ORL SS: 350-357 (1976)
Rhinoscleroma: a Scanning Electron-Microscopic Study H. Gaafar and Y. Harada ENT Department, Alexandria University Faculty of Medicine, Alexandria, and Department of Otolaryngology, Hiroshima University School of Medicine, Hiroshima
Key Words. Rhinoscleroma • Scanning electron microscopy Abstract. Nasal biopsies from 6 patients with rhinoscleroma were studied by scanning electron microscopy. Numerous bacilli of different sizes were found on the epithelial sur face. Few bacilli with thin spiral terminal cilia were seen over the surface of large protruding non-epithelial cells. These cells appeared to be the Mikulicz cells migrating from the tunica propria to the epithelial surface through small ulcerations. In the tunica propria, Mikulicz cells containing numerous bacilli were observed. In 4 patients, round bodies and long tubu lar structures were found on the epithelial surface. These bodies were suggested to be fungi, yet their exact nature and their relation to Klebsiella rhinoscleromatis bacilli need fur ther investigation.
Received: May 5, 1976; accepted: June 23, 1976.
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Rhinoscleroma is a chronic granulomatous disease of the nose and upper respiratory system. Endemic foci were reported to exist in 25 countries in Europe, Asia, Africa and America (Muzyka and Gubina, 1972). Several other sporadic cases were also described outside endemic areas. Till now, the exact mode of infection and the factors influencing the formation of endemic foci are not known. Beside the wide and nonspecific geographical distribution, rhino scleroma has many peculiar and, as yet, unexplained features. Although Klebsiella rhinoscleromatis is easy to grow from patients, the disease is difficult to repro duce experimentally (Steffen and Smith, 1961). Lesions often reappear fol lowing an initial response to antibiotic therapy (El-Mofty, 1962). The organisms seldom spread to the regional lymph nodes; only 2 cases were reported in the literature (Badrawy andShennawy, 1974).
Gaafar/Harada
351
Recently, rhinoscleroma was investigated by the transmission electron microscope {Welsh et al., 1963; Fisher and Dimling, 1964; Woyke et al., 1969; Shokeir and Osman, \912\Gonzales-Angelo et al., 1974; Gaafar et al., 1976). To our knowledge, there are no prior reports on the scanning electron microscopy of rhinoscleroma. In this work, the three-dimensional fine structure of some clinicopathological stages of rhinoscleroma and of the causative organisms are well illustrated. The possible mechanisms involved in the host-bacillus relation ship are discussed.
Methods and Material Nasal biopsies were taken from 6 patients with rhinoscleroma seen at the Alexandria University Hospital, Egypt. Cases were diagnosed clinically and investigated by the ordinary histologic and bacteriologic criteria. 4 patients were diagnosed as being in the ‘granulo matous stage’, while the remaining 2 showed atrophic changes in the nasal mucosa. Immediate fixation of the specimens was done in 2 % glutaraldehyde buffered at pH 7.4 for 2 h. For observation of surface structures postfixation was made in 2 % osmium tetroxide solution for 2 h. Tissues were dehydrated in ascending grades of alcohol, then placed in a few changes of isoamyl acetate for 30 min. The critical-point drying method using carbon dioxide was applied. For observation of intercellular structures, the primary fixed tissues were dehydrated in ascending grades of alcohol, then kept in an equal amount of 100 % ethyl alcohol and styren for 30 min, followed by styren alone for 10 h in the refrigerator. 2 % benzoyl peroxide was then added to the styren containing the specimens and the solution incubated in the oven at 60 °C for 24 h. Hardened specimens in styren were broken and immersed in propylene oxide for 2 h to dissolve the styren. The criticalpoint drying method and ion-etching method were then applied. After double coating of the specimens with carbon and gold, the scanning electron microscope (JSM-U3) was Used for examination.
