Presence Of Squamous Metaplasia Research Articles

Changes of the bulbar conjunctiva as the result of glaucoma medication treatment

Aims/Purpose: To determine changes of the bulbar conjunctiva as the result of glaucoma medication treatment.Methods: We used an impression cytology method which implies the application of a cellulose acetate filter to the ocular surface, twice in the same place, to remove superficial layers of the nasal quadrant conjunctiva epithelium. The strips were removed after a few seconds of exposure, transferred into a fixative solution, followed by histological staining and light microscopy examination. The presence of squamous metaplasia was assessed using Nelson's scale, based on cells' morphology, staining behaviour, integrity and nucleoplasmic ratio. The case study included the first group of patients suffering from POAG and DED (80) (mean age = 63.8 ± 6.7 years) which was divided into 4 subgroups: 1 ‐ patients (40), who suffer from glaucoma for less than 5 years; 2 (40) ‐ more than 5 years; subgroup a (40) ‐ with one drug instilled, b (40) ‐ 2 or more drugs instilled. The second group consisted of almost healthy patients (mean age = 67.9 ± 8.9 years) All of them underwent general ophthalmological examination.Results: According to OSDI all glaucoma patients had dry eye symptoms (15 or more points). In subgroup 1 40% were diagnosed with Nelson I, 60% with Nelson II. In subgroup 2 15% had Nelson I, 55% had Nelson II and 30% had Nelson III. In subgroup a 20% of patients had Nelson I, 60% had Nelson II, and 20% were diagnosed with Nelson III. In subgroup b 30% had Nelson I, 60% had Nelson II, 10% of patients had Nelson III.Conclusions: 80% of cases show changes that correspond to II‐III Nelson degrees according to Nelson classification. The severity of metaplasia correlated with the duration of eye drops therapy, but not with the amount of them. According to the results that we received, and the international data, it is recommended to choose drugs without preservatives and other potentially toxic components for the long‐term treatment of glaucoma.

Analytical Study of Ocular Surface Changes in Patients of Chronic Kidney Disease undergoing Hemodialysis and Peritoneal Dialysis

Objectives The idiopathic group is a significant cause of chronic kidney disease (CKD) in developing countries. Literature available on ocular surface changes has predominantly been reported in patients undergoing hemodialysis. Little is known about the changes in patients undergoing peritoneal dialysis. The present study aimed to identify ocular surface changes in an idiopathic group of CKD undergoing dialysis. Aim To compare tear film disorders and the severity of ocular surface changes (goblet cell density, squamous metaplasia, and corneoconjunctival calcification) in patients of idiopathic etiology with CKD undergoing hemodialysis and peritoneal dialysis. This is an analytical study. Materials and Methods Asymptomatic adult patients of idiopathic CKD, on treatment with dialysis underwent comprehensive ophthalmic examination, including best-corrected visual acuity, slit-lamp examination, and a dilated fundus examination. Dry eye assessment was done by ocular surface staining score, Schirmer test, and tear breakup time (TBUT). Conjunctival impression cytology was studied to assess changes on ocular surface. Chest X-rays for aortic calcification were reviewed and data analyzed. Results Both eyes of 76 patients of hemodialysis and 32 patients of peritoneal dialysis were studied. Ocular surface staining (OSS) scores were low. Impression cytology showed a drop in goblet cell density, presence of squamous metaplasia, and conjunctival keratinization significantly more in the hemodialysis group. No correlation was seen between the presence of conjunctival calcification and aortic calcification. Conclusion The hemodialysis group had mild subclinical dry eye but keratinization of conjunctiva was seen. Similarly, advanced squamous metaplasia was seen in the peritoneal dialysis group. These changes were positively correlated to decrease in goblet cell density.

Lower-Than-Expected Vitamin A Concentrations in a Commercial Diet Associated with Uroliths and Pyelonephritis in Rats.

