A histopathological study: Chronic rhinosinusitis in adolescents versus adults

Department of Otorhinolaryngology, Head & Neck Surgery, Beijing Tongren Hospital Affiliated to Capital University of Medical Sciences, Key Laboratory Otolaryngology, Head & Neck Surgery, Beijing 100730, China.
Zhonghua yi xue za zhi 07/2009; 89(28):1975-8. DOI: 10.3760/cma.j.issn.0376-2491.2009.28.011
Source: PubMed


To conduct a histopathology study of adolescents with chronic rhinosinusitis (CRS) to compare the sinus mucosa with adult CRS and to explore their different pathological characteristics and lesion patterns.
Twenty cases of adolescents (median age: 14 years; range: 11-16 years) and 16 cases of adult CRS (median age: 36 years; range: 21-56 years) were performed functional endoscopy operation despite conventional medical therapy, histopathology of uncinate process mucosa were analyzed for inflammatory cell and morphologic studies. Archival tissue from adolescents and adults with CRS were stained with HE, AB-PAS (alcian blue-periodic acid-schiff) as well as Van Gieson. Statistical analysis t-test was performed using SPSS.
Adolescents CRS sinus mucosa, as compared with adult CRS control, had a higher density of submucosal lymphocytes (t = 2.09, P = 0.04), higher density of submucosal plasma cell (t = 2.46, P = 0.02), lower density of submucosal eosinophils (t = -3.72, P = 0.01), thinner basement membranes and more intact epithelium (t = -2.50, P = 0.02 and t = 5.63, P = 0.00 respectively) and fewer submucosal mucous glands (t = -2.13, P = 0.04). There were significant differences between two groups.
Lymphocytes were the predominant inflammatory cell type in the sinus mucosa of adolescents with CRS. But it has less eosinophilic inflammation, more plasma cell infiltration, basement membrane thickening, and mucus gland hyperplasia in characteristic adult CRS. Differences between adolescents and adult CRS suggest differing pathogenic mechanisms or progression in the inflammatory response with a protracted disease.

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    ABSTRACT: Purpose of review: Evidence suggests that some structural changes caused by mucosal remodeling may be primarily irreversible, which theoretically challenges the current management model of chronic rhinosinusitis (CRS). The relationship between inflammation and remodeling in the mucosa remains complex, yet better understanding of involved pathways holds potential clinical implications. This article reviews the controversies as well as current applications from the literature. Recent findings: First, the relationship between inflammation and remodeling is a complex one involving multiple pathways, with evidence suggesting that remodeling is not a simple fibrotic end-stage process secondary to long-standing inflammation. Second, anti-inflammatory approaches alone are probably not successful in reversing changes such as collagen deposition, indicating that early treatment might be crucial for preventing disease progression. Third, a dysfunctional sinus remains a pure clinical/surgical phenomenon with lack of histological characterization. Fourth, maximal/extensive surgical techniques are advocated for patients with severe disease or dysfunctional sinuses. Summary: Reversibility of remodeling holds implications for the management of CRS. Although clinical applications (both medical and surgical) exist, further research is required for solidifying current evidence as well as exploring new avenues for therapy.
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