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Lymphoid papillary hyperplasia of the tonsils is a rare, benign lesion and is characterized by a papillomatous appearance with reactive follicular hyperplasia. Our case was unique because the lesion involved the unilateral and focal palatine tonsil, as the lesion usually involves the bilateral and entire palatine tonsils.

The riboswitch is a class of RNA-based gene regulatory machinery that is dependent on recognition of its target ligand by RNA tertiary structures. Ligand recognition is achieved by the aptamer domain, and ligand-dependent structural changes of the expression platform then usually mediate termination of transcription or translational initiation. Ligand-dependent structural changes of the aptamer domain and expression platform have been reported for several riboswitches with short (

Background: Mucoepidermoid carcinoma (MEC) is the most common malignant salivary glandtumor. Histological diagnosis of MECs that exhibit classical histological features is not difficult. However,diagnosis of some histological variants or high-grade MEC tumors can be challenging because of overlapsin histological features with other diseases. Recently, chromosomal translocations in salivary glandtumors have been recognized, and the detection of MAML2 rearrangements can support the pathologicaldiagnosis of MECs. Recently, MECs without MAML2 rearrangements might be reclassified as hyalinizingclear cell carcinoma (HCCC) based on the detection of EWSR1 -ATF1 gene fusions. The present studyaimed to investigate the presence of MAML2 and EWSR1 rearrangements in MECs via fluorescence insitu hybridization (FISH).Materials and methods: We retrospectively analyzed tumor samples from five MEC patients diagnosed inour hospital between 2008 to 2015. A total of six tumors from the five cases were pathologically evaluatedand subjected to FISH analysis, which was performed using a MetaSystems image analysis system.Results: The median age of the patients was 75 years (range: 32-79), with the majority of patientsbeing male (male to female ratio, 4:1). The localization and pathological classification (histologicalgrade, histological variant) of the six tumors were parotid gland/low grade/classical histology (n=2),submandibular gland/low grade/clear cell variant (n=1), lung/high grade (n=1), lung/low grade/classical(n=1), and maxillary sinus/low grade/clear cell variant (n=1). Less than 10% of the background nonneoplasticcells showed split signals of MAML2 . Positive MAML2 rearrangements were observed in twoparotid tumors and one maxillary sinus tumor because each tumor showed over 90% of MAML2 splitsignals. The other tumors appeared to show equivocal results for MAML2 rearrangement. No EWSR1rearrangements were detected in all cases, suggesting that HCCC was not present.Conclusion: FISH was found to be effective for obtaining conclusive MEC diagnoses with small biopsysamples. However, this method may have a high rate of returning equivocal results, thereby limiting itsuse in confirming the presence of gene rearrangements.

A 35-year-old Japanese man who had experienced hoarseness for 10 years presented with a vocal cord lesion. A gross examination revealed a left vocal cord polyp occupying two-thirds of the vocal space. The endoscopically resected lesion contained scattered atypical fibroblastic, stellate, or ganglion-like cells with mucoid stroma. Vacuolated cells were also seen. Lymphoplasmacytic infiltrate was largely undetectable. A vocal cord polyp was first suspected, but well-differentiated liposarcoma and inflammatory myofibroblastic tumor (IMT) were included in the differential diagnoses. The tumor cells were positive for anaplastic lymphoma kinase (ALK), calponin, and vimentin, and negative for other smooth muscle markers by immunohistochemistry. Structures resembling myofibroblasts were not observed by electron microscopy, which confirmed abundant rough endoplasmic reticulum in the tumor cells and accumulated lipid droplets in some tumor cells. ALK gene rearrangement was detected by fluorescence in situ hybridization, and TIMP3-ALK fusion was confirmed by 5' rapid amplification of cDNA ends. We diagnosed the lesion as an IMT, and an ALK-rearranged stellate cell tumor may be postulated. This is the first report of a fusion partner gene of ALK in a case of laryngeal IMT.

In this paper, we report a rare tumor arising in the nasal cavity here.