Simple SummaryRats are often used to screen new foods or medications to ensure they are safe for human consumption. As the presence of lesions in a rat in such a study could indicate toxicity, it is essential that rats do not develop background lesions due to other diseases. In the present report, around 5% of rats in an oral safety study developed uroliths, with two of the affected rats also developing kidney infections. Histology was suggestive of vitamin A deficiency. Analysis of the food revealed much lower levels of vitamin A than stated on the label, but enough vitamin A to meet the published minimal nutritional requirements of rats. When the study was continued using rats fed food from a different source, no urinary tract lesions were observed. This suggests dietary factors may have caused the development of the uroliths in this case. It is hypothesized that the lower-than-expected concentration of vitamin A in the diet, potentially along with other dietary and environmental factors, resulted in squamous metaplasia of the uroepithelium and subsequent uroliths and pyelonephritis. The observations highlight the need to use high-quality diets for safety studies in rats.Five of 95 rats in an oral safety study developed uroliths, with two of these rats also developing pyelonephritis. Histology of the urinary tract revealed squamous metaplasia suggestive of vitamin A deficiency. Analysis of the diet showed around half the expected concentration of vitamin A, although the concentrations were close to the published nutritional requirements for rats. Due to the presence of squamous metaplasia of the transitional epithelium and the low vitamin A concentration in the diet, a presumptive diagnosis of vitamin A deficiency was made, although an interaction between the low vitamin A concentrations and other dietary components appears possible. Although the uroliths did not cause clinical signs of disease, the lesions observed during this study could have been misinterpreted as being due to the test substance. Observations from this study highlight the need for high-quality food to ensure background lesions do not develop when performing safety studies in rats.

Inter-pathologist Agreement on Structured Histopathology Reporting in Chronic Rhinosinusitis

Structured histopathology reporting is increasingly being utilized in rhinology to characterize endotypes in chronic rhinosinusitis and guide management decisions after sinus surgery. The goal of this investigation is to evaluate inter-observer agreement in structured histopathology reporting. Two experienced head and neck pathologists independently compiled structured histopathology reports for tissue samples collected during functional endoscopic sinus surgery. Cohen's standard kappa (κ) coefficients were calculated for each histopathologic variable to assess inter-pathologist agreement. A total of 92 cases were analyzed. Substantial inter-pathologist agreement was reached on tissue eosinophil count (κ = 0.64, P < .001), the presence of eosinophil aggregates (κ = 0.62, P < .001), and the presence of fungal elements (κ = 0.74, P < .001). There was moderate agreement on the degree of inflammation (κ = 0.56, P < .001) and the presence of squamous metaplasia (κ = 0.46, P < .001). There was fair agreement on the presence of neutrophil infiltrates (κ = 0.33, P < .001), the presence of hyperplastic changes (κ = 0.40, P < .001), and the presence of fibrosis (κ = 0.24, P = .022). There was only slight agreement on the degree of subepithelial edema (κ = 0.20, P = .008). The κ coefficients for basement membrane thickening and mucosal ulceration were not statistically significant. High inter-pathologist agreement was demonstrated for several salient histopathologic variables, including tissue eosinophil count and the presence of eosinophil aggregates. However, refining the definitions of certain histopathologic variables may improve the reproducibility of structured histopathology reporting.

The significance of mucinous metaplasia in Warthin tumor: a frequent occurrence and potential pitfall

