[in Japanese]

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We report a case of diffuse large B-cell lymphoma arising from Warthin’s tumor in the parotid gland. An 8X-year-old man presented with a mass in the right side of the parotid gland which was painful and gradually enlarged over two months. CT showed a uniform region in the parotid gland. A positron emission tomography/computed tomography （PET/CT） scan showed abnormal accumulation in the same area. The histological diagnosis was Warthin’s tumor in the first biopsy. However, since the tumor was rapidly enlarging, a second biopsy was performed. Histological analysis showed variant cell, which stained positively for CD20, CD25, and CD79 and negatively for CD3, CD4, and CD8, and the tumor was diagnosed as malignant lymphoma, diffuse large B-cell type. Taking those findings together, we diagnosed the patient as malignant lymphoma with Warthin’s tumor in the parotid gland.

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We investigated the relationship between PD-L1 expression and CD8 positive tumor infiltrating lymphocyte （TIL） and p16 immunostaining in cases of oropharyngeal carcinoma with curative treatment in our department from 2007 to 2016. 110 cases were analyzed; the median age was 66 years old and the median observation period was 35 months. 46% of p16 positive cases and 42% of p16 negative cases were found to be PD-L1 positive, showing no significant relationship between PD-L1 and p16 positivity （p＝0.70）. There were no differences in disease-specific survival rate between PD-L1 positive and negative cases （p＝0.97）. High CD8 TIL expression was observed in 57% of p16 positive cases and 52% of p16 negative cases, also showing no significant relationship between CD8 TIL expression and p16 positivity （p＝0.70）. High CD8 TIL expression was associated with a good prognosis （p＝0.02）. There was no clear correlation between PD-L1 and CD8 TIL expression （p＝0.25）. The frequency of PD-L1 positivity and high CD8 TIL expression, which is thought to indicate a good response to Nivolumab, was about 30% in our oropharyngeal cases.

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HIV-related otolaryngological symptoms vary widely. Eighty patients referred to our clinic with a diagnosis of AIDS/HIV infection were reviewed. Twelve of them were diagnosed as AIDS/HIV because of symptoms of the otolaryngology field. Among them, pharyngitis/tonsillitis, oral candida, and cervical lymphadenopathy were common, but there were no specific findings. In a patient with refractory sore pharyngitis/tonsillitis, oral candida, or cervical lymphadenopathy, it is important to consider AIDS/HIV infection and conduct a detailed inquiry for early detection.

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This paper reports on the 10-year prognosis for tonsillectomy and pulse therapy for IgA nephropathy following renal transplantation at the Kochi Health Sciences Center. The study subjects consisted of four patients with IgA nephropathy following renal transplantation who underwent tonsillectomy at the Center’s Department of Otorhinolaryngology between March 1, 2005 and May 25, 2009 and were followed up for 10 years. Three subjects underwent both tonsillectomy and pulse therapy, and the other one underwent tonsillectomy alone. The parameters examined were urinary occult blood （qualitative, sediments） and urinary protein （qualitative）, and their findings obtained at 10 years post-operation were compared with those obtained before the surgery. All subjects were negative for urinary occult blood in terms of both qualitative testing and sediments. Three subjects were negative for urinary protein in terms of qualitative testing both at the time of surgery and after 10 years, whereas the other one subject became positive 9 years after tonsillectomy. Since no recurrence was noted in any subject during the 10 post-operative years, it is considered that tonsillectomy and pulse therapy may be effective.