Background Warthin tumor is a common, benign, painless salivary gland neoplasm. Rarely, Warthin tumors show large areas of squamous metaplasia; such Warthin tumors are called metaplastic or infarcted Warthin tumors because they are occasionally accompanied with tumor necrosis. The histological distinction between mucoepidermoid carcinomas and the metaplastic portions of Warthin tumors can be challenging; without a genetic study, mucoepidermoid carcinomas can be misdiagnosed as metaplastic Warthin tumors. We report a case of infarcted Warthin tumor partly showing mucoepidermoid carcinoma-like epithelial metaplasia. Only two cases of infarcted Warthin tumor similar to our case have been reported. Case presentation A 69-year-old Japanese man presented with a right parotid tumor. He had noticed the swelling on his right buccal region 1 year previously; the lesion had rapidly enlarged, with associated pain, 1 month previously. A radiological examination revealed a mass in the tail of the right parotid gland. Superficial parotidectomy was performed. On histological examination, the mass showed typical focal features of Warthin tumor; other areas showed coagulation necrosis of the tumor. These areas were surrounded by non-oncocytic epithelium comprising squamous and mucinous epithelial cells. Although cellular atypia of the non-oncocytic epithelium was not observed, a mixture of squamous and mucinous cells and lack of abundant lymphoid tissue mimicked low-grade mucoepidermoid carcinoma. Based on the results of fluorescence in situ hybridization, MAML2 gene rearrangement was not present in the typical portions of Warthin tumor and the mucoepidermoid carcinoma-like lesion. Therefore, a metaplastic or infarcted Warthin tumor was diagnosed. Our patient was disease-free 8 months after surgery. Conclusions Clinicians need to know that pain is a clinical symptom of infarcted/metaplastic Warthin tumor. Pathologists should be aware that a metaplastic Warthin tumor can mimic a low-grade mucoepidermoid carcinoma. Our case showed a mucoepidermoid carcinoma-like lesion that was confined near the area of tumor necrosis, and neither cytological atypia nor apparent invasive growth was present. These findings appeared to be histological clues of a metaplastic Warthin tumor rather than a mucoepidermoid carcinoma. Careful clinicopathological evaluation as well as genetic studies are needed to clarify the distinction between mucoepidermoid carcinoma and metaplastic portions of Warthin tumors.

Mammary analogue secretory carcinoma (MASC) of salivary gland has been identified at 2010 by Skalova et al. There are only four cases occurring in buccal mucosa among the previously reported 70 cases. In this article, we present such fifth case. A 59-year-old Japanese man noticed the nodule measuring 5 mm in maximum diameter of the left buccal mucosa and subsequent biopsy showed the finding of tubular and microcystic configurations of the tumor cells. Secretory materials in glandular lumens were positive for periodic acid–Schiff stain with and without diastase treatment. Immunohistochemically, neoplastic cells demonstrated diffuse immunolabeling for vimentin, cytokeratin 7, cytokeratin 19 and S-100 protein. Additionally, the bilayer structure of CD34-positive stromal cells and alpha-smooth muscle actin-positive myofibroblasts in the capsule was identified. Finally, otolaryngologists and oral surgeon should bear in mind that MASC may occasionally arise from buccal mucosa. CD34-positive stromal cells and myofibroblasts may be associated with the regulation of tumor growth of MASC, like other salivary gland tumors. This is the smallest tumor among the previously reported cases.

Objective : Globus pharyngeus (GP) is a common symptom of laryngopharyngeal reflux disease (LPRD), and proton pump inhibitor (PPI) and rikkunshito, a traditional Japanese medicine having prokinetic effect improve LPRD symptoms. In the present study, we examined the efficacy of high-dose PPI in combination with rikkunshito in patients complaining of GP. Methods : 106 patients complaining of GP without any organic endoscopic findings were enrolled. Results : Patients were first administrated with high-dose PPI alone for 4 to 8 weeks and the symptom was improved in 65 patients. Among 41 patients with PPI-refractory GP, 22 patients were administrated with high-dose PPI in combination with rikkunshito, and the symptom was improved in 14 of 22 patients 4 weeks later. The average value of a modified reflux symptom index of the responders was similar to that of non-responders. Only a few patients had positive values in reflux finding scores in both groups. Conclusion : The present findings suggest the existence of a high prevalence of LPRD in patients complaining of GP. The data also suggest that gastroesophageal dysmotility is involved in GP, in addition to excessive acid reflux. The pretherapeutic laryngopharyngeal symptoms and endoscopic findings could not predict the efficacy of the treatment for GP.

