Nasal polyposis is a condition characterized by chronic inflammation and structual abnormalities including thickening of the basement menbrane and stromal fibrosis. Myofibroblasts (MF) are fibroblast-like cells with contractile features and thought to express different types of collagen and extracellular matrix, thus contributing to the fibrotic process. A phenotypic hallmark of myofi-broblasts is the expression of α-smooth muscle actin (αSMA). In this study, We used immunohistochemistry applied periodatelysine-paraformaldehyde (PLP) fixed nasal polyp (NP) tissues and fibroblast cell lines from nasal polyps to investigate whether nasal polyps contain myofibroblasts, and topical steroid (ST) treatment affects the expression of the myofibroblast phenotype or not. NP tissues from both ST-treated and STuntreated patients contained a similar number of spindle-shape vimentin positive cells. In contrast, NP tissues from ST-untreated patients contained a substantial number of αSMA positive fibroblasts. The percentage of αSMA positive area/total area except blood vessels in tissues from ST-untreated patients was significantly higher than that in tissues from ST-treated patients (p<0.005). Exposure of fibroblast cell lines from nasal polyps to budesonide (10^-10, 10^-8, 10^-6M) decreased the number of αSMA positive cells in the cultures in a dose-dependent manner. NP tissues from ST-untreated patients, suggesting, taken together with our in vitro results, that this is due, in part, to a direct inhibitory effect of ST on αSMA expression of NP stromal cells.

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Asthma, nasal allergy and nasal polyposis are diseases of respiratory tract characterized by chronic inflammation in which the accumulation of activated eosinophils in the tissue is a prevalent feature. To elucidate the role of eosinophils in the pathogenesis of these diseases, we isolated eosinophils directly from nasal polyp tissues. This time, purity of eosinophils after isolation was 80.0±9.2% and 98% of these eosinophils were EG₂ positive which indicates activated eosinophils. Then, we also examined the survival of these eosinophils. Our data show that thespontaneous (unstimulated) survival ex vivo of such in vivo activated eosinophils was enhanced as compared to that of peripheral blood eosinophils from healthy subjects. This enhanced survival of tissue eosinophils must be the part of the mechanism of eosinophil accumulation in the tissues.

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The present immunocytochemical study was conducted to characterize the epidermis of the middle ear cholesteatoma by using various epithelial markers, including cytokeratin (CK) 10, CK 16, glutathione S transferase (GST), filaggrin, and involucrin. The expression patterns of CK 16 and GST, known hyperproliferative markers, in the middle ear cholesteatoma were similar to those found in the bony part of the meatal skin rather than to those in the cartilageous part. This resemblance suggested that the hyperproliferative nature in the bony part of the meatal skin is involved in the etiopathogenesis of cholesteatoma. The heterogenous staining patterns of CK 10 and filaggrin found in cholesteatoma probably indicate retarded keratinization in the stratified epithelia. Involucrin-immunoreactive basal cells found in the cholesteatoma epithelia are also indicative of abnormal keratinization.

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A case of metastasis of renal cancer to the nasal cavity and paranasal sinuses 2 years after a right nephrectomy in a 61-year-old male is reported. This patient visited our hospital suffering from massive nasal hemorrhage. There was a tumor in the right nasal cavity. We suspected metastasis of renal cancer to the nasal cavity from anamnesis, symptom and CT (computed tomography). The tumor was removed by lateral rhinotomy. Histopathologic examination revealed a clear cell carcinoma due to metastasis from a renal cancer.
There was no sign of recurrence during the past 8 months after operation.
It is believed that metastasis of renal cancer occurs by circuration, and mainly in the lung, liver and bone. It is reported that metastasis to otolaryngology area is rare. Otherwise tumors metastatic to the nasal cavity and paranasal sinuses are most commonly from the renal cancer.
Latent metastasis from renal cancer may arise many years after primary tumor has been removed.
In renal cancer surgical treatment is effective in primary tumor and if metastasis can be removed totally, patients are recovering well.

