Objective::This review aims to discuss the basic anatomy and physiology of the palatine and pharyngeal tonsils,with reference to how this foundational understanding may affect patient management and surgical procedure...Objective::This review aims to discuss the basic anatomy and physiology of the palatine and pharyngeal tonsils,with reference to how this foundational understanding may affect patient management and surgical procedures in these regions of the upper airway.Methods::A literature search was performed using PubMed and Google Scholar using the MeSH terms tonsils,adenoids,anatomy,physiology,and adenotonsillectomy.Primary sources were excluded if they were abstracts only,non-English language,or non-human studies.Thirty-five sources were included in this review.Results and conclusions::The pharyngeal and palatine tonsils are compact yet physiologically complex mucosa-associated lymphoid tissues that make up a portion of Waldeyer’s ring.As part of the mucosal immune system,these structures function in exogenous antigen sampling and stimulation of immune responses.Aberrant immune activation and/or regulation can lead to a myriad of pathologies,with adenotonsillar hypertrophy,chronic tonsillitis/adenoiditis,and recurrent otitis media among the most commonly encountered conditions by otolaryngologists.While the pathophysiology of these conditions is still incompletely understood,current evidence and future investigations may reveal patterns amenable to targeted medical management.When medical management fails,tonsillectomy and/or adenoidectomy may be indicated for patient care.Though routine procedures,the execution of tonsil and/or adenoid removal requires a thorough understanding of the anatomy of these lymphoepithelial organs so as to minimize the risk for rare serious complications that can occur.展开更多
Background： Adenoid hypertrophy （AH） is associated with pediatric chronic rhinosinusitis （pCRS）, but its role in the inflammatory process of pCRS is unclear. It is thought that innate immunity gene expression is ...Background： Adenoid hypertrophy （AH） is associated with pediatric chronic rhinosinusitis （pCRS）, but its role in the inflammatory process of pCRS is unclear. It is thought that innate immunity gene expression is disrupted in the epithelium of patients with chronic rhinosinusitis （CRS）, including antimicrobial peptides and pattern recognition receptors （PRRs）. The aim of this preliminary study was to detect the expression of innate immunity genes in epithelial cells of hypertrophic adenoids with and without pCRS to better understand their role in pCRS. Methods： Nine pCRS patients and nine simple AH patients undergoing adenoidectomy were recruited for the study. Adenoidal epithelium was isolated, and real-time quantitative polymerase chain reaction （RT-qPCR） was employed to measure relative expression levels of the following messenger RNAs in hypertrophic adenoid epithelial cells of pediatric patients with and without CRS： Human β-defensin （HBD） 2 and 3, surfactant protein （SP）-A and D, toll-like receptors 1-10, nucleotide-binding oligomerization domain （NOD）-like receptors NOD 1, NOD 2, and NACHT, LRR and PYD domains-containing protein 3, retinoic acid-induced gene 1, melanoma differentiation-associated gene 5, and nuclear factor-riB （NF-KB）. RT-qPCR data from two groups were analyzed by independent sample t-tests and Mann-Whitney U-tests. Results： The relative expression of SP-D in adenoidal epithelium ofpCRS group was significantly lower than that in AH group （pCRS 0.73 ± 0.10 vs. AH 1.21 ±0.15; P = 0.0173, t = 2.654）. The relative expression levels of all tested PRRs and NF-κB, as well as HBD-2, HBD-3, and SP-A, showed no statistically significant differences in isolated adenoidal epithelium between pCRS group and AH group. Conclusions： Down-regulated SP-D levels in adenoidal epithelium may contribute to the development of pCRS. PRRs, however, are unlikely to play a significant role in the inflammatory process ofpCRS.展开更多
Adenoid cystic carcinoma of the lacrimal gland(LGACC)is the most common type of malignant epithelial tumor of the lacrimal gland,which is characterized by a high recurrence rate,perineural invasion,and a propensity to...Adenoid cystic carcinoma of the lacrimal gland(LGACC)is the most common type of malignant epithelial tumor of the lacrimal gland,which is characterized by a high recurrence rate,perineural invasion,and a propensity to metastasize to distant sites.Due to its unclear pathogenesis,LGACC has a poor prognosis and a high mortality rate.In recent years,a range of radiotherapy and chemotherapy have been clinically applied,leading to a shift in the treatment approach for LGACC.This article discussed the advances being made in the treatment of LGACC and provides readers with an overview of the impact of LGACC treatment modalities on patient survival and prognostic levels.展开更多