The Granulomatous Stage The mucosal epithelium was preserved in the majority of specimens ex amined, but the surface was irregular with deep crevices between the cells (fig. 1). On the cell surface, short microvilli and occasionally degenerated short cilia were observed. The microvilli were numerous in some cells, while others had only few or no microvilli. In 2 patients (male, aged 40 years and female, aged 33 years), numerous round and ovoid bodies measuring about 3.8 /tm were found in the furrows between the cells (fig. 2). Long tubular structures with side branches were also observed (fig. 3). In some specimens, these long structures were seen to end blindly or appeared as if penetrating or arising through epithelial cells (fig. 4). Slender bacillary bodies were seen attached to the sides of these struc-
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 1:42:06 AM
Results
352
Fig. 1. Surface epithelium of the granulomatous stage of rhinoscleroma. Short micro villi are visible on the cell surface. Deep crevices between the cells. X 800. Fig. 2. Round and ovoid bodies in the furrows between cells. X 2,400. Fig. 3. Long tubular structures (L) with side branches on the epithelial surface. X 800. Fig. 4. Higher magnification of the long structures. Note the side branches (arrow). X 8,000.
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Gaafar/Harada
353
Fig. 5. Numerous bacilli (B) on the epithelial surface. X 2,400. Fig. 6. Higher magnification of bacilli (B). Some appear to be longer and more slender (arrow). Note the long structure (L) and microvilli (M). X 8,000. Fig. 7. Large protruding cells between epithelial cells. Note the irregular surface and absence of microvilli, x 2,400. Fig. 8. Short and stout bacilli (B) with thin spiral terminal cilia. X 3,000.
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Rhinoscleroma: a Scanning Electron-Microscopic Study
354
Fig. 9. Numerous bacilli found on the epithelial surface. No long structure or round bodies are visible. X 2,400. Fig. 10. Groups of Mikulicz cells (M) found in the tunica propria with numerous bacilli inside, one of them apparently dividing (arrow). X 3,200. Fig. 11. Higher magnification of Mikulicz cell showing numerous bacilli of different sizes inside large cavity. X 8,000. Fig. 12. Surface epithelium of the atrophic stage of rhinoscleroma. Few short microvilli are found on the cell surface. No crevices are found between cells. Note the long branched structure (L) and the round body (R). X 800.
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Gaafar/Haracla
Rhinoscleroma: a Scanning Electron-Microscopic Study
355
tures above the epithelial surface level or connected to it by fine thread-like filaments. On the epithelial surface, numerous bacilli were observed (fig. 5). The majority of these bacilli were stout, measuring about 3 /am in length. A few bacilli appeared more slender and longer (fig. 6). Small areas were covered by non-epithelial, large cells which were protruding out through the surface (fig. 7). These cells had an irregular surface and no microvilli. On these cells, short and stout bacillary structures measuring about 2 /am in length, with thin spiral ter minal cilia were observed (fig. 7, 8). In some specimens, bacilli were identified on the surface of these cells by their long characteristic cilia. In the other 2 patients (females aged 31 and 37 years), numerous bacilli were found on the cell surface and in the furrows between the cells (fig. 9). Occasional round bodies were also seen, but no long tubular structures or large protruding cells were observed. In the cracked surface of the specimens, numerous groups of Mikulicz cells were observed in the tunica propria (fig. 10). Mikulicz cells were large, vacuo lated and contained numerous bacilli (fig. 11). Some bacilli appeared as if divid ing. Few bacilli were observed outside the Mikulicz cells. The A trophic Stage The mucosal epithelium was preserved with no crevices between individual cells (fig. 12). A small number of short microvilli were seen arising from the cell surface. On the epithelium, round and ovoid bodies were seen in some specimens (female, aged 42 years and male, aged 37 years). The long tubular structures with side branches were also found. A small number of protruding cells with irregular surfaces were also seen. Numerous bacilli were observed on the surface of the epithelial cells. Some appeared to have terminal cilia. On the cracked surface, Mikulicz cells were found deep in the tunica propria containing numerous bacilli.
