Although tonsillectomy are used as therapeutic options to prevent chronic renal failure in IgA nephropathy (IgAN) patients, the relationship between IgAN and tonsils is not fully proved by basic research. Recently, circulating CX3CR1-positive cells were reportedly involved in promoting hematuria in patients with IgAN. In this study, we focused on the expression of CX3CR1 in tonsillar mononuclear cells in IgAN patients. Immunohistological analysis revealed greater distribution of CX3CR1-positive cells in the inter-follicular area of tonsils in IgAN patients than in non-IgAN patients. CX3CR1-positive cells were also found in the affected renal glomerulus of IgAN patients. Flow cytometric analysis revealed the expression of CX3CR1 on tonsillar CD8-positive cells to be significantly higher in IgAN patients. CpG-oligodeoxynucleotides enhanced the expression in IgAN patients. The chemotactic response of tonsillar mononuclear cells to fractalkine was significantly higher in IgAN patients. Expression of CX3CR1 on peripheral blood CD8-positive cells in IgAN patients was significantly higher, and decreased after tonsillectomy, along with the disappearance of hematuria. These results suggest that hyper-immune response to microbial DNA enhanced the expression of CX3CR1 on tonsillar CD8-positive cells in IgAN patients, followed by the migration of the cells to renal lesions via blood circulation, resulting in the development of hematuria.
Benign tumors of the esophagus are rare, and most of them are leiomyoma. We present a rare case of cervical esophageal schwannoma. A 69-year-old female with a thyroid tumor suffered from dysphagia. A CT scan revealed two tumors including a thyroid tumor and an esophageal tumor. In the operation we found that the two tumors were separated : one tumor was in the left lobe of the thyroid gland and the other was in the cervical esophagus. Histologically, the esophageal tumor was composed of thin densely cellular spindle-shaped cells arranged in interlacing fascicles and the tumor cells showed positive immunohistochemical staining for S-100 protein. The esophageal tumor was diagnosed as schwannoma. She was discharged from the hospital and has been doing well with no recurrence for 6 months after surgery. We also summarize the clinical characteristics of patients with esophageal schwannoma reported in the literature.
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