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Chronic Rhinosinusitis Definition (clinical):

Chronic Rhinosinusitis Definition (clinical):. Inflammatory response involving the following: mucous membranes, nasal cavity and paranasal sinuses. Fluid within the cavities and/or underlying bones.

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Chronic Rhinosinusitis Definition (clinical):

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  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 (<4 weeks) • Subacute (4-12 weeks) • Recurrent acute (> 4 episodes per year) • Chronic (>12 weeks) • Acute exacerbation of chronic

  3. Chronic adult rhinosinusitis • Lasting > 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. Proposed new histologic classification: • Polypoid CRS • Glandular CRS

  6. 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

  7. 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

  8. 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

  9. 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)?

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