Mucinous metaplasia in Warthin tumor (WT) is a recognized phenomenon. Nevertheless, its presence can create a diagnostic challenge in the distinction from the newly proposed variant of mucoepidermoid carcinoma (MEC), Warthin-like MEC. In this study, we evaluated the significance and diagnostic relevance of mucinous metaplasia in WTs. A total of 30 WTs diagnosed based on resection specimens formed the basis of this retrospective study. Mucicarmine staining was performed to identify mucinous metaplasia, and fluorescence in situ hybridization (FISH) analysis was used to detect MAML2 gene rearrangement. After review, one MAML2 rearranged case was reclassified as Warthin-like MEC as the classic bilayered epithelium in WT was not identified. The diagnosis of WT was confirmed in the remaining 29 cases. Mucinous metaplasia was encountered in 24 WTs (83%), with 14% (4/29) having an abundant amount. We found that mucinous metaplasia correlated with tumor size (p<0.05). Age and sex distribution were similar in WT cases with or without mucinous metaplasia. In addition, neither the presence of squamous metaplasia nor the time interval between fine-needle aspiration and surgery was related to mucinous metaplasia (p>0.05). The MAML2 FISH analyses performed in 18 WTs with variable amounts of mucinous metaplasia were negative for rearrangement. In conclusion, mucinous metaplasia is fairly common in WTs and shows a significant correlation with tumor size. Therefore, caution should be taken to avoid overinterpretation of WT with mucinous metaplasia as MEC in cases showing the classic bilayered oncocytic lining epithelium.

Epithelial Squamous Metaplasia and Dysplasia in Inflammatory Nasal Polyps: An Observational Study.

Nasal polyposis (NP) is characterized by polypoid outgrowths of chronically inflamed respiratory mucosa. The presence of squamous metaplasia and dysplasia on the mucosal surface of nasal polyps (NPs) represents different manifestations of epithelial atypia. The aim of this investigation was to evaluate the presence of epithelial squamous metaplasia and dysplasia in ethmoidal NPs. This retrospective analysis of prospectively collected data involved 212 patients with NP undergoing endoscopic ethmoidectomy. To evaluate possible etiological factors for epithelial atypia, the patients in whom we histopathologically detected the presence of epithelial atypia were compared with patients with "normal" NPs in accordance with the following characteristics as found in the patients' medical records: gender, age, main symptoms, preoperative extent of sinus disease on computed tomography, atopic status, aspirin sensitivity, cigarette smoking, and occupational exposure to different noxious factors. Epithelial atypia were detected histopathologically in 44 (20.7%) NP patients, whereas features of "true" dysplasia were found in only 1 (0.5%) patient. The presence of atypia was more frequent in males than in females (P = .008). The association with aspirin-exacerbated respiratory disease and with long-term occupational exposure to different noxious chemicals, especially in workers exposed to salts of heavy metals, was more frequent in NP patients with epithelial atypia than in patients without atypia (P = .023; P = .006, respectively). Our results suggest epithelial atypia in NPs are associated with aspirin sensitivity and occupational exposure to different noxious chemicals. Although extremely rare, epithelial dysplasia may occasionally be noted in NPs, a fact potentially useful for both rhinologists and pathologists.

Клиническая оценка тяжести течения хронического цистита у женщин разных возрастных групп

The aim of the study was to estimate course the peculiarities of chronic cystitis in women of different ages. The study included 334 women with chronic cystitis (CC). The patients were divided into 3 age groups: group 1 — 20 to 39 years old; group 2 — 40 to 59 years old; group 3 — elderly age (60 years old and older). Cystoscopy was performed, the frequency of cystitis exacerbations was estimated, a survey was carried out using the PUF Scale (Pelvic Pain and Urgency/Frequency Patient Symptom Scale) questionnaire, and urination diaries were evaluated. A higher severity of symptoms was revealed in patients with leukoplakia in all age groups. However, the incidence of leukoplakia signifi cantly decreased with age. In this regard, the observed age-related increase in clinical symptoms of CC is most likely associated with the emergence of age-related pathogenesis factors. An inverse correlation between the presence of leukoplakia and mucosal edema was detected in women with the same symptoms. The two-way analysis of variance revealed two factors associated with increasing severity of chronic cystitis symptoms: age and the presence of squamous metaplasia (leukoplakia).

Relative abundance of nasal microbiota in chronic rhinosinusitis by structured histopathology.

