The Difference in the Clinical Features Between Carcinoma ex Pleomorphic Adenoma and Pleomorphic Adenoma.

Carcinoma ex pleomorphic adenoma (CXPA) arises from the primary or recurrent benign pleomorphic adenoma. The purpose of this study was to evaluate the clinical features that could be referenced in the differentiation. The medical records of 221 patients with pleomorphic adenoma and 15 patients with CXPA were retrospectively reviewed. Clinical characteristics, computed tomography and magnetic resonance imaging findings, and surgical pathology were analyzed. Patients with CXPA were older (55.1 vs 42.3; P < .01). Carcinoma ex pleomorphic adenoma was observed at higher rates in the minor salivary glands (24.9% vs 2.7%) and higher incidence of regional lymph node enlargement (P = .04). While all CXPA showed a low-to-intermediate mean apparent diffusion coefficient value (ADC), most of pleomorphic adenoma had an intermediate-to-high (P = .01). From this study, the following features should be considered as the clinical features of CXPA: (1) old age; (2) minor salivary gland tumor; (3) regional lymph node enlargement (>5 mm); and (4) low ADC findings.

Two-Track Medical Treatment Strategy According to the Clinical Scoring System for Chronic Rhinosinusitis.

PURPOSE: The previously reported Japanese clinical scoring study (JESREC) suggests that chronic rhinosinusitis (CRS) can be divided into 4 subtypes according to the degree of eosinophilic CRS (ECRS) and offers the information regarding the prognosis of CRS to clinicians. However, this scoring system has not yet been validated by an immunological study and needs to provide treatment guidelines based on underlying immunologic profiles. We investigated the immunologic profile of each CRS subgroup according to the JESREC classification and suggest its clinical application. METHODS: A total of 140 CRS patients and 20 control subjects were enrolled. All patients were classified into 4 groups according to the JESREC (non-, mild, moderate and severe ECRS). Nasal tissues were analyzed for mRNA expression of major cytokines (IL-5, IL-10, IL-13, IL-17A, IL-22, IL-23p19, IFN-γ, periostin, thymic stromal lymphopoietin [TSLP] and ST2), major chemokines (CCL11, CCL24, CXCL1 and CXCL2), transcription factors (T-bet, GATA3, RORC and FOXP3) and COL1A1 for type I collagen. Protein levels of 3 major cytokines (IL-5, IL-17A and IFN-γ) were also measured by multiplex immunoassay. Principal component analysis (PCA) was conducted to investigate the overall profile of multiple mediators. RESULTS: The moderate/severe ECRS showed up-regulation of type 2-related mediators (IL-5, IL-13, periostin, TSLP and ST-2), whereas INF-γ (type 1 cytokine) and CXCL1 (neutrophil chemokine) expressions were increased in non-/mild ECRS compared with moderate/severe ECRS. The JESREC classification reflected an immunological endotype. In PCA data, PCA1 indicates a relative type 2 profile, whereas PCA2 represents a type 1/type 17-related profile. In this analysis, mild ECRS was indistinguishable from non-ECRS, whereas moderate to severe ECRS showed a distinct distribution compared with non-ECRS. The JESREC classification could be divided into 2 categories, non-/mild vs. moderate/severe ECRS based on underlying immunological analyses. CONCLUSIONS: The CRS clinical scoring system from the JESREC study reflects an inflammatory endotype. However, the immunologic profile of mild ECRS was similar to that of non-ECRS. Therefore, we propose type 2-targeted medical treatment for moderate to severe ECRS and type 1/type 17-targeted for non-ECRS and mild ECRS as the first treatment option.