Background:Adenoid hypertrophy(AH)is a common pediatric disease that signifi-cantly impacts the growth and quality of life of children.However,there is no replica-ble and valid model for AH.Methods:An AH rat model was...Background:Adenoid hypertrophy(AH)is a common pediatric disease that signifi-cantly impacts the growth and quality of life of children.However,there is no replica-ble and valid model for AH.Methods:An AH rat model was developed via comprehensive allergic sensitization,chronic inflammation induction,and chronic intermittent hypoxia(CIH).The modeling process involved three steps:female Sprague-Dawley rats(aged 4-5 weeks)were used for modeling.Allergen sensitization was induced via intraperitoneal administra-tion and intranasal provocation using ovalbumin(OVA);chronic nasal inflammation was induced through intranasal lipopolysaccharide(LPS)administration for sustained nasal irritation;CIH akin to obstructive sleep apnea/hypopnea syndrome was induced using an animal hypoxia chamber.Postmodel establishment,behaviors,and histologi-cal changes in nasopharynx-associated lymphoid tissue(NALT)and nasal mucosa were assessed.Arterial blood gas analysis and quantification of serum and tissue levels of(interleukin)IL-4 and IL-13,OVA-specific immunoglobulin E(sIgE),eosinophil cationic protein(ECP),tumor necrosis factor(TNF-α),IL-17,and transforming growth factor(TGF)-βwere conducted for assessment.The treatment group received a combination of mometasone furoate and montelukast sodium for a week and then was evaluated.Results:Rats exhibited notable nasal symptoms and hypoxia after modeling.Histopathological analysis revealed NALT follicle hypertrophy and nasal mucosa in-flammatory cell infiltration.Elevated IL-4,IL-13,IL-17,OVA-sIgE,ECP,and TNF-αlev-els and reduced TGF-βlevels were observed in the serum and tissue of model-group rats.After a week of treatment,the treatment group exhibited symptom and inflam-matory factor improvement.Conclusion:The model effectively simulates AH symptoms and pathological changes.But it should be further validated for genetic,immunological,and hormonal back-grounds in the currently used and other strains and species.展开更多
BACKGROUND Adenoid cystic carcinoma(ACC)of the Bartholin’s gland represents an exceptionally rare malignancy with limited documented cases in the medical literature.It typically manifests as a solid mass that clinica...BACKGROUND Adenoid cystic carcinoma(ACC)of the Bartholin’s gland represents an exceptionally rare malignancy with limited documented cases in the medical literature.It typically manifests as a solid mass that clinically warrants suspicion for neoplastic processes.CASE SUMMARY This case series details two cases of primary ACC cases involving the Bartholin’s gland treated with radical surgical resection of the vaginal lesions.Notably,divergent therapeutic approaches resulted in contrasting prognoses:The patient receiving adjuvant radiotherapy following surgery maintained disease-free status with no locoregional recurrence or metastatic progression through 58 months of surveillance.Conversely,the non-radiated patient experienced disease recurrence within 18 months postoperatively.CONCLUSION Our findings suggest that postoperative radiation therapy may significantly decrease local recurrence rates in Bartholin’s gland ACC,potentially influencing long-term disease control.This comparative outcome analysis underscores the importance of integrating adjuvant radiotherapy integration into treatment protocols for this rare malignancy.展开更多
A case of surgical nursing cooperation during extracorporeal membrane oxygenation(ECMO)-assisted hybrid sleeve left pneumonectomy,which included a right open carinal resection,tracheal bronchial anastomosis,and thorac...A case of surgical nursing cooperation during extracorporeal membrane oxygenation(ECMO)-assisted hybrid sleeve left pneumonectomy,which included a right open carinal resection,tracheal bronchial anastomosis,and thoracoscopic left pneumonectomy,has been documented.A thorough nursing intervention focused on patient safety and proactive measures to address potential complications was implemented throughout the surgical process.The procedure was completed without incident,and no postoperative complications were reported.展开更多