Chronic rhinosinusitis (CRS) is an inflammatory disease process with several different phenotypes. Recent data has shown that CRS phenotypes maintain distinct nasal microbiota that may predict surgical outcomes. Nasal microbiota and structured histopathologic reporting have the potential to further differentiate subtypes and provide additional insight into the pathophysiology of CRS. Sinus swabs collected during functional endoscopic sinus surgery (FESS) were studied by polymerase chain reaction analysis of 16S ribosomal RNA. A structured histopathology report of 13 variables was utilized to analyze sinus tissue removed during FESS. Histopathology variables and relative abundance of nasal microbiota were compared among CRS patients. A total of 51 CRS patients who underwent FESS were included. Relative abundance of the Firmicutes phylum in nasal microbiota of CRS patients was associated with presence of neutrophilic infiltrate (27.47 ± 44.75 vs 9.21 ± 11.84, p < 0.029), presence of mucosal ulceration (47.67 ± 45.52 vs 13.27 ± 26.48, p < 0.041), presence of squamous metaplasia (5562.70 ± 2715.66 vs 3563.73 ± 2580.84, p < 0.035), and absence of Charcot-Leyden crystals (5423.00 ± 3320.57 vs 679.94 ± 1653.66, p < 0.001). Relative abundance of the Bacteroidetes phylum in nasal microbiota of CRS patients was associated with increased severity of inflammatory degree (p < 0.004) and presence of mucosal ulceration (p < 0.004). Distinct histopathologic features of CRS are associated with relative abundance of nasal microbiota phyla, specifically Firmicutes and Bacteroidetes. These findings contribute to the growing body of literature on microbiota in sinonasal disease and may have important implications for understanding pathophysiologic mechanisms of CRS subtypes and disease management.

Pleomorphic adenoma with extensive squamous metaplasia and keratin pearls

Background : Pleomorphic adenoma is the most common salivary gland tumor, accounting for 54 to 65% of all salivary gland neoplasams.80% of all the benign salivary gland neoplasms is constituted by pleomorphic adenoma. Parotid is the most commonly affected gland followed by submandibular salivary gland and the minor salivary glands. Histo-morphologically a pleomorphic adenoma shows both stromal as well as epithelial components. Case History : Here we present the case of a 22 yr. old male who presented to the ENTOPD with complains of swelling in front of the ear on the left side around the parotid region since 2yrs. A biopsy of the swelling was done and sent to the department of Pathology. A diagnosis of pleomorphic adenoma with squamous metaplasia and keratin pearls formation was given. A superficial parotidectomy was performed under general anesthesia. Discussion : Pleomorphic adenoma is one of the most common salivary gland tumors the mean age of occurrence being 43.6 yrs. Squamous metaplasia in the pleomorphic adenoma results in formation of an extensive keratin-filled cysts lined by squamous epithelium. Many a times excessive squamous metaplasia is mistaken for malignancy, including mucoepidermoid carcinoma and squamous cell carcinoma. Conclusion : The presence of squamous metaplasia in pleomorphic adenoma makes up 25% of the total secondary changes in the tumor. The patient was taken up for surgery & discharged after three days and was on follow-up for one month, after which he recovered completely.

Warthin tumor with extensive squamous and mucinous metaplasia: Pathologist′s dilemma

Secondary changes in Warthin tumor (WT) are not uncommon. Diagnostic error in Fine Needle Aspiration (FNA) is caused by a lack of typical features and the presence of individual atypical squamous cells in a necrotic background, mimicking carcinoma. Mucoepidermoid carcinoma, squamous cell carcinoma, and oncocytoma are the commonest tumors diagnosed in place of WT, the source of error being the presence of squamous metaplasia in the former two and the absence of the lymphoid cells in the latter. We report a case of WT with extensive squamous and mucinous metaplasia with desmoplasia and a certain degree of atypia which was diagnosed on FNA as Low Grade Mucoepidermoid Carcinoma (LGMEC). Prior FNA of the lesion may be the reason for the extensive metaplasia, desmoplasia, as well as atypia in our case. An extensive histopathological examination of the superficial parotidectomy specimen helped us arrive at the correct diagnosis.

