Tonsilla Palatina Research Articles

Pronounced tonsil stone in a crypt of the left tonsilla palatina - Radiological findings on panoramic tomography and digital volume tomography

Tonsilloliths (tonsil stones) are ectopic calcifications that can form in the crypts of the tonsilla palatina (palatine tonsil), the tonsilla lingualis (lingual tonsil) and also the tonsilla pharyngealis (pharyngeal tonsil). The exact aetiology and pathogenesis leading to the formation of these tonsil stones is still unknown.

Responsiveness of various reservoir species to oral rabies vaccination correlates with differences in vaccine uptake of mucosa associated lymphoid tissues

Oral rabies vaccination (ORV) is highly effective in foxes and raccoon dogs, whereas for unknown reasons the efficacy of ORV in other reservoir species is less pronounced. To investigate possible variations in species-specific cell tropism and local replication of vaccine virus, different reservoir species including foxes, raccoon dogs, raccoons, mongooses, dogs and skunks were orally immunised with a highly attenuated, high-titred GFP-expressing rabies virus (RABV). Immunofluorescence and RT-qPCR screenings revealed clear differences among species suggesting host specific limitations to ORV. While for responsive species the palatine tonsils (tonsilla palatina) were identified as a main site of virus replication, less virus dissemination was observed in the tonsils of rather refractory species. While our comparison of vaccine virus tropism emphasizes the important role that the tonsilla palatina plays in eliciting an immune response to ORV, our data also indicate that other lymphoid tissues may have a more important role than originally anticipated. Overall, these data support a model in which the susceptibility to oral live RABV vaccine infection of lymphatic tissue is a major determinant in vaccination efficacy. The present results may help to direct future research for improving vaccine uptake and efficacy of oral rabies vaccines under field conditions.

口腔底から前頸部に移動した魚骨異物例

As we know, most foreign bodies are often removed easily. We experienced a case of a foreign body removed by transcervical approach. A 61 year-old-male had a sore throat for two days after ingesting a fish. At the first medical examination, we were unable to find the foreign body at his tonsilla palatina, pharynx or larynx, so the patient underwent a follow-up examination. One week later, his sore throat continued, and computed tomography (CT) revealed the foreign body in his oral floor. It was possible to remove it by the transoral approach at that time, and we proposed removing it immediately, but the patient did not accept. Forty three days later, the foreign body moved downwards. We removed it by not via the transoral but the transcervical approach. Granulation tissues had surrounded the foreign body. The patient’s postoperative progress was favorable. There are some points for consideration regarding not performing the operation immediately. There are severe complications associated with foreign bodies; such as abscess formation, vascular injury and so on. Furthermore, the transcervical approach is more invasive than the transoral one. Fortunately, our patient had no complications. On the other hand, he had peristent scars on his neck. From the above, we should perform CT imaging at the first visit, and remove any foreign body as soon as possible.

A Rare Tumor of the Parapharyngeal Space

Parapharyngeal space tumors are uncommon, most are salivary gland tumors (50%), and they are often pleomorphic adenomas. Neurogenic tumors are the second most common primary tumors of all neoplasms in the parapharyngeal space (30%). Angiomyxolipoma is a very rare form of lipoma. Up until now, only 12 cases located on different sides of the body were reported. Presented here is a case report of a patient with an angiomyxolipoma of the parapharyngeal space. A 17-year-old boy had a slowly growing, painless mass on the left side of the neck. During the oropharyngeal examination, medial displacement of the left tonsilla palatina was observed. Magnetic resonance imaging findings were of a 6 × 5.5 × 3-cm "dumbbell"-shaped parapharyngeal mass. A fine needle aspiration of the mass showed no specific histopathology. The patient underwent a transparotid-transcervical approach for the excision of the tumoral mass under general anesthesia. Although an angiomyxolipoma is a rare form of lipoma, it is a pathology that should be kept in mind for the differential diagnosis of parapharyngeal tumors.

Morphological asymmetry in tonsilla palatina by handedness in patients with chronic tonsillitis

In this study, the possible asymmetry in palatine tonsil sizes by handedness was investigated. Right tonsil volume and weight were higher compared to left in right-handed patients with chronic tonsillitis; vice versa in left-handed patients. These results support the peripheral immune asymmetry hypothesis.