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Objective: There have been many reports on age-associated changes in taste, with most demonstrating taste thresholds to increase with age. However, the period when age-associated changes in taste and deterioration of taste quality begin, and influencing factors, remain unclear. The aim of this study was to investigate age-related changes in taste and lingual somatosensory function on the anterior tongue.
Subjects and Methods: The investigation involved 1200 subjects comprising 560 men and 640 women, with a mean age of 43.6 years and age range from 6 to 88 years. Electrogustometry （EGM, n＝1,200）, filter paper disc test （FPD, n＝885）, two-point discrimination （n＝166）, and electrostimulation （n＝107） were performed on the healthy side before middle ear surgery. Taste and lingual somatosensory sensitivities were assessed on the anterior tongue region.
Results: The thresholds of all tests increased with age. Significant differences in the thresholds on EGM and FPD were found in subjects from their 50s. The threshold of sweet taste was not significantly different among the age groups, except between those in their 10s and 50s. Women had lower thresholds on both EGM and FPD than men. There was a significant correlation between the lingual somatosensory thresholds and age, even in children and young subjects.
Conclusions: Taste and lingual somatosensory functions deteriorated with age; however, sensitivity to sweet taste was less affected by aging than the other tastes. The somatosensory threshold on the tongue increased linearly from the pediatric period.

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HPV-related oropharynx cancer is known to have a favorable prognosis, but it is clearly categorized into HPV-related oropharynx cancer with “Positive” and “Negative” by p16 immunohistochemistry according to the New Tumor Node Metastasis （TNM） classification （UICC/AJCC, 8th edition） revised in 2017. Since then, the detection of p16 has been actively conducted at various institutions, and individualized treatment with minimal invasion has been discussed for p16 Positive cases. For 40 cases undergoing primary treatment for oropharyngeal squamous cell carcinoma at our center during the period from November 2014 to July 2019, the present study aimed to clarify differences in background and prognosis of patients between those with HPV-related and non-HPV-related oropharynx cancer by p16 protein immunohistochemistry. It then examined whether the survival rate by disease stage reflects a prognosis of longer life in the 8th edition classification compared to the 7th edition classification of UICC/AJCC. Regarding the patients’ background, Brinkman’s index was significantly higher for non-HPV-related oropharynx cancer, indicating more double cancers. Overall survival （OS）/disease-free survival （DFS） of all cases for 3 years were 77.8%/54.7% respectively, and comparing the two groups, OS/DFS of HPV and non-HPV-related oropharynx cancer for 3 years were 92.9%/54.7% and 69.1/49.2% respectively with a hazard ratio of 0.267/0.691 and log-rank p-value of 0.222/0.504. There was no significant difference, but non-HPV-related oropharynx cancer tended to have a poor prognosis. Furthermore, because of the revision for the new TMM classification （UJCC/AFCC, 8th edition）, oropharynx cancer can be stratified with greater reflection of the prognosis through the overall down staging. Since HPV-related oropharynx cancer has a better prognosis compared to non-HPV-related oropharynx cancer, it may possibly reduce the intensity of treatment, but there is no clear conclusion yet. A future issue is to achieve minimally-invasive treatment to improve quality of life （QOL） after treatment without worsening the survival rate for oropharynx cancer.

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Secretory carcinoma was added to the new WHO classification of salivary gland tumors revised in 2017. The clinical behavior of such tumors is not completely understood because there are few reports by otolaryngologists to date. We report a case of secretory carcinoma of the salivary gland. The patient was a 61-year-old man who underwent surgical excision with a diagnosis of malignant tumor of the left parotid gland （cT3N0M0）, and histopathological examination indicated secretory carcinoma. Two years postoperatively, lung metastasis was observed, but we decided to follow up at the request of the patient. Although the mass has grown slowly, he has survived with the tumor for five years. Secretory carcinoma is thought to follow a clinical course of low-grade carcinoma, but there have been reports of a poor prognosis in some cases of distant metastasis, and a sudden exacerbation in other cases, so careful follow-up is important.