Endocrinopathy, Vision, Headache, and Recurrence After Transsphenoidal Surgery for Rathke Cleft Cysts

Rathke cleft cyst can enlarge and become symptomatic. To review the clinical data and results of all patients treated by the senior author for a Rathke cleft cyst. A prospectively maintained surgical database, supplemented with updates from telephone conversations, of all patients presenting to the Barrow Neurological Institute from 1992 to the present was reviewed. Seventy-three patients (17 males, 56 females; mean age, 40 years; range, 5-80 years) underwent 77 resections. The mean length of follow-up was 27 months (range, 0-129 months). Presenting symptoms included headache (75%), followed by endocrinopathy (49%), and visual symptoms (39%). Preoperative chiasmopathy resolved in 75% and improved in 21% of the patients. Patients' preoperative endocrinopathy resolved at various rates, depending on the specific axis (29%-100%). Endocrinopathies were more likely to resolve in females than males. New postoperative endocrinopathies also occurred (0-8%). Headache resolved (68%) or improved (21%) in most patients. No patient had worsened headaches. Eight patients had a recurrence, 4 of whom underwent reoperation. The presence of squamous metaplasia was the only predictor of recurrence. Surgical fenestration and/or resection of Rathke cleft cyst via the transsphenoidal approach are a rational choice for surgical management of these lesions when symptomatic. In most cases, visual symptoms and headache can be expected to improve. New persistent endocrine deficits can be expected in a small percentage of patients, but preexisting endocrinopathies resolve in many patients.

A Morphologic and Immunohistochemical Study of Nasal Mucosa in Leatherworkers

The association between intestinal-type sinonasal adenocarcinoma and the occupational exposure to leather dusts has been widely documented, but the identification of precursor lesions in exposed workers has remained controversial. The purpose of this study was to investigate the histological changes and modifications in the phenotype of epithelial cells in nasal mucosa of leather workers. Biopsy specimens of the mucosa of the middle turbinate were obtained from 139 subjects who had been employed in leather factories for 10-48 years (median, 29 years). Tissue fragments were routinely processed for histological examination and immunostainings for cytokeratin 20, CDX-2, and MUC-2 were performed. Regarding the surface epithelium, the most common histopathological finding was the presence of squamous metaplasia (64.7%), which was associated with mild to moderate dysplasia in 37 cases (41.1%), and goblet cell hyperplasia was identified in 30 biopsy specimens (21.6%). Positivity for MUC-2 was detected in goblet cells of 20 of the 30 samples with goblet cell hyperplasia (66.6%), whereas no immunostaining was observed for cytokeratin 20 and CDX-2. Presence of goblet cell hyperplasia was significantly associated with longer occupational exposure in leather tanning activities (p = 0.03). None of the alterations observed (squamous metaplasia, dysplasia, or goblet cell hyperplasia) showed correlation with smoking habits. Similarly, there was no correlation between squamous metaplasia with or without dysplasia and type and duration of occupational exposure. Our data identify goblet cell hyperplasia as possible work-related alterations of nasal mucosa in leather workers. Additional investigations are needed to clarify the significance of these findings in the development of sinonasal intestinal-type carcinoma.

Primary endometrioid adenocarcinoma of the cervix with widespread squamous metaplasia – a potential diagnostic pitfall

BackgroundUterine or endocervical biopsies that contain endometrioid adenocarcinoma with widespread squamous metaplasia are usually of endometrial origin. The presence of squamous metaplasia is said to be helpful in distinguishing endocervical from endometrial adenocarcinomas in small biopsy samples.Case presentationA 51-year-old woman presented with post-coital and post-menopausal bleeding. Biopsy of a friable lesion in the proximal endocervical canal revealed an endocervical adenocarcinoma of endometrioid type with widespread squamous metaplasia. The latter feature initially raised the possible diagnosis of a primary endometrial adenocarcinoma. However, immunohistochemical marker studies indicated a diagnosis of primary endocervical adenocarcinoma of endometrioid type and this was confirmed at hysterectomy.ConclusionSquamous differentiation is not well documented in endocervical adenocarcinomas of endometrioid type and, when widespread, may represent a diagnostic pitfall for pathologists. Interpretation of small biopsies from the endocervical canal on the basis of morphology alone may lead to misdiagnosis and inappropriate surgical management.