口腔・咽頭の異物としての魚骨に関する研究（２）

In recent years, seafood consumption has been declining nationwide. One of the suggested reasons for this downtrend, known as flight from fish, is the problem with throat lodgement of fish bone from seafood dish. The Pacific saury, Japanese jack mackerel, sardine, mackerel, and Japanese eel are commonly consumed fish, but their small bones tend to lodge in the throat. Here, we report the morphological characteristics of small bones of these types of fish. Twenty samples of each of the Pacific saury, Japanese jack mackerel, sardine, mackerel, and Japanese eel were purchased from fish markets during the period from January to December 2009. Abdomens of raw or cooked fish were dissected to recover small bones (ribs, epipleural, epicentral, epineural and pteygiophore). The bone samples were first subjected to softex radiography and then stained with alizarin red S. The length and diameter of these bone specimens were measured and their form were observed under a microscope. Decalcification of small bones immersed in acetic acid was observed in a similar manner. It was found that the tips of the small bones of the Pacific saury, sardine, and Japanese jack mackerel were very pointed, suggesting that these can easily damage the tonsilla palatina and lodge in the pharynx. Formation of hook-shaped lumps in their base parts were also observed, and this was considered to cause frequent deep lodgement of bones in the larynx leading to difficulties in their removal. The small bones of the Pacific saury and sardine were finer, denser and more elastic than those of the Japanese jack mackerel and mackerel, and that the small bones of the Japanese eel were sharply pointed at both ends and finer than those of the other types of fish. These results suggest that the sites, forms, and incidence of lodgement of small fish bones in the throat vary depending on the types of fish.

Human β-Defensins in different states of diseases of the tonsilla palatina

Tonsils are believed to play an important role during the development of the immune system. Although diseases of the tonsils like hypertrophy of the tonsil, acute tonsillitis, chronic tonsillitis or peritonsillar abscess are common, little is known about the underlying pathophysiology. Little is known about antimicrobial peptides produced by the tonsils. The human beta-Defensins 1-3 (hBD1-3) are naturally produced "antibiotics" with antimicrobial activity against different bacteria, fungi, and viruses. The objective of the study was to determine the concentrations for hBD1-3 in different states of diseases of the tonsilla palatina. After tonsillectomy and tissue fixation in formalin, total proteins were isolated from 38 samples (11 hypertrophy of the tonsil, 8 acute tonsillitis, 11 chronic tonsillitis, 8 peritonsillar abscesses). The protein concentration was determined and ELISA for hBD1-3 were performed. We also conducted immunofluorescence double stainings for the co-expression of streptococcus group A and hBD1-3. We could verify a significant difference for the mean hBD1 score of the acute tonsillitis in comparison to the hyperplastic tonsil, the chronic tonsillitis, and the peritonsillar abscess. There was no statistically significant difference in the hBD2 and hBD3 concentrations between the four groups. The immunofluorescence stainings showed that hBD1-3 and the streptococcus group A in the same place. We conclude that in the hyperplastic tonsilla palatina hBD1-3 play an important role. The mouth is constantly faced with a high bacterial load. During a tonsillitis, the hBD1 concentration is lower than in the non-acute infected tonsil because hBD1 is being consumed for fighting the bacterial infection. But, the existence of hBD1-3 in the tonsil cannot prevent the tonsillitis to become chronic.

Partial tonsillectomy with scalpel in children with obstructive tonsillar hypertrophy

To compare postoperative pain of partial tonsillectomy (PT) with scalpel and total classical tonsillectomy (TT). Prospective, randomized study at a tertiary care institution. Ninety-six children who were diagnosed with obstructive tonsillar hypertrophy were included to the study. Children's tonsils were removed totally (Group TT) by classical dissection tonsillectomy or partially (Group PT) using scalpel and tissue scissors. The parents were instructed to fill out a form daily for nine postoperative days; recording total amount of analgesics administered that day and a Visual Analog Scale (VAS) each day assessing child's life quality and daily activities. Eighty-one children (2-14 years old) who completed the study were included in the analysis. Total tonsillectomy group (Group TT) consisted of 41 patients and partial tonsillectomy group (Group PT) consisted of 40 patients. There was no difference between two groups' operative parameters such as operation time [21.3 min (PT) and 22.3 min (TT)] and blood loss [44.2 ml (PT) and 46.0 ml (TT)] (p>0.05). PT group received significantly less dosage of analgesics per day; 1.18+/-1.27 vs. 2.00+/-1.45 (p<0.005). Total used analgesic dose in PT group were also lower than TT group (10.7+/-7.13 vs. 18.02+/-6.99 doses). When each day's analgesic use was compared separately a significant difference was found (p<0.05) in all days except 9th postoperative day (p>0.05). There was no difference in the pain scores between two techniques (p>0.05). Unlike tonsillectomy, PT aims to remove the tonsilla palatina subtotally. It is especially performed in children with obstructive tonsils. PT with scalpel is an inexpensive and safe method necessitating only standard surgical instruments. It causes less postoperative pain than classical dissection tonsillectomy.

