The authors present a case of dumbbell-shaped schwannoma arising from the vagus nerve. A 40-year-old woman was admitted with a 3-month history of hearing loss on the left ear without vertigo. Neuro-otological examinations revealed retrocochlear deafness with abnormal left vestibular function. Magnetic resonance imaging revealed a dumbbell-shaped tumor of the jugular foramen. The tumor was removed through a cervical-transmastoid approach using Cavitoron ultrasonic surgical aspiration. Two months after the operation, the patient's hearing loss had improved, although she still had some aspiration of saliva and hoarseness.

The accumulation of mast cells in the allergic nasal epithelium is well known, yet the mechanism remains unclear. We studied whether there is a candidate for mast cell progenitors in the allergic nasal mucosa tissue removed at the time of surgery. We first confirmed that most mast cells in nasal mucosae of 10 nasal allergic patients had c-kit receptor by immunohistochemistry using the mirror sectioning technique. We then investigated whether c-kit receptor+, tryptase–, IgE– cells existed in nasal mucosae of 15 nasal allergic patients and 15 nonallergic ones using sequential triple immunohistochemistry. We observed the area in which 1,000 to 1,100 tryptase-positive cells (mast cells) existed in both the subepithelial layer and the deep layer of each nasal lamina propria. The epithelial layer above this area was also examined. Some c-kit receptor+, tryptase– cells existed in the nasal mucosae of 11 patients with nasal allergy and of 5 patients with nonallergic rhinitis. From one to four of these cells in the nasal epithelium and subepithelial layer of the 4 allergic patients were IgE-negative. In contrast, no IgE-negative cells existed in the deep layer of allergic nasal mucosae or in any nonallergic nasal mucosae. Our results suggest that mast cell progenitors, hematopoietic progenitor cells or multipotential blood cells exist in the allergic nasal mucosa, and may contribute to the increase of mast cells in the epithelium and subepithelial layer of allergic nasal mucosa.

Birch pollen is a very common cause of nasal allergy (pollinosis) not only in Scandinavia, Europe, Canada, and the northern part of the United States but also in Hokkaido, Japan. Although there are many papers describing the association of HLA antigens and pollinosis caused by many other allergens, there is no report about the association of HLA antigens and birch pollen allergy. In this paper, we performed an HLA population study of birch pollen-allergic patients in Japan and their pattern analysis of HLA-DRB and HLA-DQB gene by the Southern blot hybridization technique. Our population study data indicated that the HLA-DR9 and HLA-DQw3 phenotypes strongly associated with the development of birch pollen allergy in Japanese subjects. By restriction fragment length polymorphism pattern analysis, some restriction fragments of the HLA-DQB gene were detected only in the patient group. These data suggested that there was a significant association between HLA class II antigens and the development of birch pollen allergy in Japanese subjects.

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