Last Journal - Volume XX, Number 2, 2016
Predictive significance of histopathologic parameters in the outcome of chronic rhinosinusitis with nasal polyposis
Abstract: Abstract. Introduction. Chronic rhinosinusitis with nasal polyposis is an important and complex disease characterized by a persistent inflammatory process involving the sinonasal mucosa, representing a serious health problem and economic challenge, with pathogenic mechanisms still debated. Researchers in this area are currently concerned with finding new molecular pathways that coordinate this complex chronic inflammatory process of the sinonasal mucosa, thus aiming to identify both clear pathogenic mechanisms and a potential value of predictive and prognostic markers. OBJECTIVE. The aim of this study was to estimate the predictive value of the ultrastructural changes in the nasal mucosa in patients with chronic rhinosinusitis with nasal polyps, in order to establish the best therapeutic option. MATHERIAL AND METHODS. We performed a prospective study between January 2012- February 2014 on 82 patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) assessed by histopathologic and immunohistochemical methods to determine the presence of inflammatory markers such as eosinophilic infiltrate and proinflammatory protein HMGB1. The patients underwent endoscopic sinus surgery and the specimens taken during the surgery were examined .Histopathological evaluation of biopsy fragments taken from nasal polyps was performed to quantify the eosinophilic infiltrate from a much complex score containing also fibrosis, angiogenesis and oedema of the mucosa. Immunohistochemistry determined the distribution of the proinflammatory protein HMGB1 extracellulary. Based on these parameters, the patients were categorized in four groups. To evaluate the outcomes a visual analogue scale (VAS) for each symptom (nasal obstruction, rhinorrhea, anosmia/hyposmia) was filled by the patients and the nasal endoscopic score Lund-Kennedy was assessed by the physician. The predictive value of the histopathological and immuhistochemical parameters in clinical evolution and recurrence of nasal polyposis was evaluated by comparing these results at 1 month, 3,6 months and 1 year). RESULTS. Our results demonstrated that the extracellular HMGB1protein and eosinophilic infiltrate show a great importance as predictive factors for both evolution and recurrences in patients with chronic rhinosinusitis with nasal polyps. Analyzing all four groups, we observed that group 4(HMGB1 extracellular positive and eosinophilic infiltrate) had the worst evolution and the highest number of recurrences(19,23%)-, while group 1(HMGB1extracellular negative with infiltrate non-eosinophilic), exhibited the best improvement and a recurrence of only 3%. CONCLUSION. The results of our study showed that HP and IHC parameters could be considered significant predictive factors in post-therapeutic clinical evolution and recurrence of nasal polyposis.