Nasal polyp diseases in allergic and nonallergic patients and steroid therapy

To investigate widespread disease causes, cellular-structural differences, and steroid response of nasal polyps (NPs). Study group consisted of NPs, allergic-NPs, NPs with steroid therapy (ST), antrochoanal polyp (ACP), and controls. We investigated stromal eosinophil, mast cell, CD4+ and CD8+ cell counts and presence of squamous metaplasia, Ki-67 expression, intraepithelial eosinophils-mast cells, epithelial damage, edema, fibrosis, hyalinization, polymorphonuclear leukocyte, and glandular hyperplasia. In allergic-NPs, intraepithelial eosinophils and epithelial damage CD4+ were significantly higher than NPs and also, eosinophils, mast cells, intraepithelial eosinophils, and epithelial damage were significantly higher than ACP. Only stromal eosinophilic infiltration was significantly higher in NPs than ACP. There was significant increased glandular hyperplasia and decreased intraepithelial eosinophils, mast cells, CD4+ cells, squamous metaplasia, and epithelial damage with ST in allergic-NPs. There were no significant differences with ST in NPs. NPs in allergic and nonallergic patients may differ in their histology and in their histologic responses to ST. B-3b.

Rathke Cleft Cysts

Object. Microscopic Rathke cleft cysts are a common incidental autopsy finding, but some Rathke cleft cysts can become sufficiently large to cause visual impairment, hypothalamic-pituitary dysfunction, and headaches. In this study patients were evaluated preand postoperatively to ascertain the clinical significance of surgical intervention on endocrine and visual improvement. Factors correlated with cyst recurrence were also evaluated. Methods. A retrospective analysis was conducted in 160 patients with Rathke cleft cysts who were treated between 1984 and 1995 and completed at least a 5-year follow-up period. Of these 160 patients, 118 initially exhibited symptoms of visual impairment or endocrine dysfunction, became symptomatic during the follow-up period, or were found to have cyst enlargement. These 118 patients underwent transsphenoidal surgery. Forty-two patients with incidental lesions that demonstrated no growth on magnetic resonance (MR) images were followed up without an operation. Complete resection, as observed on MR images 3 months postoperatively, was obtained in 114 (97%) of 118 patients. Vision improved postoperatively in 57 (98%) of 58 patients. Hypogonadism improved in 11 (18%) of 62 patients, growth hormone deficiency resolved in 14 (18%) of 78 patients, and hypocortisolemia resolved in one (14%) of seven patients. Twenty-two patients (19%) began to exhibit symptoms of diabetes insipidus, which had not been present preoperatively. The total 5-year recurrence rate was 18% (21 of 118 patients), with 12 patients requiring a repeated operation. Surgical and pathological factors that were found to be statistically associated with recurrence were the use of a fat and/or fascial graft for closure (p < 0.01) and the presence of squamous metaplasia in the cyst wall (p < 0.01). The extent of resection of the cyst wall was not associated with an increased rate of recurrence. In 42 (69%) of 61 patients the incidental cysts did not progress on imaging studies or clinically. Conclusions. This is the largest series of patients with symptomatic Rathke cleft cysts who received operative intervention and participated in the longest postoperative follow up reported in the literature. The high recurrence rate (18%) supports the theory that a relationship exists between a symptomatic Rathke cleft cyst and craniopharyngioma. Improvements in visual and endocrine dysfunction can be expected after surgical decompression of the optic apparatus and the hypothalamic-pituitary axis.