We reported three cases of Mikuhcz's disease. Mikulicz's disease was diagnosed by the following criteria: 1) symmetrical enlargement of the lacrimal and salivary glands lasting at least 3 months', 2) the lacrimal and salivary glands were microscopically involved in the infiltration of inflammatory cells, 3) sarcoidosis and other lymphoproliferative diseases were excluded. Three patients with Mikulicz's disease were all characterized by elevated IgG4 concentration in the serum and prominent infiltration of IgG4-positive plasmacytes in the minor salivary glands. On the contrary, there were no findings indicating sicca syndrome or anti-SS-A and SS-B antibodies, which characterize Sjogren syndrome. It is suggested that Mikulicz's disease is an IgG4-related plasmacytec disease, with a pathogenesis differing from that of Sjogren syndrome.

We report a sixty-four-year-old woman with an extrapharyngeal foreign body due to swallowing a fish bone. The patient complained of a sore throat after she swallowed fried cutlass fish. However, there was no foreign body detected under pharyngolaryngoscopy or on the cervical X-ray film. Although the sore throat disappeared, cervical CT was carried out, because fish bone as a foreign body was strongly suspected based on the case history. Accordingly, it was demonstrated that the fish bone had extruded from the pharyngeal lumen and penetrated the thyroid. The extrapharyngeal foreign body was successfully removed by lateral neck incision under general anesthesia.

FDG-PET (2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography) is clinically useful in detecting head and neck cancer providing accurate estimate of primary cancer and metastasis lymph node especially in cancers that are equivocal on conventional imaging. FDG-PET scan shows unknown primary cancer and metastatic lymph nodes that appear normal CT scan/or MRI. Furthmore, whole body FDG-PET makes it possible to simultaneously detect distant metastasis.We reported 4 cases of head and neck cancer and showed the efficacy of 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in the diagnosis of head and neck cancer. FDG-PET is highly useful for detecting previously unrecognized primary cancer with lymph node metastasis to the neck. FDG-PET also has a high potential for detecting neck lymph node metastasis, staging head and neck cancer and assessing its response to irradiation and chemotherapy. Finally, FDG-PET is useful for diagnosing recurrent or residual head and neck cancer and its distant metastasis.

The alpha-fodrin N-terminal portion (AFN) autoantigen mediates in vivo immunoregulation of autoimmune responses in primary Sjögren's syndrome (SS). We further examined this process and found that cleavage products of AFN were frequently detected in the salivary gland duct cells of SS patients. In in vitro studies using human salivary gland HSY cells, anti-Fas-induced apoptosis resulted in specific cleavage of alpha-fodrin into the 120-kd fragment, in association of alpha-fodrin with mu-calpain, and activation of caspase 3. Significant proliferative responses against AlphaFN autoantigen were observed in the peripheral blood mononuclear cells (PBMCs) from SS patients with higher pathological score (grade 4) and with short duration from onset (within 5 years). In vivo roles of AFN peptides were investigated using PBMCs from patients with SS, systemic lupus erythematosus, and rheumatoid arthritis. Significant proliferative T-cell responses of PBMCs to AFN peptide were detected in SS but not in systemic lupus erythematosus or rheumatoid arthritis. AFN peptide induced Th1-immune responses and accelerated down-regulation of Fas-mediated T-cell apoptosis in SS. Our data further elucidate the in vivo role of AFN autoantigen on the development of SS and suggest that the AFN autoantigen is a novel participant in peripheral tolerance.

We report a case of Calcific retropharyngeal tendinitis that was difficult to distinguish from retropharyngeal abscess. The patient was a 36-year-old woman who complained of severe cervical pain. Clinical findings of moderately elevated WBC count and MRI findings of fluid filling the retropharyngeal space suggested retropharyngeal abscess. However, the patient was not very sick, without high fever or sore throat. CT scan showed a clump of calcification in front of the C1-C2 cervical spines, which is characteristic of calcific retropharyngeal tendinitis. Emergency drainage operation was avoided and the patient fully recovered after treatment by NSAIDs.