Rzadki przypadek jednoczasowego obustronnego raka migdałków podniebiennych z rozległymi przerzutami do węzłów chłonnych szyjnych

The cases of simultaneous carcinomas of tonsilla palatina are not often described in the literature and they form a complex diagnostic and therapeutic problem. The rare case of simultaneous bilateral cancer of tonsilla palatina with large metastases to lymphoid glands of the neck was described in this paper. Clinical disorders of only one tonsilla were visible. Epidemiology and general ways of treatment were presented. The precautions should be taken in the presence of bilateral metastases to the lymph nodes of the neck. The risk of bilateral simultaneous carcinoma of the tonsilla palatina is probable. Bilateral tonsillectomy should be a routine step in search on for the primary.

Effects of nicotine with special consideration given to tumorigenesis in the head and neck region

Tumorigenesis is based on initiation, promotion, and progression, whereas tobacco smoke is a decisive predisposing factor for squamous cell carcinomas of the upper aerodigestive tract. A variety of tobacco smoke compounds is known to potentially initiate tumors, but the alkaloid nicotine is generally considered to induce addiction only. However, there is growing evidence that nicotine may also contribute to early stages of tumorigenesis. In the present study, a possible direct genotoxic potential of nicotine is investigated. Lymphatic tissue of the tonsilla palatina of eight donors was harvested during surgery and incubated with nicotine. DNA damage was measured with the comet assay. Genotoxic effects of nicotine could be demonstrated. The results suggest a direct contribution of nicotine to tumor initiation and carcinogenesis.

Diagnosis and management of carcinoma of unknown primary in the head and neck.

Carcinoma of unknown primary is defined as the histological diagnosis of metastasis without the detection of a primary tumor. In the literature, the incidence of CUP in all patients with a malignant disease is said to be between 3% and 15%. The most frequent histopathological results of CUP metastases are adenocarcinoma, followed by undifferentiated carcinoma and squamous cell carcinoma. In this retrospective investigation the clinical records of 167 patients were studied. All patients had been admitted and treated for cervical CUP at the Department of Otorhinolaryngology of the Grosshadern Clinic from 1979 to 1998. Cervical swelling was the first noted symptom in all cases, followed by pain and dysphagia. The study group comprised 134 men and 33 women with an average age of 55 years at admission. Squamous cell carcinoma (n=123) was the predominant histopathological finding of the cervical lymph nodes. During the 10-year follow-up, a primary tumor was detected in 36 (21.5%) of the 167 initially diagnosed CUP patients. In over 90% of these cases the tumor was localized in the head and neck region. The most frequent origin of the tumor was the tonsilla palatina (n=7). Neck dissection and additional postoperative radiotherapy was performed in 118 (70.7%) of the 167 CUP patients. Primary radiotherapy was the treatment of choice in 28 patients; eight patients received combined radio-chemotherapy as the primary treatment and seven patients were treated with chemotherapy alone. Six patients had no treatment. Comparison of different treatment protocols revealed a significant difference in patient survival: in comparison with primary radiotherapy alone or neck dissection and postoperative radiotherapy, the survival rate improved significantly in patients that received a bilateral tonsillectomy in addition to neck dissection and postoperative radiotherapy. The treatment of choice in patients with cervical CUP should be a surgical procedure including (radical) neck dissection and diagnostic bilateral tonsillectomy followed by postoperative radiation of the cervical lymph drainage. Bilateral tonsillectomy is especially important and is correlated with a significant improvement of the survival rate in CUP patients. Additional postoperative radiation of the entire pharyngeal and laryngeal mucosa should also be considered in order to treat a possible small primary tumor in this region.