To the Editor:Sleep-disordered breathing(SDB)is a health problem affecting approximately 12%of children in China,[1]characterized by habitual loud snoring and increased respiratory effort.Increased upper airway resist...To the Editor:Sleep-disordered breathing(SDB)is a health problem affecting approximately 12%of children in China,[1]characterized by habitual loud snoring and increased respiratory effort.Increased upper airway resistance related to enlarged adenoids has been identified as the most common cause in children with obstructive SDB,and adenoidectomy is the standard treatment for the disorder.Similar to lymphoid tissues,adenoids show a unique natural growth pattern,which incorporates both overgrowth and involution.However,the development patterns of adenoids have not been clearly elucidated.Since the adenoids are located in the nasopharynx roof,direct evaluation of their size and proportion to the upper airway area is difficult.Thus,radiological methods have been employed widely for such purposes,including traditional plain cranial radiographs,computed tomography(CT),cone-beam CT,and magnetic resonance imaging(MRI).MRI can reveal the accurate size of adenoids by differentiating them from other soft tissue structures without any ionizing radiation;therefore,it can effectively study the adenoids’developmental pattern in normal children.Previous studies have evaluated age-associated changes in adenoid size by MRI.Arens et al[2]indicated that adenoids grow proportionally to the skeletal structures in children aged 1 to 11 years.Papaioannou et al[3]reported that head MRI examinations demonstrated increased adenoid size during the first 7–8 years of life and then decreased gradually in children without snoring signs.Variabilities of the above-reported adenoids’development pattern exist due to the limitations associated with the small sample size.Furthermore,none of the above-mentioned studies on normal children used a strict method to exclude SDB.Additionally,for adenoid hypertrophy,the adenoid/nasopharyngeal(A/N)ratio was found to be a useful,tolerable,and confident diagnostic method in pediatric patients,with emphasis on the correlation of the adenoid size and upper airway lumen to variable degrees.Therefore,the A/N ratio can be considered a useful objective tool in evaluating adenoid development in children.We aimed to investigate the growth and involution patterns of adenoids in consecutive age groups from birth to 16 years in Chinese children without SDB using MRI data,which may benefit the study of diseases associated with the development of adenoids.展开更多
AIM:To explore the prognostic factors for lacrimal gland adenoid cystic carcinoma(LGACC)in Chinese patients.METHODS:Clinical and histopathological data were reviewed in patients with pathologically confirmed LGACC.Loc...AIM:To explore the prognostic factors for lacrimal gland adenoid cystic carcinoma(LGACC)in Chinese patients.METHODS:Clinical and histopathological data were reviewed in patients with pathologically confirmed LGACC.Local recurrence,metastasis,and disease-specific death were the main outcome measures.Univariate and multivariate analyses were performed by the Kaplan-Meier method and a Cox proportional hazard model.RESULTS:This retrospective cohort study included 45 patients with pathologically confirmed LGACC between January 2008 and June 2022.Tumor(T)classification(P=0.005),nodal metastasis(N)classification(P=0.018)and positive margin(P=0.008)were independent risk factors of recurrence;T(P=0.013)and N(P=0.003)classification and the basaloid tumor type(P=0.032)were independent risk factors for metastasis;T classification(P<0.001)was an independent factor of death of disease.In the further analysis,the durations from first surgery to radiotherapy is correlated with metastatic risk in LGACC patients with basaloid component(P=0.022).CONCLUSION:Histological subtype should be emphasized when evaluating prognosis and guiding treatment.Timely radiotherapy may reduce the risk of metastasis in patients with basaloid component.展开更多
AIM:To evaluate the outcomes of eye-sparing surgery for lacrimal gland adenoid cystic carcinoma and the impact on tumor recurrence and orbital integrity.METHODS:The study enrolled four patients with recurrent lacrimal...AIM:To evaluate the outcomes of eye-sparing surgery for lacrimal gland adenoid cystic carcinoma and the impact on tumor recurrence and orbital integrity.METHODS:The study enrolled four patients with recurrent lacrimal gland adenoid cystic carcinoma.The outcome focused on the relevance of the integrity of the lateral orbital wall to the occurrence of extraorbital metastasis in the local recurrence of lacrimal gland adenoid cystic carcinoma.RESULTS:Three patients underwent eye-sparing surgery via lateral orbitotomy without postoperative radiotherapy,and one patient who underwent eye-sparing surgery via sub-brow approach.These four patients all demonstrated a recurrence involving the invasion of extraorbital tissues as metastatic form through surgical bone seams.CONCLUSION:Preserving intact orbital bone tissue is crucial for mitigating direct cross-organ metastasis of lacrimal gland adenoid cystic carcinoma.The findings suggest avoiding the lateral orbitotomy approach with no or limited orbital bone wall invasion.展开更多