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The varicella-zoster virus （VZV） can cause meningitis and lead to multiple central nerve involvement. A 69-year-old man complaining of sore throat and progressively worsening difficulty with oral intake for 6 days was referred to our hospital with a diagnosis of varicella zoster pharyngitis. A physical examination identified vesicular eruptions on the left auricle, external ear canal, and left side of the oropharynx, accompanied by scattered vesicles throughout his body surface. However, there was no evidence of cranial nerve involvement. Therefore, he was hospitalized in a depressurized room, and 1,500mg of Acicrobil was administered per day. By day 6 of hospitalization, most of the vesicles had scabbed over, but left vocal cord palsy manifested. On day 7 to 10 of hospitalization, palsy of cranial nerves Ⅶ, Ⅸ, Ⅹ, and Ⅺ appeared. The results of cerebrospinal fluid examination suggested that the patient suffered from VZV meningoencephalitis. Therefore, additional Acicrobil and Methylprednisolone therapy was administered. On day 41 of hospitalization, the patient was discharged on foot. However, paralysis of the left side of his facial nerve and accessory nerve remained.

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Sialolithiasis of minor salivary glands is very rare. We encountered a case of multiple sialolithiasis of the cheek. A 54-year-old woman complained of pain and swelling of the right cheek. She had a history of an operation in that area 29 years earlier, but the details were unknown. Computed tomography showed irregular calcified nodules at the lesion. Because a benign tumor was clinically suspected, the lesion was surgically excised. Intraoperative findings showed a lesion with surrounding adhesion tissue containing multiple spherical calcifications. Those calcifications were histopathologically considered as multiple salivary stones in minor salivary glands.

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Teratoma is a germ cell tumor composed of different types of tissues and the symptoms depend on the site of occurrence. The tumor rarely occurs in the nasopharynx, but it causes underdeveloped poor suckling and severe conditions such as intracranial invasion. In this report, we describe a case with teratoma in the pharynx. The newborn presented with poor suckling. To prevent respiratory failure by airway constriction, surgical resection was performed under general anesthesia by the intraoral approach. The post-operative course was uneventful.

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We report a case of intraductal papilloma in the deep lobe of the parotid gland. An 81-year-old male complained about swelling of the left parotid gland. A CT scan showed a tumor about 2cm in diameter with homogeneous enhancement in the deep lobe of the parotid gland. We diagnosed it as a benign parotid tumor and performed left parotidectomy. Histological examination revealed intraductal papilloma. Intraductal papilloma is a rare benign tumor that occurs mainly in the minor salivary glands. To date, only 11 cases of intraductal papilloma arising from the parotid gland have been reported. The present case is the first report of intraductal papilloma of the parotid gland arising from the deep lobe.

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Zenker diverticulum is a rare cause of dysphasia. It is important to diagnose it promptly because the symptoms can be improved by surgery in most cases. Generally, open or endoscopic diverticulectomy with or without myotomy is performed. As for which surgery is safer, we believe that it depends on the pattern of dysphasia. We herein report a case of giant Zenker diverticulum with a characteristic pattern, and an examination of the dysphasia pattern. We recently treated an 83-year-old patient with dysphasia with Zenker diverticulum. He had suffered from exacerbated dysphasia for four years. Preoperative video endoscopy and video fluorography showed a characteristic pattern of dysphasia. Contrast agent repeatedly went into the lumen of the diverticulum and exited back into the pharynx, revealing Zenker diverticulum of ›5cm. This situation resulted in his swallowing pressure escaping into the lumen of the diverticulum, thereby inducing dysphasia. The patient underwent open diverticulectomy assisted by endoscopy in our hospital and achieved a good swallowing function and good nutritional status. We reviewed previous reports on this condition and concluded that there were two patterns of dysphasia with Zenker diverticulum. One mechanism involves pressure escape, as in this case. The other involves failure of the cricopharyngeal muscle to relax Please check this. A large diverticulum tends to allow the escape of the swallowing pressure, so the dysphasia pattern of small diverticula may usually involve cricopharyngeal muscle relaxation failure. The pattern of the dysphasia in cases of Zenker diverticulum may therefore determine the need for myotomy in surgery and minimize the risk of complications.

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