F-18-FDG-PET zur Detektion des okkulten Primärtumors bei Patienten mit Lymphknotenmetastasen der Halsregion

The occult primary tumor remains an important diagnostic problem in patients with lymph node metastases despite a large variety of imaging modalities. Therefore, the aim of our study was to evaluate the impact of F-18-FDG-positron-emission-tomography (PET) in these patients. The study group included a total of 28 patients aged 39 to 84 years with cervical lymph node metastases of a histologically confirmed squamous cell carcinoma (n = 24) or an undifferentiated carcinoma (n = 4). All patients received 370 MBq F-18-FDG intravenously, and whole-body images were acquired at 60 min p.i. with an ECAT EXACT 47 (921) (Siemens, CTI). All lesions were evaluated either by histology or by CT/MRI. In 12 patients PET did not reveal suspected tumorous lesions. In contrast in 16/28 patients PET showed focal tracer accumulations corresponding to potential primary tumor sites located in the lungs (n = 7), in the region of the tonsilla palatina (n = 5), in the submandibular gland (n = 1), in the nasopharynx (n = 1), in the larynx (n = 1), or at the base of the tongue (n = 1). In nine out of these 16 patients, the primary was confirmed in the lungs in 5 patients, in the larynx, at the base of the tongue, in the nasopharynx, and the tonsilla palatina in one patient each, respectively. Moreover, in 6 out of 16 patients, PET was false-positive. One patient refused further evaluation of PET findings. In approximately one third of all patients, PET detected the primary tumor site, which significantly influenced further therapeutic procedures. Thus, F-18-FDG-PET may be a valuable diagnostic tool in the detection of the primary tumor in patients with cervical lymph node metastases.

Bactericidal activity of cefditoren against a clinical isolate of Haemophilus influenzae simulating human tonsilla palatina level concentrations

Bactericidal activity of cefditoren against a clinical isolate of <I>Haemophilus influenzae</I> simulating human tonsilla palatina level concentrations

Fluoreszenzserologische und histologische Untersuchungen zur Antigenverteilung bei Parvovirusinfektionen von Hund und Katze*

In organs known as replication sites of parvovirus and additionally in stratified squamous epithelia from different regions of 35 dogs with lethal parvovirus enteritis and 19 cats with lethal panleukopenia the distribution of antigen and the prevalence of histologic lesions were studied by immunofluorescence and histologic techniques. The findings showed no striking differences between dogs and cats. Antigen was found in the epithelia of the dorsal side of the tongue (96.3%), pharynx (81.0%), esophagus (50.0%), ventral side of the tongue (20.4%) and planum nasale (5.6%). The epithelia of the skin and the mucous membranes of the male and female genital organs never contained antigen. Moreover antigen was detected in the mucosa of the small intestine (85.2%), bone marrow (81.6%), spleen (79.6%), thymus (66.7%), mesenteric lymph nodes (60.4%), tonsilla palatina (58.5%), smooth muscle cells of the tunica muscularis of the small intestine (9.3%) and myocardium (1.9%). The histologic lesions found in intestinal mucosa, lymphatic tissues, bone marrow and myocardium are in accordance with literature. The tunica muscularis of the small intestine and the epithelium of tongue, pharynx and esophagus contained intranuclear inclusion bodies, the epithelium of tongue and pharynx showed necroses additionally. Tongue- and esophagus-erosions as well as -ulcers reported mainly in panleukopenia according to our results may be explained as a sequel of parvovirus infection of the epithelia of these organs. The prevalence of antigen and intranuclear inclusion bodies in the myocardium and smooth muscle cells of the small intestine--tissues with low or no mitotic activity,--allows to question the postulate of the parvoviruses' exclusive affinity to rapidly dividing cells.

Development and functional anatomy of the human tonsilla palatina.

