THE ROLE OF DENDRITIC CELLS IN THE DEVELOPMENT OF CHRONIC TONSILLAR DISEASE IN CHILDREN

Thirty-one children, 2.6-12.2 years (mean = 7.9 +/- 5.0) were divided into four clinical categories: normal controls (n = 7), recurrent tons illitis (n = 8), idiopathic tonsillar hyperplasia (n = 9) and recurren t tonsillitis with hyperplasia (n = 7). Immunohistopathologic studies were performed to determine the presence and location of HLA-DR, S-100 positive antigen presenting dendritic cells (DCs) in six microanatomi c compartments: surface and crypt epithelium and submucosae, extrafoll icular areas and lymphoid follicles. The results were analyzed in the context of the clinical history, bacteriology, and routine histopathol ogy. The distribution of DCs was altered significantly with disease-fe wer numbers of DCs were found in the surface epithelium and greater nu mbers in the crypts and extrafollicular areas, than in normals, p < 0. 01. The surface:crypt ratio of DCs was 1 : 1 for normal tonsils, but d ropped to 1 : 3 in disease. Chronic cryptitis was moe common in diseas e and correlated strongly to the presence of beta-lactamase producing microorganisms (R = 1.0). An increased total bacterial concentration w as correlated with increased numbers of DCs in the surface epithelium (R = 0.5, p < 0.009). In summary, the microanatomical distribution of DCs within the tonsil is significantly altered in disease. These alter ations appear to be influenced by potentially pathogenic bacteria more often found in the crypts of abnormal tonsils.