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Chronic Rhinosinusitis Definition (clinical):

This article provides a comprehensive overview of chronic rhinosinusitis, including its definition, classification based on temporal nature, morphologic features, proposed mechanisms, and clinical applications. It also discusses the importance of communication between clinicians and pathologists and the relevant information clinicians should provide for accurate pathology reports.

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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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