- Lingual (Not Palatine) Tonsillolith: Case Report. [Journal Article]
- JOJ Oral Maxillofac Surg 2019 Mar 19
- The lingual tonsil (LT), located at the base of the tongue posterior to the circumvallate papillae, consists of aggregates of lymphoid tissue separated by a median glossoepiglottic ligament that spli…
The lingual tonsil (LT), located at the base of the tongue posterior to the circumvallate papillae, consists of aggregates of lymphoid tissue separated by a median glossoepiglottic ligament that splits the LT into right and left halves. Tonsillar tissue on either side of the ligament exhibits discrete round nodules that project upward. Each prominence is covered by nonkeratinized epithelium and has a central crypt formed by an invagination of the overlying epithelium. Ducts of adjacent mucous glands empty into the crypt, serving as a flushing mechanism to cleanse the crypt. A thin fibrous connective tissue capsule isolates the LT from the underlying tongue musculature. Lingual tonsillar tissue tends to regress with aging. Hypertrophy and pathologic changes of the LT can develop and cause subjective symptomatology. Patient complaints include sore throats, dysphagia, globus sensation, dyspnea, obstructive sleep apnea, dysgeusia, halitosis, and otalgia. Tonsilloliths in the palatine tonsil are often reported, but the LT also can develop a tonsillolith. Only 1 report of LT tonsilloliths was found in the English-language dental literature. Because of its literary rarity, this report presents a case of an incidental finding of a lingual tonsillolith. Diagnostic skills are sharpened when such cases are brought to the attention of the profession.
- The Adenoids but Not the Palatine Tonsils Serve as a Reservoir for Bacteria Associated with Secretory Otitis Media in Small Children. [Journal Article]
- MmSystems 2019 Jan-Feb; 4(1)
- Acute otitis media (AOM), secretory otitis media (SOM), and acute pharyngotonsillitis are the most frequent reasons for visits to general practitioners, pediatricians, and otolaryngologists. Microbia…
Acute otitis media (AOM), secretory otitis media (SOM), and acute pharyngotonsillitis are the most frequent reasons for visits to general practitioners, pediatricians, and otolaryngologists. Microbial colonization of the epithelial lining of Waldeyer's lymphatic tissues, consisting of the palatine tonsils, lingual tonsils, adenoids, and Eustachian tube tonsil, is a well-known clinical challenge during infancy due to frequent episodes of upper respiratory tract infections. However, no previous studies have investigated the combined role of the palatine tonsils and the adenoids as a reservoir for pathogens associated with SOM in small children. We analyzed the combined crypt microbiome of the palatine tonsils and adenoids from 14 small children with hyperplasia of the tonsils or adenoids and 14 small children with SOM using 16S rRNA gene pyrosequencing. Our study demonstrated a significant difference between the microbiome of the adenoids and that of the palatine tonsils in the two groups but not between the two anatomical locations within the two groups. In particular, the potential pathogens Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis were almost exclusively found in the adenoids of both patient groups, indicating that the adenoids and not the palatine tonsils are the main reservoir for potential pathogens leading to AOM and SOM. IMPORTANCE Our findings that the microbiome differs between crypts of the adenoids and crypts of the palatine tonsils, including the relative abundances of potential pathogens such as Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis, may be the stepping stone for further investigation of individual microbiomes in a longitudinal design that includes recording of the fluctuating health status of the child. Such studies may have the potential to lead to new preventive measurements such as implantation of protective nonpathogens at the nasopharynx as an alternative to adenoidectomy.
- [Clinicopathological characteristics of HPV(+) oropharyngeal squamous cell carcinoma]. [Journal Article]
- ZBZhonghua Bing Li Xue Za Zhi 2019 Feb 08; 48(2):127-131
- CONCLUSIONS: OPSCC-HPV is a pathologically and clinically distinct form of head and neck squamous cell carcinoma. OPSCC-HPV is associated with high-risk HPV (type 16) in all cases. Detection of high-risk HPV16 mRNA by RNAscope is of great significance in the final diagnosis and pathogen identification.