The long-term prognosis of vertigo and hearing loss in patients with Ramsay Hunt syndrome was examined in the present study. We treated 23 patients with facial palsy, herpes zoster oticus and vertigo and/or hearing loss with steroids and acyclovir at our university hospital between 1998 and 2000. Facial palsy and herpes zoster oticus were accompanied by vertigo in 11 patients and by sensorineural hearing loss in 7 patients. One year after onset, 4 of 11 patients with vertigo showed persistent severe CP (canal paresis). They had persistent head-shaking after nystagmus and were handicapped in their daily life due to dizziness. The prognosis of vertigo is similar to that of vestibular neuronitis, but unlike that of vertigo with sudden deafness, in which a lesion is likely present in the inner ear. This finding suggests that vertigo with Ramsay Hunt syndrome is due to a lesion of the vestibular nerve. One year after onset, all 7 patients with mild to moderate sensorineural hearing loss demonstrated by falling audiogram showed normal hearing irrespective of accompaniment of vertigo. The prognosis of sensorineural hearing loss is different from that of sudden deafness. This finding suggests that sensorineural hearing loss with Ramsay Hunt syndrome is due to a lesion of the cochlear nerve.

In the Cu 50 Ti 50-x Al x system, amorphous alloys are obtained by melt-quenching technique in the range O≤x≤40. The structure of these glasses is investigated by X-ray radial distribution function (RDF) analysis, and the crystallization behavior is studied by differential scanning calorimetry and X-ray diffraction. A Cu-Cu pair correlation is resolved in the differential reduced RDF, ΔG(r), which has been obtained by subtracting G(r) for binary Cu 50 Ti 50 from those for ternary alloy glasses. The radial distances for the correlation peaks are consistent with those for a dense random packing

IgG4-related disease has been recently described. This disease occurs in various anatomic locations including pancreas, biliary tract, liver, retroperitoneum, kidney, breast, lung, thyroid gland, prostate, salivary gland, lacrimal gland, and lymph node. In this article, we report the first case of IgG4-related disease arising in the renal pelvis. A 49-year-old Japanese woman was found to show left hydronephrosis by a medical checkup. Histological examination of the renal pelvic tumor showed IgG4-related disease. Her postoperative serum IgG4 was elevated, and this was compatible with IgG4-related disease. Systemic examination showed swelling of major and minor salivary glands and the lacrimal glands, and biopsy of the minor salivary gland revealed the finding of IgG4-related disease. Finally, pathologists and clinicians should be aware of the possibility that the renal pelvis may be involved in IgG4-related systemic disease.

Soft tissue hybrid peripheral nerve sheath tumors (PNST), including schwannoma-perineurioma or neurofibroma-perineurioma, have recently been described. However, there are no reports on hybrid PNST arising in the nasopharyngeal area. In this article, we report such a case. A 58-year-old Japanese man presented with nasal obstruction and was found to have bilateral polypoid lesions in the middle meatus of the nose. Subsequently, nasal polypectomy was performed. Histologically, the tumor consisted of three components including schwannoma, neurofibroma, and perineurioma. Immunohistochemically, schwannoma, neurofibroma, and perineurioma components were positive for S-100 protein, CD34, and epithelial membrane antigen, respectively. In conclusion, this is the first case of hybrid PNST reported to occur in the nasopharyngeal area. Pathologists should be aware of the possibility that hybrid PNST may present outside soft tissue.

Although a number of autoimmune diseases are known to develop in postmenopausal women, the mechanisms by which estrogen deficiency influences autoimmune lesions remain unclear. We speculate that antiestrogenic actions might be a potent factor in the formation of pathogenic autoantigens. Previously, we have identified 120-kd alpha-fodrin as an important autoantigen in Sjogren's syndrome (SS). When healthy C57BL/6 (B6) mice were treated with an ovariectomy (Ovx), we found a significant increase in TUNEL(+)-apoptotic epithelial cells in the salivary gland cells associated with alpha-fodrin cleavage during 2 and 3 weeks after Ovx. By contrast, no apoptotic cells were found in estrogen receptor-alpha knockout mice. In in vitro studies using primary cultured mouse salivary gland cells and human salivary gland cells, we found a cleavage product of 120-kd alpha-fodrin in cells that had undergone tamoxifen (Tam)-induced apoptosis through caspase activation, especially caspase-1. Adoptive transfer of alpha-fodrin-reactive T cells into Ovx-B6 and -SCID mice resulted in the development of autoimmune exocrinopathy quite similar to SS. These results suggest that estrogen deficiency exerts a crucial influence on autoantigen cleavage, and may cause, in part, autoimmune exocrinopathy in postmenopausal women.