BACKGROUND Esophageal adenoid cystic carcinoma(EACC)is an exceedingly rare malignant tumor of the esophagus,posing significant challenges in the clinic.CASE SUMMARY This report detailed the case of a 72-year-old male ...BACKGROUND Esophageal adenoid cystic carcinoma(EACC)is an exceedingly rare malignant tumor of the esophagus,posing significant challenges in the clinic.CASE SUMMARY This report detailed the case of a 72-year-old male whose diagnosis of EACC was confirmed through postoperative histopathological examination.The patient underwent thoracoscopy-assisted radical resection of the esophageal tumor,coupled with lymph node dissection.Pathological findings revealed an adenoid cystic carcinoma infiltrating the entire layer of the muscularis propria,locally extending into the outer membrane of the esophageal fiber,involving the cardia and exhibiting no lymph node metastasis.The patient’s condition was classified as primary EACC,T3N0M0,per the American Joint Committee on Cancer(2017;8th edition).One month after surgery,the patient received postoperative adjuvant radiation therapy.CONCLUSION In addressing the rarity and high potential for biopsy misdiagnosis of EACC,this study delved into its diagnostic methods and treatment.展开更多
BACKGROUND Esophageal cancer is the sixth leading cause of cancer-related death and eighth most common cancer,affecting>450000 people worldwide.Esophageal squamous cell carcinoma is the most common histological typ...BACKGROUND Esophageal cancer is the sixth leading cause of cancer-related death and eighth most common cancer,affecting>450000 people worldwide.Esophageal squamous cell carcinoma is the most common histological type,whereas esophageal adenoid cystic carcinoma(EACC)is rare.The liver is the most common distant metastatic site in esophageal cancer.Anal metastasis is rare and has not been reported in clinical practice before.Here,we report anal metastases in a patient with EACC after regular chemotherapy and surgical resection.CASE SUMMARY A 61-year-old esophageal cancer patient was found to have lung and brain metastases during standardized treatment.The patient’s treatment plan was continuously adjusted according to the latest treatment guidelines.However,the patient subsequently noticed rectal bleeding and itching,and after obtaining pathology results at the local hospital,anal metastasis of esophageal cancer was diagnosed.CONCLUSION Postoperative pathology and immunohistochemistry confirmed EACC with rare anal metastasis.More exploration of EACC diagnosis and treatment is needed.展开更多
Background: Ethmoidal polyposis coexisting with adenoid enlargement and tympanic membrane perforation is a rare condition in otolaryngological practice. Evidences have shown that antrochoanal polyp often times coexist...Background: Ethmoidal polyposis coexisting with adenoid enlargement and tympanic membrane perforation is a rare condition in otolaryngological practice. Evidences have shown that antrochoanal polyp often times coexists with adenoid enlargement especially in the young which was in sharp contrast to ethmoidal polyposis occurring in the presence of adenoid enlargement. Moreover, the hidden location of nasopharynx housing the adenoids, coupled with the masking effect of bilateral sinonasal polyps, leads to inadvertent misdiagnosis of this complex pathology with subsequent difficulty in providing effective management. Case Presentation: A 24 year-old lady presented with recurrent bilateral nasal obstruction that became persistent associated with nasal discharge and anosmia. She also had recurrent right otorrhoea with associated hearing loss. Diagnostic rigid nasal endoscopy revealed mucoid discharge with bilateral polypoid masses filling both nasal cavities. Otoendoscopic finding revealed a small (about 5%) central tympanic membrane perforation. A clinical assessment of chronic rhinosinusitis with nasal polyposis complicated by chronic suppurative otitis media (CSOM) was made. A non-contrast CT scan of the paranasal sinuses showed isodense lesions in the nasal cavities, all paranasal sinuses and the entire nasopharynx. She had endoscopic sinus surgery and a nasopharyngeal clearance biopsy. The nasal, paranasal and nasopharyngeal masses had histologic confirmation of inflammatory nasal polyps and lymphoid (adenoid) hyperplasia respectively. Her condition improved remarkably with subsequent medical treatment. She was followed up for 8 months and no recurrence was observed. Conclusion: Sinonasal polyposis can coexist with adenoid hypertrophy and middle ear disease as a single pathological condition. Hence, a high index of suspicion and thorough evaluation become necessary for making timely diagnoses and instituting effective management.展开更多