In our study, the numerous bacilli found on the epithelial surface in both the granulomatous and atrophic stage are suggestive of the role of nasal discharge from rhinoscleroma patients in the spread of infection. It also recommends the nasal smear as a simple method for the bactériologie diagnosis of the disease. The presence of bacilli of different shapes and sizes could indicate that more than one species of K. rhinoscleromatis was responsible for producing the disease in Egypt. The occasional ciliated bacilli observed, seemed to represent a certain stage in the evolution of the organism. These bacilli were mostly seen to be attached to the large protruding cells. Similar bacilli were also observed inside the vacuoles of Mikulicz cells in a recent electron-microscopic study (Gaafar et
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 1:42:06 AM
Discussion
Gaafar/Harada
356
al, 1976). Although all authors describe K. rhinoscleromatis as a non-motile organism, the spiral long cilia observed on some bacilli are suggestive of their motility. The nature of the large protruding cells between the epithelial cells was not clear. Cisternal dilatation and cytoplasmic swelling of some epithelial cells leading to their rupture were reported in an electron-microscopic study of rhinoscleroma (Shokeir and Osman, 1972). On the other hand, in our research, the size of configuration of these protruding cells were similar to those of Mikulicz cells. The possibility of Mikulicz cells migrating from the tunica propria to the epithelial surface through small ulcerations seemed reasonable. This appeared to be the only possible way to transfer the large number of bacilli from the tunica propria to the surface as there were only few bacilli outside Mikulicz cells. On the epithelial surface, Mikulicz cells might rupture thus releasing the bacilli. Fragmentation and rupture of the limiting membranes inside the vacuoles of Mikulicz cells have been demonstrated previously (Welsh et al., 1963; H off mann et al, 1973). This was suggested to be due to increased osmotic pressure within the vacuoles of Mikulicz cells caused by the mucopolysaccharides of the bacilli. This would allow water to be drawn inside, increasing the intravascular pressure; if this is extreme, the cell itself could rupture.
Zusammenfassung In der vorliegenden Arbeit wird über die Ergebnisse elektronenmikroskopischer Unter suchungen von Nasenschleimhaut-Probeexzisionen bei 6 Rhinosklerom-Patienten berichtet. An der Epitheloberflächc konnten zahlreiche Bazillen verschiedener Grösse nachgewiesen werden, während nur wenige Mikroorganismen mit dünnen spiraligen Terminalzilien an der Oberfläche grösserer, nicht epithelialer Zellelemente gefunden wurden. Letztere glichen Mikulicz-Zellen, welche aus der Tunica propria zur epithelialen Oberfläche emporgewandert waren. In der Tunica propria fanden sich zahlreiche Mikulicz-Zellen, welche reichlich Bak terien enthielten. Bei 4 Patienten wurden rundliche Körper und längliche tubuläre Struk turen an der epithelialen Oberfläche nachgewiesen. Wahrscheinlich handelt es sich dabei um Pilze, doch wird es notwendig sein, in späteren Untersuchungen ihre Herkunft und Art näher zu bestimmen sowie ihre Beziehungen zur Klebsiella rhinoscleromatis.
Ce travail présente les résultats des examens au microscope électronique de la biopsie de muqueuses pratiquées pour 6 rhinoscléromes. De nombreux bacilles de taille variable ont été mis en évidence à la surface épithéliale. Par contre, peu de micro-organismes présentant des cils terminaux fins et spiralés ont été trouvés à la surface de grosses cellules nonépithéliales. Ces cellules ressemblent aux cellules de Mikulicz qui migrent de la tunique propre vers la surface épithéliale. De nombreuses cellules de Mikulicz contenant beaucoup
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 1:42:06 AM
Résumé
Rhinoscleroma: a Scanning Electron-Microscopic Study
357
de bactéries se trouvent dans la tunique propre. Chez 4 patients, des corps arrondis et des structures tubulaires allongées ont été mis en évidence à la surface épithéliale. Il s’agit probablement de fongi; il sera cependant nécessaire, lors d’examens ultérieurs, de déterminer leur origine, leur espèce et leurs rapports avec la Klebsiella rhinoscleromatis.