Surgical outcomes in 118 patients with Rathke cleft cysts

Microscopic Rathke cleft cysts are a common incidental autopsy finding, but some Rathke cleft cysts can become sufficiently large to cause visual impairment, hypothalamic-pituitary dysfunction, and headaches. In this study patients were evaluated pre- and postoperatively to ascertain the clinical significance of surgical intervention on endocrine and visual improvement. Factors correlated with cyst recurrence were also evaluated. A retrospective analysis was conducted in 160 patients with Rathke cleft cysts who were treated between 1984 and 1995 and completed at least a 5-year follow-up period. Of these 160 patients, 118 initially exhibited symptoms of visual impairment or endocrine dysfunction, became symptomatic during the follow-up period, or were found to have cyst enlargement. These 118 patients underwent transsphenoidal surgery. Forty-two patients with incidental lesions that demonstrated no growth on magnetic resonance (MR) images were followed up without an operation. Complete resection, as observed on MR images 3 months postoperatively, was obtained in 114 (97%) of 118 patients. Vision improved postoperatively in 57 (98%) of 58 patients. Hypogonadism improved in 11 (18%) of 62 patients, growth hormone deficiency resolved in 14 (18%) of 78 patients, and hypocortisolemia resolved in one (14%) of seven patients. Twenty-two patients (19%) began to exhibit symptoms of diabetes insipidus, which had not been present preoperatively. The total 5-year recurrence rate was 18% (21 of 118 patients), with 12 patients requiring a repeated operation. Surgical and pathological factors that were found to be statistically associated with recurrence were the use of a fat and/or fascial graft for closure (p < 0.01) and the presence of squamous metaplasia in the cyst wall (p < 0.01). The extent of resection of the cyst wall was not associated with an increased rate of recurrence. In 42 (69%) of 61 patients the incidental cysts did not progress on imaging studies or clinically. This is the largest series of patients with symptomatic Rathke cleft cysts who received operative intervention and participated in the longest postoperative follow up reported in the literature. The high recurrence rate (18%) supports the theory that a relationship exists between a symptomatic Rathke cleft cyst and craniopharyngioma. Improvements in visual and endocrine dysfunction can be expected after surgical decompression of the optic apparatus and the hypothalamic-pituitary axis.

Occupational rhinitis: a poorly diagnosed condition.

The civil claim of occupational rhinitis may be difficult to prove on the balance of probabilities and is the responsibility of the claimant. There are two types of occupational rhinitis, an allergic rhinitis or a rhinitis due to irritation. Occupational rhinitis can be likened to occupational asthma. Particular attention must be paid to the relationship to alleged exposure and symptoms. Irritation causes symptoms during exposure that cease afterwards unless clinically obvious damage has occurred. Tobacco smoke and nicotine may also cause symptoms. A full examination, both externally and internally of the nose, mouth and eyes should be undertaken. The presence of squamous metaplasia is important. The validity of a claimant's symptoms must be checked against the medical records. Details of all occupations, compounds and protection should be noted. Manufacturing data on the compounds should also be obtained. The Health and Safety Executive publish occupational exposure limits for many industrial chemicals. Allergen-specific IgE may be raised when an allergy is considered to cause the occupational rhinitis. Nasal challenge tests have been used in Scandinavia to diagnose allergic occupational rhinitis. The sense of smell should be tested. There are two approaches, detecting threshold or recognition, which is suprathreshold. When present, three degrees of social effect occur: impairment, disability and handicap. The degree depends on the occupation of the individual.

Necrotizing Sialometaplasia

Necrotizing sialometaplasia is a benign self-limited condition of salivary glands most commonly involving the palate, although extrapalatal involvement also occurs. The exact pathogenesis is unknown, but the most widely accepted theory is that necrotizing sialometaplasia develops as a result of ischemic injury to the salivary gland lobule, Necrotizing sialometaplasia has been mistaken histologically for carcinoma, particularly mucoepidermoid and squamous carcinomas. Misdiagnosis can be avoided by appreciating the characteristic maintenance of lobular architecture despite necrosis of salivary gland tissue and the presence of squamous metaplasia within residual ducts and acini. The recognition of necrotizing sialometaplasia as a potential simulator of carcinoma is essential in sparing patients inappropriate and excessive therapy.