文摘Objective::This review aims to discuss the basic anatomy and physiology of the palatine and pharyngeal tonsils,with reference to how this foundational understanding may affect patient management and surgical procedures in these regions of the upper airway.Methods::A literature search was performed using PubMed and Google Scholar using the MeSH terms tonsils,adenoids,anatomy,physiology,and adenotonsillectomy.Primary sources were excluded if they were abstracts only,non-English language,or non-human studies.Thirty-five sources were included in this review.Results and conclusions::The pharyngeal and palatine tonsils are compact yet physiologically complex mucosa-associated lymphoid tissues that make up a portion of Waldeyer’s ring.As part of the mucosal immune system,these structures function in exogenous antigen sampling and stimulation of immune responses.Aberrant immune activation and/or regulation can lead to a myriad of pathologies,with adenotonsillar hypertrophy,chronic tonsillitis/adenoiditis,and recurrent otitis media among the most commonly encountered conditions by otolaryngologists.While the pathophysiology of these conditions is still incompletely understood,current evidence and future investigations may reveal patterns amenable to targeted medical management.When medical management fails,tonsillectomy and/or adenoidectomy may be indicated for patient care.Though routine procedures,the execution of tonsil and/or adenoid removal requires a thorough understanding of the anatomy of these lymphoepithelial organs so as to minimize the risk for rare serious complications that can occur.
文摘Background： Adenoid hypertrophy （AH） is associated with pediatric chronic rhinosinusitis （pCRS）, but its role in the inflammatory process of pCRS is unclear. It is thought that innate immunity gene expression is disrupted in the epithelium of patients with chronic rhinosinusitis （CRS）, including antimicrobial peptides and pattern recognition receptors （PRRs）. The aim of this preliminary study was to detect the expression of innate immunity genes in epithelial cells of hypertrophic adenoids with and without pCRS to better understand their role in pCRS. Methods： Nine pCRS patients and nine simple AH patients undergoing adenoidectomy were recruited for the study. Adenoidal epithelium was isolated, and real-time quantitative polymerase chain reaction （RT-qPCR） was employed to measure relative expression levels of the following messenger RNAs in hypertrophic adenoid epithelial cells of pediatric patients with and without CRS： Human β-defensin （HBD） 2 and 3, surfactant protein （SP）-A and D, toll-like receptors 1-10, nucleotide-binding oligomerization domain （NOD）-like receptors NOD 1, NOD 2, and NACHT, LRR and PYD domains-containing protein 3, retinoic acid-induced gene 1, melanoma differentiation-associated gene 5, and nuclear factor-riB （NF-KB）. RT-qPCR data from two groups were analyzed by independent sample t-tests and Mann-Whitney U-tests. Results： The relative expression of SP-D in adenoidal epithelium ofpCRS group was significantly lower than that in AH group （pCRS 0.73 ± 0.10 vs. AH 1.21 ±0.15; P = 0.0173, t = 2.654）. The relative expression levels of all tested PRRs and NF-κB, as well as HBD-2, HBD-3, and SP-A, showed no statistically significant differences in isolated adenoidal epithelium between pCRS group and AH group. Conclusions： Down-regulated SP-D levels in adenoidal epithelium may contribute to the development of pCRS. PRRs, however, are unlikely to play a significant role in the inflammatory process ofpCRS.
基金Supported by National Key R&D Program of China(No.2023YFC2410203)Beijing Hospitals Authority Clinical medicine Development of Special Funding Support(No.ZLRK202503).
文摘Adenoid cystic carcinoma of the lacrimal gland(LGACC)is the most common type of malignant epithelial tumor of the lacrimal gland,which is characterized by a high recurrence rate,perineural invasion,and a propensity to metastasize to distant sites.Due to its unclear pathogenesis,LGACC has a poor prognosis and a high mortality rate.In recent years,a range of radiotherapy and chemotherapy have been clinically applied,leading to a shift in the treatment approach for LGACC.This article discussed the advances being made in the treatment of LGACC and provides readers with an overview of the impact of LGACC treatment modalities on patient survival and prognostic levels.
