Heilingoetter Ashley L, Tajudeen Bobby, Kuhar Hannah N, Gattuso Paolo, Ghai Ritu, Mahdavinia Mahboobeh, Batra Pete S
1 Rush Medical College, Rush University Medical Center, Chicago, IL, USA.
2 Department of Otorhinolaryngology-Head and Neck Surgery and Rush Sinus Program, Rush University Medical Center, Chicago, IL, USA.
Am J Rhinol Allergy. 2018 Mar;32(2):112-118. doi: 10.1177/1945892418762863.
Background Structured histopathology reporting facilitates better understanding of the underlying pathophysiologic mechanisms of chronic rhinosinusitis. The microbiology of chronic rhinosinusitis has been studied extensively; however, distinct histopathologic changes associated with bacteria isolated in chronic rhinosinusitis are largely unknown. Objective The goal of this study is to better understand the relationship between culturable bacteria and histopathology in chronic rhinosinusitis. Methods A structured histopathology report was utilized to analyze sinus tissue removed during functional endoscopic sinus surgery in a group of patients with chronic rhinosinusitis refractory to medical therapy. Patients with cystic fibrosis or ciliary dysfunction were excluded. Histology variables included eosinophil count per high-power field, neutrophil infiltrate, basement membrane thickening, subepithelial edema, hyperplastic/papillary changes, mucosal ulceration, squamous metaplasia, fibrosis, fungal elements, Charcot-Leyden crystals, and eosinophil aggregates. Baseline Lund-Mackay score and Sinonasal Outcome Test 22 score were also collected. The association of culture data with the aforementioned variables was assessed. Results A total of 59 chronic rhinosinusitis patients who underwent functional endoscopic sinus surgery were included. Chronic rhinosinusitis patients with Pseudomonas aeruginosa had significantly increased neutrophil infiltrate (71.4% vs. 26.9%, p = 0.048), subepithelial edema (28.6% vs. 3.8%, p = 0.047), and a trend toward increased fungal elements (28.6% vs. 5.8%, p = 0.071). Chronic rhinosinusitis patients with Staphylococcus aureus had significantly more hyperplastic changes (20% vs. 2.3%, p = 0.050) and a trend toward increased squamous metaplasia (33.3% vs. 14.2%, p = 0.069). Conclusion Distinct histopathologic changes were noted based on sinus culture data for S. aureus and P. aeruginosa. These findings may have important implications on the extent of surgical management and prognosis after surgery.
背景 结构化组织病理学报告有助于更好地理解慢性鼻-鼻窦炎的潜在病理生理机制。慢性鼻-鼻窦炎的微生物学已得到广泛研究；然而，与慢性鼻-鼻窦炎中分离出的细菌相关的独特组织病理学变化在很大程度上尚不清楚。目的 本研究的目的是更好地理解慢性鼻-鼻窦炎中可培养细菌与组织病理学之间的关系。方法 利用结构化组织病理学报告分析一组药物治疗无效的慢性鼻-鼻窦炎患者在功能性鼻内镜鼻窦手术中切除的鼻窦组织。排除患有囊性纤维化或纤毛功能障碍的患者。组织学变量包括每高倍视野嗜酸性粒细胞计数、中性粒细胞浸润、基底膜增厚、上皮下水肿、增生/乳头样改变、黏膜溃疡、鳞状化生、纤维化、真菌成分、夏科-莱登结晶和嗜酸性粒细胞聚集。还收集了基线Lund-Mackay评分和鼻鼻窦结局测试22评分。评估培养数据与上述变量之间的关联。结果 总共纳入了59例接受功能性鼻内镜鼻窦手术的慢性鼻-鼻窦炎患者。患有铜绿假单胞菌的慢性鼻-鼻窦炎患者中性粒细胞浸润显著增加（71.4% 对26.9%，p = 0.048）、上皮下水肿显著增加（28.6% 对3.8%，p = 0.047），并且真菌成分有增加趋势（28.6% 对5.8%，p = 0.071）。患有金黄色葡萄球菌的慢性鼻-鼻窦炎患者增生性改变显著更多（20% 对2.3%，p = 0.050），并且鳞状化生有增加趋势（33.3% 对14.2%，p = 0.069）。结论 根据金黄色葡萄球菌和铜绿假单胞菌的鼻窦培养数据发现了独特的组织病理学变化。这些发现可能对手术治疗范围和术后预后具有重要意义。
