Chronic Rhinosinusitis Definition clinical:

1
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.

2
Rhinosinusitis Classification

• Based on temporal nature
• Acute (lt4 weeks)
• Subacute (4-12 weeks)
• Recurrent acute (gt 4 episodes per year)
• Chronic (gt12 weeks)
• Acute exacerbation of chronic

3
Chronic adult rhinosinusitis

• Lasting gt 12 weeks
• Diagnostically proven (major and minor clinical
  features)
• With or without physical findings

4
Chronic rhinosinusitismorphologic features

• Inflammatory infiltrates
• Edema
• Glandular hyperplasia
• Thickened basement membrane
• Squamous metaplasia
• Eosinophils, may be present, can be numerous

5
(No Transcript)
6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
Proposed new histologic classification

• Polypoid CRS
• Glandular CRS

14
Proposed mechanism Polypoid CRS
Epithelial Disruption
Migration of immature branching epithelium
Disregulation of eosinophils
mediators
e.g., IL-5, by eosinophils
Exudation
Microcavities
Fusion of glands
Cleavage plane of mucosal surface
15
Proposed mechanismGlandular CRS
? sICAM-1
Pathogenic induced (rhinovirus)
No eosinophilic activity
Prolonged low grade immunologic response
Neutrophils recruitment
mediators
? ? Glandular hypertrophy/hyperplasia
Release of mucus glycoproteins
16
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

17
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)?