Sayed R H, Abu-Dief E E
Department of ENT, Faculty of Medicine, Sohag University, Egypt.
J Laryngol Otol. 2010 May;124(5):505-9. doi: 10.1017/S0022215109992301. Epub 2009 Dec 11.
To compare the gross and microscopic appearance of antrochoanal polyps associated with recurrent epistaxis, with those with a more typical presentation.
Prospective, controlled study.
All patients underwent clinical and endoscopic examination, computed tomography scanning, and examination under anaesthesia, in order to detect the gross diagnostic criteria for antrochoanal polyp. Histological findings on light microscopy were compared for polyps presenting with epistaxis versus those without. The number of predominant inflammatory cells in the corium was determined in both groups and statistically compared using the Student t-test.
Recurrent epistaxis was a presenting symptom in 10/84 (11.9 per cent) patients with gross diagnostic criteria for antrochoanal polyp. Grossly, these patients' polyps had a reddish, vascular surface in parts. Histologically, these polyps showed a highly vascular stroma with multiple dilated blood vessels, the typical appearance of an angiomatous antrochoanal polyp. Thrombi at different stages of development were detected, with no infarcts. The remaining cases (88.1 per cent) had no history of epistaxis; histologically, these patients' polyps showed an oedematous connective tissue core with few inflammatory cells. Plasma cells were predominant in the angiomatous polyps, being significantly more prevalent than in the ordinary antrochoanal polyps (p < 0.00).
It would appear that only angiomatous antrochoanal polyps present with epistaxis. Detection of the characteristic gross appearance of these polyps may help avoid unwanted surgery. Histopathological analysis confirms the diagnosis. A significantly increased number of plasma cells may be the underlying cause of the histological changes seen in angiomatous antrochoanal polyps.
比较伴有反复鼻出血的上颌窦后鼻孔息肉与具有更典型表现的上颌窦后鼻孔息肉的大体和微观外观。
前瞻性对照研究。
所有患者均接受临床和内镜检查、计算机断层扫描以及麻醉下检查，以检测上颌窦后鼻孔息肉的大体诊断标准。比较有鼻出血表现的息肉与无鼻出血表现的息肉在光镜下的组织学结果。确定两组真皮中主要炎症细胞的数量，并使用学生t检验进行统计学比较。
在84例符合上颌窦后鼻孔息肉大体诊断标准的患者中，10例（11.9%）以反复鼻出血为主要症状。大体上，这些患者的息肉部分表面呈红色、血管丰富。组织学上，这些息肉表现为高度血管化的间质，有多个扩张的血管，这是血管瘤样上颌窦后鼻孔息肉的典型表现。检测到不同发育阶段的血栓，但无梗死灶。其余病例（88.1%）无鼻出血病史；组织学上，这些患者的息肉表现为水肿的结缔组织核心，炎症细胞较少。血管瘤样息肉中浆细胞占主导，明显比普通上颌窦后鼻孔息肉中更常见（p<0.00）。
似乎只有血管瘤样上颌窦后鼻孔息肉会出现鼻出血。检测这些息肉的特征性大体外观可能有助于避免不必要的手术。组织病理学分析可确诊。浆细胞数量显著增加可能是血管瘤样上颌窦后鼻孔息肉组织学改变的潜在原因。
