Yonsei Med J.  2007 Jun;48(3):449-456. 10.3349/ymj.2007.48.3.449.

Squamous Metaplasia and BCL-6 in Pediatric Adenoid Accompanied by Otitis Media with Effusion

• Yeo SG
• Park DC
• Choo JH
• Cha CI

• KMID: 724100
• DOI: http://doi.org/10.3349/ymj.2007.48.3.449

Abstract

PURPOSE
Deterioration of local immunity in the adenoids may make them vulnerable to infection by microorganisms, resulting in otitis media with effusion. To determine the factors associated with this condition, we evaluated adenoid size, mucosal barrier, squamous changes of ciliated epithelium, IgA secretion, and BCL-6 expression in adenoids. MATERIALS AND METHODS: Seventeen children diagnosed with otitis media with effusion (OME group) and 20 children without any history of OME (control group) were enrolled. Their adenoids were sized by lateral view X-ray and stained with hematoxylin and eosin to detect squamous metaplasia. The adenoids were also stained with cytokeratin to evaluate mucosal barriers, and with anti- IgA antibody and anti- BCL-6 antibody to determine expression of IgA and BCL-6. RESULTS: The OME group showed greater incidence of squamous metaplasia, fewer ciliated cells, and lower expression of BCL-6 (p < 0.05 each). Deterioration of the mucosal barrier was detected in the OME group (p > 0.05). IgA secretion and adenoid size were the same for the OME and the control groups. CONCLUSION: These results suggest that increased squamous metaplasia and lower BCL-6 expression in adenoids may be associated with increased susceptibility to OME.

Keyword

Otitis media; squamous metaplasia; BCL-6; adenoid

MeSH Terms

Adenoids/chemistry/*pathology
Child
Child, Preschool
Female
Humans
Immunoglobulin A/analysis
Immunohistochemistry
Keratins/analysis
Male
Metaplasia
Mucous Membrane/chemistry/pathology
Otitis Media with Effusion/metabolism/*pathology
Proto-Oncogene Proteins c-bcl-6/*analysis

Figure

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  Fig. 1 Squamous metaplasia of adenoid. Upper hinge of box, upper range; midline of box (-☐-), mean. Samples were graded by percent (%) squamous metaplasia, as determine by H-E staining. *p < 0.05.

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  Fig. 2 H-E stain for squamous metaplasia. In OME adenoids, thin squamous epithelium (↙) is transposed to thick squamous epithelium (↙) without respiratory ciliated cells. Control adenoids, however, have respiratory ciliated cells without squamous epithelium. Original magnification, × 100.

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  Fig. 3 Mucosal barrier of adenoid. Upper hinge of box: upper range, midline of box(-☐-): mean. The number of areas of deterioration area were calculated by immunohistochemical staining for cytokeratin.

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  Fig. 4 Cytokeratin immunohistochemistry for mucosal barrier. Microscopic deterioration of the mucosal barrier was detected microscopically in OME adenoid (arrow head), but not in control, adenoids. Original magnification, × 40.

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  Fig. 5 IgA positive cells in adenoids. Upper hinge of box: upper range, midline of box(-☐-): mean. Samples were graded by the percent (%) IgA positive cells.

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  Fig. 6 IgA immunohistochemistry. Nearly the same percentage of cells were positive for IgA in control and OME adenoids. Original magnification, × 400.

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  Fig. 7 BCL-6 positive cells of adenoid. Upper hinge of box, upper range; midline of box (-☐-), mean; lower hinge of box, lower range. Samples were graded by the percent (%) BCL-6 positive cells. *p < 0.05.

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  Fig. 8 BCL-6 immunohistochemistry. More cells in control adenoid show immunoreactivity for BCL-6 than in OME adenoid. Original magnification, × 400.

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  Fig. 9 Adenoid size. Upper hinge of box: upper range, midline of box (-☐-): mean, lower hinge of box: lower range. Samples were graded by adenoid to nasopharynx (A/N) ratio in neck lateral X-rays.

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