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A case of chondrosarcoma arising from the nasal septum is reported.
The patient, 29-year-old female, visited our hospital complaining of bilateral nasal obstruction of 2 months'duration. Rhinoscopic examination revealed both the nasal cavities almost completely obstructed by the markedly bulged nasal septum. CT and MRI showed a mass extending from the posterior nasal cavity, posterior ethmoid sinus and sphenoid sinus. A diagnosis of chondrosarcoma was made by biopsy of the mass through the nasal cavity. Under general anesthesia the tumor was removed through sublabial transnasal approach. Moderate or slightly welldifferentiated chondrosarcoma was pathohistologically identified.

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We report a 54-year-old female with follicular carcinoma of the thyroid gland accompanied with papillary carcinoma. She underwent resection of follicular adenocarcinoma of the thyroid gland about 20 years ago. She visited our department complaining of an anterior neck mass presenting for 2 years. CT revealed masses in the bilateral lobe of the thyroid gland. As we suspected regrowth of follicular adenocarcinoma, we performed total thyroidectomy. The pathological diagnosis was follicular carcinoma of the right lobe and papillary carcinoma of the left lobe. Preoperative radiological examination including MRI could not distinguish between follicular and papillary carcinomas. Following the operation, ¹³¹I scintigraphy did not denote any other metastasis.
Though complication of differential histological type of thyroid carcinoma is rare, we suggest that it should be strongly suspected during diagnosis and should be accorded treatment common for thyroid carcinoma.

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The cause of bone destruction in cases of cholesteatoma has been considered to be pressure necrosis and enzymatic substances from the matrix and desquamated epithelial debris. Kaneko, et al., based on observation of materials from various parts of the middle ear in 100 surgical cases of cholesteatoma, reported that in such cases, bone destruction was found in the vicinity of the rupture.
We found bone destruction in the vicinity of the rupture of the cholesteatoma sac in the temporal bone of a 45-year-old female. Cholesteatoma with desquamated epithelial debris was seen in the attic portion. Cholesteatoma sac was ruptured in the malleus head and in a part of the external auditory canal. The bone destruction and granulation with infiltration by lymphocytes and giant cells in the subepithelial layer were seen especially in the ruptured portions. From these facts, the escape of contents from the sac of cholesteatoma into the subepithelial layer is considered to be an important factor in the mechanism of bone destruction.

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Pure tone audiograms of eighty-one ears withcholesteatoma otitis operated in our departmentfrom 1984 to 1993 were studied, and comparedwith those of thirty-six ears with otitis mediachronica (the cases without cholesteatoma).
Bone conduction threshold of the opposite earin these all cases is within normal range at theaudiometory before operation.
As a result, bone conduction threshold and air-bone gap of the cases with cholesteatoma otitisshowed a tendency to increase, as being prolongedof their courses and compared with thoseof the ears of otitis media chronica.
Flat type audiograms were shown more frequentlyin the cases with cholesteatoma otitis, onthe other hand the low tone type was shown morefrequently in the cases with otitis media chronica.
The cases with increasing bone conductionthreshold were shown more frequently in thecases with cholesteatoma of tympanic cavity andin the cases with their course more than tenyears.

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The incidence of cholesteatoma which wasthought to be related to a longstanding habit ofsniffing to alleviate unpleasant aural symptomsdue to closing failure of the eustachian tube isstudied in a consecutive series of cases fromJanuary 1992 to January 1994.
In 20 out of 86 cases of cholesteatomas, thehabit of sniffing to alleviate hyperacusis, autophonicor aural fullness was disclosed. In thesecases the incidence of bilateral abnormality ofthe tympanic membrane was prominently high.The application of the canal-up tympanoplastyfor these ears seemed to be inadequate having arisk to cause recurrence of the disease due to thecontinuation of the habit of sniffing.

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[in Japanese]

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[in Japanese]

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