- Yak (Bos grunniens) Tonsils: Morphological Description and Expression of IgA and IgG. [Journal Article]
- ARAnat Rec (Hoboken) 2019; 302(6):999-1009
- This study aimed to describe the morphology, expression of IgA and IgG in adult yak tonsils. The 12 clinically healthy yak tonsils [3- to 6-year old, n = 12] were examined for morphology using light,…
This study aimed to describe the morphology, expression of IgA and IgG in adult yak tonsils. The 12 clinically healthy yak tonsils [3- to 6-year old, n = 12] were examined for morphology using light, and transmission electron microscopes. Expression of IgA and IgG was measured by qRT-PCR, ELISA, and immunohistochemistry. The results showed that the palatine tonsil, the tonsil of the soft palate, and the lingual tonsil were oropharyngeal tonsils. The stratified squamous epithelia covering them had a thick underlying layer of connective tissue and their crypts were heavily infiltrated by lymphocytes. The pharyngeal tonsil and the tubal tonsil were nasopharyngeal tonsils. The epithelia of them was predominantly pseudostratified columnar ciliary epithelium, which were loosely arranged with a number of desmosomes or intermediate junctions variably connecting them. The expression levels of IgA and IgG mRNA and protein from high to low was in the pharyngeal tonsil, palatine tonsil, tonsil of the soft palate, lingual tonsil, and tubal tonsil, respectively. Interestingly, the expression of IgG was very significantly higher than that of IgA in yak tonsils (P < 0.01). Both the IgA and IgG ASCs were distributed in the subepithelial areas of the non-reticular crypt epithelium, especially areas of pseudostratified columnar ciliary epithelium, the reticular crypt epithelium, lymphoid follicles, interfollicular areas, and with some of the positive cells aggregating around the glands. The results indicated that the tonsils were not only typical secondary lymphoid organs but also lymphoepithelial structures. IgG could be a significant component of mucosal immune responses in yak tonsils. Anat Rec, 302:999-1009, 2019. © 2018 Wiley Periodicals, Inc.
- The bacterial community and local lymphocyte response are markedly different in patients with recurrent tonsillitis compared to obstructive sleep apnoea. [Journal Article]
- IJInt J Pediatr Otorhinolaryngol 2018; 113:281-288
- CONCLUSIONS: These results demonstrate significant differences in the local lymphocyte response and bacterial community composition in tonsil tissue between RT and OSA patients. It suggests that the response to antibiotics used in the treatment of these two conditions may be different. Furthermore, the presence of lymphocytes in RT within the tonsil crypt outside the tonsil epithelium is a unique observation of the location of these cells.
- Genomic characterization of clonal evolution during oropharyngeal carcinogenesis driven by human papillomavirus 16. [Journal Article]
- BRBMB Rep 2018; 51(11):584-589
- Secondary prevention via earlier detection would afford the greatest chance for a cure in premalignant lesions. We investigated the exomic profiles of non-malignant and malignant changes in head and …
Secondary prevention via earlier detection would afford the greatest chance for a cure in premalignant lesions. We investigated the exomic profiles of non-malignant and malignant changes in head and neck squamous cell carcinoma (HNSCC) and the genomic blueprint of human papillomavirus (HPV)-driven carcinogenesis in oropharyngeal squamous cell carcinoma (OPSCC). Whole-exome (WES) and whole-genome (WGS) sequencing were performed on peripheral blood and adjacent non-tumor and tumor specimens obtained from eight Korean HNSCC patients from 2013 to 2015. Next-generation sequencing yielded an average coverage of 94.3× for WES and 35.3× for WGS. In comparative genomic analysis of non-tumor and tumor tissue pairs, we were unable to identify common cancer-associated early mutations and copy number alterations (CNA) except in one pair. Interestingly, in this case, we observed that non-tumor tonsillar crypts adjacent to HPV-positive OPSCC appeared normal under a microscope; however, this tissue also showed weak p16 expression. WGS revealed the infection and integration of high-risk type HPV16 in this tissue as well as in the matched tumor. Furthermore, WES identified shared and tumor-specific genomic alterations for this pair. Clonal analysis enabled us to infer the process by which this transitional crypt epithelium (TrCE) evolved into a tumor; this evolution was accompanied by the subsequent accumulation of genomic alterations, including an ERBB3 mutation and large-scale CNAs, such as 3q27-qter amplification and 9p deletion. We suggest that HPV16-driven OPSCC carcinogenesis is a stepwise evolutionary process that is consistent with a multistep carcinogenesis model. Our results highlight the carcinogenic changes driven by HPV16 infection and provide a basis for the secondary prevention of OPSCC. [BMB Reports 2018; 51(11): 584-589].
- ALDH1A1 positive cells are a unique component of the tonsillar crypt niche and are lost along with NGFR positive stem cells during tumourigenesis. [Journal Article]
- PPathology 2018; 50(5):524-529
- Interest into the cellular biology of human tonsillar crypts has grown in recent years because it is now known to be the site of origin of most human papilloma virus (HPV) induced oropharyngeal squam…
Interest into the cellular biology of human tonsillar crypts has grown in recent years because it is now known to be the site of origin of most human papilloma virus (HPV) induced oropharyngeal squamous cell carcinomas (OPSCC). Despite the interest, still relatively little is known regarding the cellular hierarchy and dynamics of this anatomical subsite. Here we evaluate normal tonsillar crypts for expression of putative stem cell markers. We found that ALDH1A1 was uniquely expressed in a subset of suprabasal tonsillar crypt epithelium. This cell population was unique from NGFR expressing cells, which were previously identified to have stem/progenitor activity in vitro. In vivo mitochondrial lineage tracing was consistent with a basal to luminal progression of cellular development. This provides support for NGFR cells as the resident stem/progenitor cells in tonsillar crypts, and suggests that the ALDH1A1 cells are not stem/progenitor cells, but merely a unique component of the crypt cellular microenvironment. Analysis of tumours found that both NGFR and ALDH1A1 are lost in HPV+ and HPV- tumours, while LGR5 expression is induced in the same tumours. These results identify a unique component of the tonsillar crypt epithelium-ALDH1A1 cells-and support a cellular model where NGFR+ cells are the long-lived progenitor cells within tonsillar crypts. They also provide evidence that NGFR and ALDH1A1+ cells are lost during tumourigenesis.
