Date post: | 18-Jan-2016 |
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Chronic Rhinosinusitis Definition (clinical) :
• Inflammatory response involving the following: mucous membranes, nasal cavity and paranasal sinuses.
• Fluid within the cavities and/or underlying bones. • Symptomatic: nasal obstruction, congestion,
discharge, purulent, postnasal drip, facial pressure and pain.
• Duration: 12 weeks• Positive physical signs of nose and face.• Ancillary studies: radiology.
Rhinosinusitis: Classification
• Based on temporal nature:– Acute (<4 weeks)– Subacute (4-12 weeks)– Recurrent acute (> 4 episodes per year)– Chronic (>12 weeks)– Acute exacerbation of chronic
Chronic adult rhinosinusitis
• Lasting > 12 weeks
• Diagnostically proven (major and minor clinical features)
• With or without physical findings
Chronic rhinosinusitismorphologic features:
• Inflammatory infiltrates
• Edema
• Glandular hyperplasia
• Thickened basement membrane
• Squamous metaplasia
• Eosinophils, may be present, can be numerous
Proposed new histologic classification :
• Polypoid CRS
• Glandular CRS
Proposed mechanism Polypoid CRS
Epithelial Disruption
Migration of immature branching epithelium
mediators e.g., IL-5, by eosinophils
Exudation
Microcavities
Fusion of glands
Cleavage plane of mucosal surface
Disregulation of eosinophils
Proposed mechanismGlandular CRS
No
eo
sin
oph
ilic
act
ivity
↑ sICAM-1
Neutrophils recruitment
mediators
Release of mucus glycoproteins
? ↑ Glandular hypertrophy/hyperplasia
Pathogenic induced
(rhinovirus)
Prolonged low grade immunologic response
Clinical applications
Polyps: • Topical steroids: 50-90% success• Oral steroids, FESS, polypectomy:
recurrence: 40-50%.
Glandular: Try conservative approach
• Long-term topical steroids• Macrolide ABx ●Pathogenic (possible infection) ●Reduce mucus hypersecretion
Objectives:
• Increasing the communication between the clinicians and the pathologists
• Introducing new clinicopathological concepts• Deciding upon clinical applications according to
the morphologic findings • Which relevant information should the clinicians
provide to the pathologists?• Should the pathologic report introduce a clinical
entity alone (nondescriptive one)?