基金This work was financially supported by the National Natural Science Foundation of China(grant number:8217150152)the Clinical Science and Technology Innovation Project of Shanghai Shenkang Hospital Development Center(grant number:SHDC12021102)the Shanghai Three-Year Action Plan to Further Accelerate the Development of Traditional Chinese Medicine Inheritance and Innovation(grant number:ZY(2021-2023)-0209-05).
文摘Background:Adenoid hypertrophy(AH)is a common pediatric disease that signifi-cantly impacts the growth and quality of life of children.However,there is no replica-ble and valid model for AH.Methods:An AH rat model was developed via comprehensive allergic sensitization,chronic inflammation induction,and chronic intermittent hypoxia(CIH).The modeling process involved three steps:female Sprague-Dawley rats(aged 4-5 weeks)were used for modeling.Allergen sensitization was induced via intraperitoneal administra-tion and intranasal provocation using ovalbumin(OVA);chronic nasal inflammation was induced through intranasal lipopolysaccharide(LPS)administration for sustained nasal irritation;CIH akin to obstructive sleep apnea/hypopnea syndrome was induced using an animal hypoxia chamber.Postmodel establishment,behaviors,and histologi-cal changes in nasopharynx-associated lymphoid tissue(NALT)and nasal mucosa were assessed.Arterial blood gas analysis and quantification of serum and tissue levels of(interleukin)IL-4 and IL-13,OVA-specific immunoglobulin E(sIgE),eosinophil cationic protein(ECP),tumor necrosis factor(TNF-α),IL-17,and transforming growth factor(TGF)-βwere conducted for assessment.The treatment group received a combination of mometasone furoate and montelukast sodium for a week and then was evaluated.Results:Rats exhibited notable nasal symptoms and hypoxia after modeling.Histopathological analysis revealed NALT follicle hypertrophy and nasal mucosa in-flammatory cell infiltration.Elevated IL-4,IL-13,IL-17,OVA-sIgE,ECP,and TNF-αlev-els and reduced TGF-βlevels were observed in the serum and tissue of model-group rats.After a week of treatment,the treatment group exhibited symptom and inflam-matory factor improvement.Conclusion:The model effectively simulates AH symptoms and pathological changes.But it should be further validated for genetic,immunological,and hormonal back-grounds in the currently used and other strains and species.
文摘BACKGROUND Adenoid cystic carcinoma(ACC)of the Bartholin’s gland represents an exceptionally rare malignancy with limited documented cases in the medical literature.It typically manifests as a solid mass that clinically warrants suspicion for neoplastic processes.CASE SUMMARY This case series details two cases of primary ACC cases involving the Bartholin’s gland treated with radical surgical resection of the vaginal lesions.Notably,divergent therapeutic approaches resulted in contrasting prognoses:The patient receiving adjuvant radiotherapy following surgery maintained disease-free status with no locoregional recurrence or metastatic progression through 58 months of surveillance.Conversely,the non-radiated patient experienced disease recurrence within 18 months postoperatively.CONCLUSION Our findings suggest that postoperative radiation therapy may significantly decrease local recurrence rates in Bartholin’s gland ACC,potentially influencing long-term disease control.This comparative outcome analysis underscores the importance of integrating adjuvant radiotherapy integration into treatment protocols for this rare malignancy.
文摘A case of surgical nursing cooperation during extracorporeal membrane oxygenation(ECMO)-assisted hybrid sleeve left pneumonectomy,which included a right open carinal resection,tracheal bronchial anastomosis,and thoracoscopic left pneumonectomy,has been documented.A thorough nursing intervention focused on patient safety and proactive measures to address potential complications was implemented throughout the surgical process.The procedure was completed without incident,and no postoperative complications were reported.
基金supported by a grant from the Beijing Municipal Administration of Hospitals Incubating Program(No.PX2020053).
