Publication: Histopathological classification of refractory chronic rhinosinusitis with nasal polips
Authors
Mortuaire, G. ; Leroy, Xavier ; Gengler, I. ; Chevalier, D. ; Prin, L. ; Picry, A.
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Publisher
Universidad de Murcia. Departamento de Biología Celular e Histología
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DOI
10.4670/HH-11-632
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info:eu-repo/semantics/article
Description
Abstract
Objective: To delineate the histopathological
characteristics of nasal mucosa in refractory chronic
rhinosinusitis with nasal polyps (CRSwNP) in order to
demonstrate subtypes of nasal polyps and their potential
relation with lower airway comorbidity. Study Design:
Clinical- and pathological-based cross-sectional study.
Methods: Nasal polyp specimens were prospectively
collected from patients with refractory CRSwNP
referred to our institution for endoscopic sinus surgery.
Oral and topical steroids were stopped 1 month before
surgery. The pathological analysis was conducted by 2
independent reviewers with light microscopy on
Hematoxylin-Eosin-Saffron stained slides. Each
observer fulfilled a standardized protocol with cell count
and stromal characterization on the most representative
field. Mean grading scores were established.
Morphological aspects were compared with the cell
distribution and the clinical conditions. Results: Among
36 patients, three subtypes of nasal polyps were
depicted: eosinophilic edematous (64%), fibrous (9%)
and intermediate with mixed edematous and collagen
stromal structure (27%). Basement membrane thickening
and seromucous gland hyperplasia were observed in the
fibrosis sub-type (p<0.03). Eosinophilic mucosal
infiltrate was significantly increased (p=0.026) in
patients with concomitant pulmonary disease (n=21).
Nasal polyp distribution was not influenced by asthma,
allergy, previous surgery and smoking.
Conclusion: Our 3-subtype classification of refractory
CRSwNP in Caucasian population shows a predominant
edematous structure whatever the clinical conditions
may have been. Eosinophilia as a major factor of
adaptive immune response in nasal inflammation is a
feature of concomitant pulmonary disease. Further
studies concerning mucosal remodelling and outcome
assessment after sinus surgery are required to evaluate
the impact of our classification on a daily basis.
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