References
Yasuo Harada, (MD), Department of Otorhino-Laryngology, Hiroshima University School of Medicine, Hiroshima (Japan)
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 1:42:06 AM
Badrawy, R. and El-Shennawy, M.: Affection of cervical lymph nodes in rhinoscleroma. J. Lar. Otol. 88: 261 (1974). El-Mofty, A.: Histological examination of scleroma. Ann. Otol. Rhinol. Lar. 71: 377 (1962). Fisher, E.R. and Dimling, C : Rhinoscleroma, light and electron microscopic studies. Archs Path. 78: 501 (1964). Gaafar, H.; El-Ghazzawi, E.; Al-Mansoor, A., and Toppozada, H.: Role of plasma cells in rhinoscleroma, an electron microscopic study. ORL (in press 1976). Gonzalez-Angelo, A.; Marques-Monter, H.; Greenberg, S.D., and Cerbon, J.: Ultrastructure of nasal scleroma. Ann. Otol. Rhinol. Lar. 74: 1022 (1964). Hoffman, E.O.; Loose, E.D., and Harkin, J.C.: The Mikulicz cell in rhinoscleroma. Am. J. Path. 73: 47 (1973). Muzyka, M.M. and Gubina, K.M.: Problems of the epidemiology of scleroma. J. Hyg. Epidem. Microbiol. Immun. 16: 8 (1972). Shokeir, A.A. and Osman, M.: Rhinoscleroma, an electron microscopic study. J. Hyg. Epidem. Microbiol. Immun. 16: 1 (1972). Steffen, T.N. and Smith, I.M.: Scleroma-klebsiella rhinoscleromatis and its effect on mice. Ann. Otol. Rhinol. Lar. 70: 935 (1961). Welsh, R.A.; Correa, P., and Herran, R.: Light and electron microscopic observations of scleroma. Expl molec. Path 2: 93 (1963). Woyke, S Domagala, W., and Olszewski, W.: Electron microscopic study of scleroma granulation tissue. Acta med. pol., Vars. 10: 231 (1969).
Rhinoscleroma: a Scanning Electron-Microscopic Study H. Gaafar and Y. Harada ENT Department, Alexandria University Faculty of Medicine, Alexandria, and Department of Otolaryngology, Hiroshima University School of Medicine, Hiroshima
Key Words. Rhinoscleroma • Scanning electron microscopy Abstract. Nasal biopsies from 6 patients with rhinoscleroma were studied by scanning electron microscopy. Numerous bacilli of different sizes were found on the epithelial sur face. Few bacilli with thin spiral terminal cilia were seen over the surface of large protruding non-epithelial cells. These cells appeared to be the Mikulicz cells migrating from the tunica propria to the epithelial surface through small ulcerations. In the tunica propria, Mikulicz cells containing numerous bacilli were observed. In 4 patients, round bodies and long tubu lar structures were found on the epithelial surface. These bodies were suggested to be fungi, yet their exact nature and their relation to Klebsiella rhinoscleromatis bacilli need fur ther investigation.
Received: May 5, 1976; accepted: June 23, 1976.
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 1:42:06 AM
Rhinoscleroma is a chronic granulomatous disease of the nose and upper respiratory system. Endemic foci were reported to exist in 25 countries in Europe, Asia, Africa and America (Muzyka and Gubina, 1972). Several other sporadic cases were also described outside endemic areas. Till now, the exact mode of infection and the factors influencing the formation of endemic foci are not known. Beside the wide and nonspecific geographical distribution, rhino scleroma has many peculiar and, as yet, unexplained features. Although Klebsiella rhinoscleromatis is easy to grow from patients, the disease is difficult to repro duce experimentally (Steffen and Smith, 1961). Lesions often reappear fol lowing an initial response to antibiotic therapy (El-Mofty, 1962). The organisms seldom spread to the regional lymph nodes; only 2 cases were reported in the literature (Badrawy andShennawy, 1974).