Clonal genetic alterations in the lungs of current and former smokers.

Genetic damage has been identified at multiple chromosomal sites (i.e., loci) in lung cancer cells. We questioned whether similar damage could be detected in the bronchial epithelial cells of chronic smokers who do not have this disease. Biopsy specimens from six different bronchial regions were obtained from 54 chronic smokers (40 current smokers and 14 former smokers). The presence of squamous metaplasia and dysplasia (abnormal histologic changes) in the specimens was documented by examination of hematoxylin-eosin-stained sections, and a metaplasia index ([number of biopsy specimens with metaplasia/total number of biopsy specimens] x 100%) was calculated for each subject. Loss of heterozygosity (i.e., loss of DNA sequences from one member of a chromosome pair) involving microsatellite DNA at three specific loci-chromosome 3p14, chromosome 9p21, and chromosome 17p13-was evaluated by means of the polymerase chain reaction. Fisher's exact test and logistic regression analysis were used to assess the data. Reported P values are two-sided. Data on microsatellite DNA status at chromosomes 3p14, 9p21, and 17p13 were available for 54, 50, and 44 subjects, respectively. The numbers of individuals who were actually informative (i.e., able to be evaluated for a loss of heterozygosity) at the three loci were 36 (67%), 37 (74%), and 34 (77%), respectively. DNA losses were detected in 27 (75%), 21 (57%), and six (18%) of the informative subjects at chromosomes 3p14, 9p21, and 17p13, respectively. Fifty-one subjects were informative for at least one of the three loci, and 39 (76%) exhibited a loss of heterozygosity. Forty-two subjects were informative for at least two of the loci, and 13 (31%) exhibited losses at a minimum of two loci. Loss of heterozygosity at chromosome 3p14 was more frequent in current smokers (22 [88%] of 25 informative) than in former smokers (five [45%] of 11 informative) (P = .01) and in subjects with a metaplasia index greater than or equal to 15% (21 [91%] of 23 informative) than in subjects with a metaplasia index of less than 15% (six [46%] of 13 informative) (P = .003). In five informative individuals among nine tested nonsmokers, a loss of heterozygosity was detected in only one subject at chromosome 3p14 (P = .03), and no losses were detected at chromosome 9p21 (P = .05). Genetic alterations at chromosomal sites containing putative tumor-suppressor genes (i.e., 3p14 and the FHIT gene, 9p21 and the p16 gene [also known as CDKN2], and 17p13 and the p53 gene [also known as TP53]) occur frequently in the histologically normal or minimally altered bronchial epithelium of chronic smokers.

Rathke Cleft Cyst

We report the radiologic findings in 23 cases of Rathke cleft cyst (RCC) and correlate them with the histopathology. We reviewed the radiology and pathology of 23 cases of surgically treated RCC operated upon at our institution or referred in consultation. There appears to be a correlation between the MR and CT appearance of the cyst, the gross appearance of the cyst contents, and the histopathologic characteristics of the cyst lining. Some of the lesions demonstrated peripheral enhancement, which in two cases was clearly due to a peripherally displaced rim of pituitary tissue. The appearance of RCC with CT and MRI is variable, and radiologic diagnosis can be difficult. Imaging features such as a sellar epicenter, smooth contour, absence of calcification, absence of internal enhancement, and homogeneous attenuation or signal intensity within the lesion suggest the diagnosis of RCC. Rim enhancement does not correlate with the presence of squamous metaplasia, hemosiderin, or cholesterol within the cyst wall and is not consistently seen in cases with changes of mild, chronic inflammation. In some cases, rim enhancement is due to a peripherally displaced rim of pituitary tissue.