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.

4 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: A child's immune system has to initiate the immune response from scratch and cannot depend on a memory-type of immune response. Moreover, the immune system in newborns is also less efficient in inducing cytokine responses. In consequence, newborns and children are more susceptible to upper-airway infections and inflammation than adults. This manuscript summarises basic considerations relating to immune and inflammatory response in the upper airways and presents data about the processes involved in immunity development and maturation in children. Literature review. Inflammation is a complex set of interactions between soluble factors and cells that can arise in any tissue in response to both exogenous (infectious, toxic...) and endogenous (auto-immune, ischaemia...) insults. It interacts actively with the adaptive immune response by launching the antigen processing and presenting phases. Reduced cytotoxic response during foetal life, poor T-lymphocyte response to mitogens, immaturity of T and B lymphocytes, inadequate cytokine synthesis, a marked deficiency of antibody production and reduced neutrophil, complement and natural killer activity are important contributors to the complex physiological deficiency of immunological function in neonates and young children. The importance of the control and self-limitation of the inflammatory reaction is demonstrated by observations that, in certain chronic infectious or inflammatory conditions, the inflammatory response causes more damage to the host than the microbe.
    B-ENT 01/2012; 8 Suppl 19:29-40. · 0.08 Impact Factor
  • [Show abstract] [Hide abstract]
    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.
    Current Opinion in Allergy and Clinical Immunology 12/2012; 13(1). DOI:10.1097/ACI.0b013e32835ad09e · 3.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Chronic rhinosinusitis (CRS) is characterized by mucous overproduction and submucosal gland hyperplasia. The global protein profile of sinonasal secretions in pediatric CRS has not been studied. We hypothesized that MUC5B, a glandular mucin, would be relatively increased in CRS secretions compared to other mucins.Methods Secretions were collected at Children's National Health System (Children's National) from CRS patients undergoing sinus surgery and from control patients without CRS undergoing craniofacial procedures. Proteins were extracted, digested to peptides, and analyzed by mass spectometry. Fold change significance was calculated using the QSpec algorithm. Western blot analysis was performed to validate proteomic findings.ResultsIn total, 294 proteins were identified. Although both MUC5B and MUC5AC were identified in a majority of samples, the relative abundance of MUC5B was found to be significantly higher (p < 0.05). Western blot data validated these findings. Other proteins with the highest significant positive-fold change in CRS samples were BP1 fold-containing family A member 1, chitinase-3-like protein 1, plastin-2, serpin 10, and BP1 fold-containing family B member 1.Conclusion Overall our data demonstrates an increase of MUC5B abundance in the sinus secretions of pediatric patients with CRS.Pediatric Research (2014); doi:10.1038/pr.2014.187.
    Pediatric Research 11/2014; 77(2). DOI:10.1038/pr.2014.187 · 2.31 Impact Factor