Gaafar/Harada
351
Recently, rhinoscleroma was investigated by the transmission electron microscope {Welsh et al., 1963; Fisher and Dimling, 1964; Woyke et al., 1969; Shokeir and Osman, \912\Gonzales-Angelo et al., 1974; Gaafar et al., 1976). To our knowledge, there are no prior reports on the scanning electron microscopy of rhinoscleroma. In this work, the three-dimensional fine structure of some clinicopathological stages of rhinoscleroma and of the causative organisms are well illustrated. The possible mechanisms involved in the host-bacillus relation ship are discussed.
Methods and Material Nasal biopsies were taken from 6 patients with rhinoscleroma seen at the Alexandria University Hospital, Egypt. Cases were diagnosed clinically and investigated by the ordinary histologic and bacteriologic criteria. 4 patients were diagnosed as being in the ‘granulo matous stage’, while the remaining 2 showed atrophic changes in the nasal mucosa. Immediate fixation of the specimens was done in 2 % glutaraldehyde buffered at pH 7.4 for 2 h. For observation of surface structures postfixation was made in 2 % osmium tetroxide solution for 2 h. Tissues were dehydrated in ascending grades of alcohol, then placed in a few changes of isoamyl acetate for 30 min. The critical-point drying method using carbon dioxide was applied. For observation of intercellular structures, the primary fixed tissues were dehydrated in ascending grades of alcohol, then kept in an equal amount of 100 % ethyl alcohol and styren for 30 min, followed by styren alone for 10 h in the refrigerator. 2 % benzoyl peroxide was then added to the styren containing the specimens and the solution incubated in the oven at 60 °C for 24 h. Hardened specimens in styren were broken and immersed in propylene oxide for 2 h to dissolve the styren. The criticalpoint drying method and ion-etching method were then applied. After double coating of the specimens with carbon and gold, the scanning electron microscope (JSM-U3) was Used for examination.
The Granulomatous Stage The mucosal epithelium was preserved in the majority of specimens ex amined, but the surface was irregular with deep crevices between the cells (fig. 1). On the cell surface, short microvilli and occasionally degenerated short cilia were observed. The microvilli were numerous in some cells, while others had only few or no microvilli. In 2 patients (male, aged 40 years and female, aged 33 years), numerous round and ovoid bodies measuring about 3.8 /tm were found in the furrows between the cells (fig. 2). Long tubular structures with side branches were also observed (fig. 3). In some specimens, these long structures were seen to end blindly or appeared as if penetrating or arising through epithelial cells (fig. 4). Slender bacillary bodies were seen attached to the sides of these struc-
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 1:42:06 AM
Results
352
Fig. 1. Surface epithelium of the granulomatous stage of rhinoscleroma. Short micro villi are visible on the cell surface. Deep crevices between the cells. X 800. Fig. 2. Round and ovoid bodies in the furrows between cells. X 2,400. Fig. 3. Long tubular structures (L) with side branches on the epithelial surface. X 800. Fig. 4. Higher magnification of the long structures. Note the side branches (arrow). X 8,000.
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 1:42:06 AM
Gaafar/Harada
353
Fig. 5. Numerous bacilli (B) on the epithelial surface. X 2,400. Fig. 6. Higher magnification of bacilli (B). Some appear to be longer and more slender (arrow). Note the long structure (L) and microvilli (M). X 8,000. Fig. 7. Large protruding cells between epithelial cells. Note the irregular surface and absence of microvilli, x 2,400. Fig. 8. Short and stout bacilli (B) with thin spiral terminal cilia. X 3,000.
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 1:42:06 AM
Rhinoscleroma: a Scanning Electron-Microscopic Study
354
Fig. 9. Numerous bacilli found on the epithelial surface. No long structure or round bodies are visible. X 2,400. Fig. 10. Groups of Mikulicz cells (M) found in the tunica propria with numerous bacilli inside, one of them apparently dividing (arrow). X 3,200. Fig. 11. Higher magnification of Mikulicz cell showing numerous bacilli of different sizes inside large cavity. X 8,000. Fig. 12. Surface epithelium of the atrophic stage of rhinoscleroma. Few short microvilli are found on the cell surface. No crevices are found between cells. Note the long branched structure (L) and the round body (R). X 800.
