The purpose of this study was to clarify the mechanism of tonsillar focal infections such as pustulosis palmaris et plantaris (PPP), especially the role of tonsil on it. In 88 cases of various tonsillar diseases, i.e., PPP, chronic tonsillitis, and sleep apnea syndrome, distribution of immunocompetent cells, i.e., B cells having various immunoglobulin isotypes (IgG, IgM, IgA, IgD, IgE, IgA1, and IgA2) on their surfaces and T cell subsets, helper/inducer (CD4+) T cell and suppressor/ cytotoxic (CD8+) T cell were investigated immunohistologically using monoclonal antibodies and ABC method. The proportion of the immunocompetent cells in four anatomical sites in tonsil (germinal center, mantle zone, interfollicular area, and subepithelial area) were quantitatively studied by the image analyzer (CUE-2, Olympus, USA) and compared among various age groups and among three groups of tonsillar diseases. The difference of immunocompetent cells in tonsils between the effective group (showing marked improvement of skin lesions of PPP after tonsillectomy) and the not-effective group (showing no improvement of skin lesions after tonsillectomy) was also investigated.
The results were summarized as follows.
1) Every type of Ig-positive cells in tonsils was decreased in proportion to age, especially the changes of IgG-, IgM-, and IgD-positive cells were inversely proportional to age with statistical significance. On the other hand, changes to T cell subsets with age were smaller in comparison with those of Ig-positive cells, especially the proportion of CD4-positive cells showed almost no changes in accordance with age.
2) Eighty percent of cases with PPP were classified into the effective group, whereas only 20% of them into the not-effective group.
3) IgG-, IgM-, and IgD-positive cells in tonsils of PPP were found to be significantly increased in the effective group compared to the not-effective group. In addition, in the effective group, CD4-positive cells were significantly increased in the interfollicular area and the subepithelial area of the tonsil.
These results indicate that the image analysis will be a breakthrough in quantitative study on the immunohistology of the tonsil and give us useful informations in terms of the mechanism of tonsillar focal infections, i.e., immunological abnormalities in tonsils may play one of the important roles in the pathogenesis of PPP.
