remarkable prognostic difference was observed on immunohistochemical analysis of TS expression. A multivariate analysis using Cox's proportional hazard model showed that early T stage (T1-2), early N stage (N0-1), and positive HPV status were significantly independent predictors for superior overall survival. Our studies suggested that positive HPV status was most strongly associated with a favorable prognosis in the patients with OSCC. TS expression has an unusual aspect as a biomarker for OSCC, though it was not related to prognosis.

We reported a case of pediatric thyroid carcinoma. A 10-year-old girl seen for dyspnea on exertion due to bilateral laryngeal paralysis. This was found to have a thyroid tumor in preoperative computed tomography (CT) examination of bilateral laryngeal paralysis. It was diagnosed with papillary carcinoma in fine needle aspiration cytology. We undertook left thyroid lobectomy with isthmus and left side neck dissection. Tracheostomy and glottic dilation was performed to improved dyspnea after thyroid lobectomy. The tumor was diagnosed as poorly differentiated carcinoma with invasion beyond the thyroid capsule, and multiple cervical lymph node metastases were diagnosed histopathologically. Dyspnea was improved by glottic dilation and the tracheosoma could be closed postoperatively. The girl remains alive without recurrence in the 2 years and 6 months since surgery.

We report an unusual case of ectopic cervical thymoma. A 35-year-old female patient presented with an anterior neck mass that developed over a five-month duration. The patient underwent fine-needle aspiration cytology (FNAC) twice, but the tumor type could not be diagnosed. The surgically removed tumor was white in color and had a smooth surface. According to the postoperative pathological examination, the tumor was diagnosed as a Stage I ectopic cervical thymoma and Type B1 according to the Masaoka staging system and the World Health Organization (WHO) histological staging system, respectively. The patient was in good overall health and remained without tumor recurrence at the time of the 10-month follow-up. Because it was difficult to make a preoperative definite diagnosis by FNAC for the thymoma, we constructed a cell block from the existing cytological specimen. Immunohistological staining using the cell-block method clearly demonstrated the biphasic cellular population pattern that is a characteristic of thymoma. Therefore, this method may be useful as a preoperative differential diagnostic modality for cervical thymomas.

From 2000 to 2002, 5 patients with hypopharyngeal carcinoma at Ti and T2 underwent laryngopharyngectomy which preserved laryngeal function. Tumor stage was 3 for T1, 2 for T2, 3 for N0, 1 for N1, and 1 for N2b. All the primary sites were the pirif orm sinus. After lateral neck dissection of the diseased side, it goes into the pharynx on a hyoid level, and the pirif orm sinus was removed with setting to clarify visualization of the tumor. A margin of about 2 cm was attached. We performed complication ablation of a quarter in hyoid and thyroid cartilage of the diseased side. If the arytenoid cartilage had no invasion of tumor, it was preserved. The defect part was reconstructed with the forearm free flap in all examples. As a result, at 15-37 months postoperation, all of the cases are satisfactory for primary control and ingestion of staple foods is possible.

We reported an 11-year-old male with leiomyoma of the parotid gland. He complained of swelling in the left parotid gland, and CT and MRI suggested a benign tumor in the parotid gland.The tumor was removed under general anesthesia.Histopathological and immunohistological studies revealed the tumor to be a vascular leiomyoma.No recurrence was seen in about 5 years of follow-up after operation.

Carcinosarcomas of the nose and the paranasal sinus are moderately rare. We experienced the rare case of a 30-year-old man with left photopsia. CT and MRI findings showed a large tumorous lesion occupying his right nasal cavity and ethomoidal sinus, which had invaded the anterior cranial fossa.Microscopic examination of the biopsy specimen from his nasal cavity revealed a poorly differentiated squamous cell carcinoma. Chemo-and radiotherapy were performed on the nasal and sinus carcinoma, however, the patient died 9 months later.A final pathological examination of the specimen after death showed a carcinosarcoma, which was comprised of both a squamous cell carcinoma and a rhabdomyosarcoma.The sixteen cases of carcinosarcoma of the nose and the paranasal sinus reported in Japan, including our case, were reviewed in this paper