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 1:42:06 AM
Gaafar/Haracla
Rhinoscleroma: a Scanning Electron-Microscopic Study
355
tures above the epithelial surface level or connected to it by fine thread-like filaments. On the epithelial surface, numerous bacilli were observed (fig. 5). The majority of these bacilli were stout, measuring about 3 /am in length. A few bacilli appeared more slender and longer (fig. 6). Small areas were covered by non-epithelial, large cells which were protruding out through the surface (fig. 7). These cells had an irregular surface and no microvilli. On these cells, short and stout bacillary structures measuring about 2 /am in length, with thin spiral ter minal cilia were observed (fig. 7, 8). In some specimens, bacilli were identified on the surface of these cells by their long characteristic cilia. In the other 2 patients (females aged 31 and 37 years), numerous bacilli were found on the cell surface and in the furrows between the cells (fig. 9). Occasional round bodies were also seen, but no long tubular structures or large protruding cells were observed. In the cracked surface of the specimens, numerous groups of Mikulicz cells were observed in the tunica propria (fig. 10). Mikulicz cells were large, vacuo lated and contained numerous bacilli (fig. 11). Some bacilli appeared as if divid ing. Few bacilli were observed outside the Mikulicz cells. The A trophic Stage The mucosal epithelium was preserved with no crevices between individual cells (fig. 12). A small number of short microvilli were seen arising from the cell surface. On the epithelium, round and ovoid bodies were seen in some specimens (female, aged 42 years and male, aged 37 years). The long tubular structures with side branches were also found. A small number of protruding cells with irregular surfaces were also seen. Numerous bacilli were observed on the surface of the epithelial cells. Some appeared to have terminal cilia. On the cracked surface, Mikulicz cells were found deep in the tunica propria containing numerous bacilli.
In our study, the numerous bacilli found on the epithelial surface in both the granulomatous and atrophic stage are suggestive of the role of nasal discharge from rhinoscleroma patients in the spread of infection. It also recommends the nasal smear as a simple method for the bactériologie diagnosis of the disease. The presence of bacilli of different shapes and sizes could indicate that more than one species of K. rhinoscleromatis was responsible for producing the disease in Egypt. The occasional ciliated bacilli observed, seemed to represent a certain stage in the evolution of the organism. These bacilli were mostly seen to be attached to the large protruding cells. Similar bacilli were also observed inside the vacuoles of Mikulicz cells in a recent electron-microscopic study (Gaafar et
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 1:42:06 AM
Discussion
Gaafar/Harada
356
al, 1976). Although all authors describe K. rhinoscleromatis as a non-motile organism, the spiral long cilia observed on some bacilli are suggestive of their motility. The nature of the large protruding cells between the epithelial cells was not clear. Cisternal dilatation and cytoplasmic swelling of some epithelial cells leading to their rupture were reported in an electron-microscopic study of rhinoscleroma (Shokeir and Osman, 1972). On the other hand, in our research, the size of configuration of these protruding cells were similar to those of Mikulicz cells. The possibility of Mikulicz cells migrating from the tunica propria to the epithelial surface through small ulcerations seemed reasonable. This appeared to be the only possible way to transfer the large number of bacilli from the tunica propria to the surface as there were only few bacilli outside Mikulicz cells. On the epithelial surface, Mikulicz cells might rupture thus releasing the bacilli. Fragmentation and rupture of the limiting membranes inside the vacuoles of Mikulicz cells have been demonstrated previously (Welsh et al., 1963; H off mann et al, 1973). This was suggested to be due to increased osmotic pressure within the vacuoles of Mikulicz cells caused by the mucopolysaccharides of the bacilli. This would allow water to be drawn inside, increasing the intravascular pressure; if this is extreme, the cell itself could rupture.