The tonsilla palatina, belonging to the gut-associated lymphoepithelial organs (GALT), shows close morphological and functional correlation between the lymphatic tissue of mesenchymal origin and the endodermal epithelium of the second pharyngeal pouch. During the 4th fetal month epithelial crypts grow down into the connective tissue and are infiltrated by non-epithelial cells. In the underlying lymphoid tissue the first primary follicles with precursors of follicular dendritic reticulum cells can be localized already in the 14th fetal week post conceptionem (p.c.). The parafollicular areas develop into T-cell regions. Interdigitating cells in these regions as well as within the crypt epithelium express the HLA-DR antigen. They were frequently found in close contact with T-helper cells. This fact is discussed as an indication of the tonsillar crypt epithelium partly serving as T-cell region. But also B-cells and macrophages invade the crypt epithelium in great numbers with a distinctly different distribution. Natural killer (NK) cells (Leu-7-positive) are localized within the crypt epithelium. Small Leu-7-positive lymphocytes (probably precursors) have been found to be numerous in the germinal centers. The interaction of specific stationary cells in the T-cell and B-cell regions is obviously an important factor for the maturation of different subpopulations of immunocompetent lymphoid cells.

Localization and characterization of T-cell subpopulations and natural killer cells (HNK 1+ cells) in the human tonsilla palatina

In the present study attention was focussed on several lymphoid subpopulations and specific stationary cells of the human tonsilla palatina. They were labeled at the light- and electron-microscopic levels by means of monoclonal antibodies to cell surface antigens. Cells resembling interdigitating cells (IDC-like cells) within the crypt epithelium and the interdigitating cells in the parafollicular T-cell region express the HLA-DR antigen. This fact suggests a relationship between these two populations of cells. Both cell types were frequently found in close contact to T-helper cells labeled with Anti-Leu 3a. This fact is discussed as a confirmation of earlier suggestions that the tonsillar crypt epithelium serves as T-cell region. Cytotoxic/suppressor-T cells (OKT8+) and Leu 7-positive cells do not appear to contact interdigitating cells. Anti-Leu 7 is a monoclonal antibody, that defines a differentiation antigen shown to be selectively expressed on human natural killer cells (NK-cells). With the use of the immuno-electron-microscopic labeling method it was possible to analyze the ultrastructure of this lymphoid subpopulation. Two morphologically distinguishable subtypes of Leu 7-positive cells populate different microenvironments: The Leu 7-positive large-granular lymphocyte was predominantly found in the crypt epithelium, while numerous Leu 7-positive cells located in the germinal centers had the appearance of small lymphocytes.(ABSTRACT TRUNCATED AT 250 WORDS)

The development of the human tonsilla palatina.

Tonsils of human fetuses at the 8th to the 28th gestational week (g.w.) were investigated by electron microscopy, enzyme histochemistry, and immunohistochemistry on cryostat sections. The development of the tonsilla palatina starts during the 14th g.w. when the mesenchyme underlying the mucous membrane of the tonsillar cavity becomes invaded by mononuclear wandering cells. In fetuses of about the 16th g.w. epithelial crypts grow down into the connective tissue and are infiltrated by T-lymphocytes. At the same time, precursors of interdigitating cells (IDC) can be identified among the epithelial cells. Frequently, lymphocytes and IDC-like cells are in close contact. From these findings it is concluded that the infiltrated crypt epithelium in the human tonsilla palatina represents a T-cell region. Primary follicles develop in earlier fetal stages than in all other secondary lymphoid organs. They contain precursors of dendritic reticulum cells and lymphoid cells that belong to the B-cell line. These primary follicles may be considered as the first assemblage of B-cell regions in human fetal lymphoid tissue. The present findings indicate that the formation of different stationary elements during the development of B-cell regions and T-cell regions is an important factor for the homing and antigen-dependent maturation of different subpopulations of immunocompetent lymphoid cells.

Ultrastructural analysis of lymphoid subpopulations and their relation to stationary cells in the epithelial crypts and the follicles during early ontogeny of the human tonsilla palatina.

The tonsilla palatina represents one of the gut-associated lympho-epithelial organs in which an oval accumulation of lymphoid tissue is associated with the oral mucus membrane. Obviously, the cellular differentiation of lymphatic cells needs the development of a specific histological architecture of stationary cells. We were able to show this during the ontogenesis of the human thymus (Gaudecker and Muller-Hermelink, 1980). Similar relations between migratory mononuclear wandering cells and the developing stationary element in the human fetal tonsilla palatina shall be analyzed here.