- Prevalence of High-Risk Human Papillomavirus in Tonsil Tissue in Healthy Adults and Colocalization in Biofilm of Tonsillar Crypts. [Journal Article]
- JOJAMA Otolaryngol Head Neck Surg 2018 Mar 01; 144(3):231-237
- CONCLUSIONS: Biofilm is present in the tonsillar crypts in a considerable proportion of tonsil tissues and may be reproducibly identified. Human papillomavirus is demonstrated to colocalize to the crypt biofilm. This has important implications with respect to the determination of HPV prevalence rates in the oropharynx. It may also play a role in the pathogenesis of HPV-related oropharyngeal carcinoma.
- Age-related changes in the morphology and the distribution of IgA and IgG in the palatine tonsils of yaks (Bos grunniens). [Journal Article]
- HHHistol Histopathol 2018; 33(6):577-588
- This study aimed to describe the age-related morphological changes and the distribution of IgA and IgG antibody-secreting cells (ASCs) in yaks. The palatine tonsils of twenty clinically healthy yaks,…
This study aimed to describe the age-related morphological changes and the distribution of IgA and IgG antibody-secreting cells (ASCs) in yaks. The palatine tonsils of twenty clinically healthy yaks, viz. newborn juvenile, adult and aged, were studied using histology, immunohistochemistry, and enzyme-linked immunosorbent assay (ELISA). The results showed that the palatine tonsils found in two tonsillar sinus were elongated kidney-shaped structures. Some external crypts and internal crypts were present. The palatine tonsils were partially enclosed by a connective tissue capsule and had trabeculae extending into the organ. Within these encapsulated organs, mucous glands were seen very obviously. Each crypt was highly branched and lined with stratified squamous non-keratinized epithelium. Several nonepithelial cells infiltrated between the epithelial cells, forming patches of reticular epithelium or lymphoepithelium. In newborn yaks, the lymphoid follicles were not observed. In other groups, the lymphoid follicles consisted of primary lymphoid follicles and secondary lymphoid follicles. Both IgA and IgG ASCs were distributed in the interfollicular areas, lymphoid follicles, the subepithelial areas of the non-reticular crypt epithelium, and the reticular crypt epithelium, with a few positive cells aggregated around the gland. The density of the two ASCs and the expression of the two proteins gradually increased from newborn to adult and reached a peak at adult age; they then decreased with age. However, the density of the IgG ASCs and the expression of IgG protein was significantly higher than that of IgA in all groups (P<0.01). The results indicated that the palatine tonsils were not only lymphoepithelial structures but also typical secondary lymphoid organs. IgG could be a significant component of mucosal immune responses in the palatine tonsils of yaks.
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- Expression and Significance of Cytokeratin 7, a Squamocolumnar Junction Marker, in Head and Neck Squamous Cell Carcinoma. [Journal Article]
- HNHead Neck Pathol 2018; 12(4):448-454
- The favorable features of high-risk human papillomavirus (HPV) in the head and neck are limited to those harboring transcriptionally-active HPV, which occur predominantly in the oropharynx (OP). Fact…
The favorable features of high-risk human papillomavirus (HPV) in the head and neck are limited to those harboring transcriptionally-active HPV, which occur predominantly in the oropharynx (OP). Factors rendering the OP susceptible to HPV oncogenesis are largely unexplored. The role of cytokeratin 7 (CK7) in predisposition to HPV and cancer in the cervix has been evaluated. However, its significance in the H&N is unknown. CK7 immunohistochemistry was performed on a tissue microarray cohort of OP and non-oropharyngeal (NOP) squamous cell carcinomas (SCC) with known clinical follow-up and HPV E6/7 mRNA status. Expression was graded based on the distribution (1 ≤ 33%, 2 = 33-66%, 3 ≥ 66%) and intensity (1 = weak, 2 = strong) with combined score of ≥ 2 considered positive. Survival analysis was performed. Seventy-four NOPSCCs and 204 OPSCCs were studied. HPV was positive in 2.7% of NOPSCCs and 70.9% of OPSCCs. CK7 was positive in 23.0% of OPSCCs and 14.8% of NOPSCCs (p = 0.2), and in 24.1% of HPV positive versus 17.2% of negative patients (p = 0.2). There was no correlation with age, race, gender, HPV status, histologic type, tumor subsite, treatment, stage, or co-morbidities, and CK7 expression was not significantly associated with overall or disease specific survival. In our series, CK7 is positive in ~ 25% of H&N SCCs, although usually only focally. While CK7 has been suspected to be overexpressed selectively in HPV-related OPSCCs due to their origination from tonsillar crypt epithelium, we did not find any significant difference by anatomic H&N subsite, nor by HPV status, for its expression and found no association with patient survival.