Zusammenfassung In der vorliegenden Arbeit wird über die Ergebnisse elektronenmikroskopischer Unter suchungen von Nasenschleimhaut-Probeexzisionen bei 6 Rhinosklerom-Patienten berichtet. An der Epitheloberflächc konnten zahlreiche Bazillen verschiedener Grösse nachgewiesen werden, während nur wenige Mikroorganismen mit dünnen spiraligen Terminalzilien an der Oberfläche grösserer, nicht epithelialer Zellelemente gefunden wurden. Letztere glichen Mikulicz-Zellen, welche aus der Tunica propria zur epithelialen Oberfläche emporgewandert waren. In der Tunica propria fanden sich zahlreiche Mikulicz-Zellen, welche reichlich Bak terien enthielten. Bei 4 Patienten wurden rundliche Körper und längliche tubuläre Struk turen an der epithelialen Oberfläche nachgewiesen. Wahrscheinlich handelt es sich dabei um Pilze, doch wird es notwendig sein, in späteren Untersuchungen ihre Herkunft und Art näher zu bestimmen sowie ihre Beziehungen zur Klebsiella rhinoscleromatis.
Ce travail présente les résultats des examens au microscope électronique de la biopsie de muqueuses pratiquées pour 6 rhinoscléromes. De nombreux bacilles de taille variable ont été mis en évidence à la surface épithéliale. Par contre, peu de micro-organismes présentant des cils terminaux fins et spiralés ont été trouvés à la surface de grosses cellules nonépithéliales. Ces cellules ressemblent aux cellules de Mikulicz qui migrent de la tunique propre vers la surface épithéliale. De nombreuses cellules de Mikulicz contenant beaucoup
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 1:42:06 AM
Résumé
Rhinoscleroma: a Scanning Electron-Microscopic Study
357
de bactéries se trouvent dans la tunique propre. Chez 4 patients, des corps arrondis et des structures tubulaires allongées ont été mis en évidence à la surface épithéliale. Il s’agit probablement de fongi; il sera cependant nécessaire, lors d’examens ultérieurs, de déterminer leur origine, leur espèce et leurs rapports avec la Klebsiella rhinoscleromatis.
References
Yasuo Harada, (MD), Department of Otorhino-Laryngology, Hiroshima University School of Medicine, Hiroshima (Japan)
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 1:42:06 AM
Badrawy, R. and El-Shennawy, M.: Affection of cervical lymph nodes in rhinoscleroma. J. Lar. Otol. 88: 261 (1974). El-Mofty, A.: Histological examination of scleroma. Ann. Otol. Rhinol. Lar. 71: 377 (1962). Fisher, E.R. and Dimling, C : Rhinoscleroma, light and electron microscopic studies. Archs Path. 78: 501 (1964). Gaafar, H.; El-Ghazzawi, E.; Al-Mansoor, A., and Toppozada, H.: Role of plasma cells in rhinoscleroma, an electron microscopic study. ORL (in press 1976). Gonzalez-Angelo, A.; Marques-Monter, H.; Greenberg, S.D., and Cerbon, J.: Ultrastructure of nasal scleroma. Ann. Otol. Rhinol. Lar. 74: 1022 (1964). Hoffman, E.O.; Loose, E.D., and Harkin, J.C.: The Mikulicz cell in rhinoscleroma. Am. J. Path. 73: 47 (1973). Muzyka, M.M. and Gubina, K.M.: Problems of the epidemiology of scleroma. J. Hyg. Epidem. Microbiol. Immun. 16: 8 (1972). Shokeir, A.A. and Osman, M.: Rhinoscleroma, an electron microscopic study. J. Hyg. Epidem. Microbiol. Immun. 16: 1 (1972). Steffen, T.N. and Smith, I.M.: Scleroma-klebsiella rhinoscleromatis and its effect on mice. Ann. Otol. Rhinol. Lar. 70: 935 (1961). Welsh, R.A.; Correa, P., and Herran, R.: Light and electron microscopic observations of scleroma. Expl molec. Path 2: 93 (1963). Woyke, S Domagala, W., and Olszewski, W.: Electron microscopic study of scleroma granulation tissue. Acta med. pol., Vars. 10: 231 (1969).