文摘To the Editor:Sleep-disordered breathing(SDB)is a health problem affecting approximately 12%of children in China,[1]characterized by habitual loud snoring and increased respiratory effort.Increased upper airway resistance related to enlarged adenoids has been identified as the most common cause in children with obstructive SDB,and adenoidectomy is the standard treatment for the disorder.Similar to lymphoid tissues,adenoids show a unique natural growth pattern,which incorporates both overgrowth and involution.However,the development patterns of adenoids have not been clearly elucidated.Since the adenoids are located in the nasopharynx roof,direct evaluation of their size and proportion to the upper airway area is difficult.Thus,radiological methods have been employed widely for such purposes,including traditional plain cranial radiographs,computed tomography(CT),cone-beam CT,and magnetic resonance imaging(MRI).MRI can reveal the accurate size of adenoids by differentiating them from other soft tissue structures without any ionizing radiation;therefore,it can effectively study the adenoids’developmental pattern in normal children.Previous studies have evaluated age-associated changes in adenoid size by MRI.Arens et al[2]indicated that adenoids grow proportionally to the skeletal structures in children aged 1 to 11 years.Papaioannou et al[3]reported that head MRI examinations demonstrated increased adenoid size during the first 7–8 years of life and then decreased gradually in children without snoring signs.Variabilities of the above-reported adenoids’development pattern exist due to the limitations associated with the small sample size.Furthermore,none of the above-mentioned studies on normal children used a strict method to exclude SDB.Additionally,for adenoid hypertrophy,the adenoid/nasopharyngeal(A/N)ratio was found to be a useful,tolerable,and confident diagnostic method in pediatric patients,with emphasis on the correlation of the adenoid size and upper airway lumen to variable degrees.Therefore,the A/N ratio can be considered a useful objective tool in evaluating adenoid development in children.We aimed to investigate the growth and involution patterns of adenoids in consecutive age groups from birth to 16 years in Chinese children without SDB using MRI data,which may benefit the study of diseases associated with the development of adenoids.
基金Supported by the National Natural Science Foundation of China (No.82303106)Innovative Research Team of High-Level Local Universities in Shanghai (No.SHSMU-ZDCX20210902)+2 种基金the Science and Technology Commission of Shanghai (No.20DZ2270800)Project of Biobank of Shanghai Ninth People’s Hospital (No.ybka202208)2023 Postdoctoral Research Project Fund of Shanghai Ninth People’s Hospital (No.202401026).
文摘AIM:To explore the prognostic factors for lacrimal gland adenoid cystic carcinoma(LGACC)in Chinese patients.METHODS:Clinical and histopathological data were reviewed in patients with pathologically confirmed LGACC.Local recurrence,metastasis,and disease-specific death were the main outcome measures.Univariate and multivariate analyses were performed by the Kaplan-Meier method and a Cox proportional hazard model.RESULTS:This retrospective cohort study included 45 patients with pathologically confirmed LGACC between January 2008 and June 2022.Tumor(T)classification(P=0.005),nodal metastasis(N)classification(P=0.018)and positive margin(P=0.008)were independent risk factors of recurrence;T(P=0.013)and N(P=0.003)classification and the basaloid tumor type(P=0.032)were independent risk factors for metastasis;T classification(P<0.001)was an independent factor of death of disease.In the further analysis,the durations from first surgery to radiotherapy is correlated with metastatic risk in LGACC patients with basaloid component(P=0.022).CONCLUSION:Histological subtype should be emphasized when evaluating prognosis and guiding treatment.Timely radiotherapy may reduce the risk of metastasis in patients with basaloid component.
基金Supported by the Beijing Nova Program-Cross-Cooperation(No.20220484218)Beijing Hospitals Authority’s Ascent Plan(No.DFL20220301).
文摘AIM:To evaluate the outcomes of eye-sparing surgery for lacrimal gland adenoid cystic carcinoma and the impact on tumor recurrence and orbital integrity.METHODS:The study enrolled four patients with recurrent lacrimal gland adenoid cystic carcinoma.The outcome focused on the relevance of the integrity of the lateral orbital wall to the occurrence of extraorbital metastasis in the local recurrence of lacrimal gland adenoid cystic carcinoma.RESULTS:Three patients underwent eye-sparing surgery via lateral orbitotomy without postoperative radiotherapy,and one patient who underwent eye-sparing surgery via sub-brow approach.These four patients all demonstrated a recurrence involving the invasion of extraorbital tissues as metastatic form through surgical bone seams.CONCLUSION:Preserving intact orbital bone tissue is crucial for mitigating direct cross-organ metastasis of lacrimal gland adenoid cystic carcinoma.The findings suggest avoiding the lateral orbitotomy approach with no or limited orbital bone wall invasion.
基金Supported by National Natural Science Foundation of China,No.U2330122and Foundation of State Key Laboratory of Ultrasound in Medicine and Engineering,No.2022KFKT011.
文摘BACKGROUND Esophageal adenoid cystic carcinoma(EACC)is an exceedingly rare malignant tumor of the esophagus,posing significant challenges in the clinic.CASE SUMMARY This report detailed the case of a 72-year-old male whose diagnosis of EACC was confirmed through postoperative histopathological examination.The patient underwent thoracoscopy-assisted radical resection of the esophageal tumor,coupled with lymph node dissection.Pathological findings revealed an adenoid cystic carcinoma infiltrating the entire layer of the muscularis propria,locally extending into the outer membrane of the esophageal fiber,involving the cardia and exhibiting no lymph node metastasis.The patient’s condition was classified as primary EACC,T3N0M0,per the American Joint Committee on Cancer(2017;8th edition).One month after surgery,the patient received postoperative adjuvant radiation therapy.CONCLUSION In addressing the rarity and high potential for biopsy misdiagnosis of EACC,this study delved into its diagnostic methods and treatment.
基金National Natural Science Foundation of China,No.82072721and Natural Science Foundation of Jiangsu Province of China,No.BK20201493.
文摘BACKGROUND Esophageal cancer is the sixth leading cause of cancer-related death and eighth most common cancer,affecting>450000 people worldwide.Esophageal squamous cell carcinoma is the most common histological type,whereas esophageal adenoid cystic carcinoma(EACC)is rare.The liver is the most common distant metastatic site in esophageal cancer.Anal metastasis is rare and has not been reported in clinical practice before.Here,we report anal metastases in a patient with EACC after regular chemotherapy and surgical resection.CASE SUMMARY A 61-year-old esophageal cancer patient was found to have lung and brain metastases during standardized treatment.The patient’s treatment plan was continuously adjusted according to the latest treatment guidelines.However,the patient subsequently noticed rectal bleeding and itching,and after obtaining pathology results at the local hospital,anal metastasis of esophageal cancer was diagnosed.CONCLUSION Postoperative pathology and immunohistochemistry confirmed EACC with rare anal metastasis.More exploration of EACC diagnosis and treatment is needed.
文摘Background: Ethmoidal polyposis coexisting with adenoid enlargement and tympanic membrane perforation is a rare condition in otolaryngological practice. Evidences have shown that antrochoanal polyp often times coexists with adenoid enlargement especially in the young which was in sharp contrast to ethmoidal polyposis occurring in the presence of adenoid enlargement. Moreover, the hidden location of nasopharynx housing the adenoids, coupled with the masking effect of bilateral sinonasal polyps, leads to inadvertent misdiagnosis of this complex pathology with subsequent difficulty in providing effective management. Case Presentation: A 24 year-old lady presented with recurrent bilateral nasal obstruction that became persistent associated with nasal discharge and anosmia. She also had recurrent right otorrhoea with associated hearing loss. Diagnostic rigid nasal endoscopy revealed mucoid discharge with bilateral polypoid masses filling both nasal cavities. Otoendoscopic finding revealed a small (about 5%) central tympanic membrane perforation. A clinical assessment of chronic rhinosinusitis with nasal polyposis complicated by chronic suppurative otitis media (CSOM) was made. A non-contrast CT scan of the paranasal sinuses showed isodense lesions in the nasal cavities, all paranasal sinuses and the entire nasopharynx. She had endoscopic sinus surgery and a nasopharyngeal clearance biopsy. The nasal, paranasal and nasopharyngeal masses had histologic confirmation of inflammatory nasal polyps and lymphoid (adenoid) hyperplasia respectively. Her condition improved remarkably with subsequent medical treatment. She was followed up for 8 months and no recurrence was observed. Conclusion: Sinonasal polyposis can coexist with adenoid hypertrophy and middle ear disease as a single pathological condition. Hence, a high index of suspicion and thorough evaluation become necessary for making timely diagnoses and instituting effective management.
