Frequency of inflammatory cell types in polyps of patients with diffuse sinonasal polyposis and association with effective factors in recurrence

IRCMJ logo
PDF
HTML

Keywords

Lund-Mackay score
Recurrence
Sinonasal polyposis
SNOT-20

How to Cite

lotfiA. reza, shahidi, nikzad, halimi, monireh, & eshagh hosseini, seyedeh naffiseh. (2020). Frequency of inflammatory cell types in polyps of patients with diffuse sinonasal polyposis and association with effective factors in recurrence. Iranian Red Crescent Medical Journal, 22(11). https://doi.org/10.32592/ircmj.2020.22.11.188

Abstract

Background: Sinonasal polyposis (SNP) is a chronic disease of nasal and paranasal sinus mucosa. Nasal polyps can be divided into two groups based on inflammatory cells’ types, namely eosinophilic and neutrophilic polyps. Eosinophilic chronic rhinosinusitis responds to corticosteroids; however, this response is less in the neutrophilic type.

Objectives: The present study aimed to determine the frequency of inflammatory cell types in the polyp tissue of patients with diffuse SNP and its association with effective factors in recurrence.

Methods: This cross-sectional study was carried out on 130 patients with diffuse SNP referring to the Ear, Nose, and Throat (ENT) clinics of Tabriz University of Medical Sciences, Tabriz, Iran, using random sampling. The severity of the disease was assessed by the Sinonasal Outcome Test 20 (SNOT-20) questionnaire filled out by an ENT surgeon. Computed tomography scans were graded by the Lund-Mackay score. The variety of the cells were determined following hematoxylin-eosin staining and pathologist light microscopy examination; then, the obtained data were statistically evaluated and their associations with the previously known factors of recurrence in other studies were reported.

Results: The most frequent cells were eosinophils, and mast cells showed the lowest frequency of inflammatory cells in the polyps of patients with diffuse SNP. Eosinophilic polyps were more common in female patients. There was no significant difference between inflammatory cells associated with age, history of surgery, and SNOT-20 score. A significant relationship was only observed between the Lund-Mackay scores of neutrophil and mast cell counts in polyps.

Conclusion: The investigation of the dominant inflammatory cell in the histopathology sample of the sinonasal polyps can help in tracking and rationalizing patient management and expectations.

https://doi.org/10.32592/ircmj.2020.22.11.188
PDF
HTML

References

  1. Erbek SS, Yurtcu E, Erbek S, Atac FB, Sahin FI, Cakmak O. Proinflammatory cytokine single nucleotide polymorphisms in nasal polyposis. Arch Otolaryngol Head Neck Surg. 2007; 133: 705-9. doi: 10.1001/archotol.133.7.705. [PubMed: 17638785].
  2. Tasi CH, Weng SF, Rang LC, Huang YC, Huang FM, Chen YJ, et al. Immunohistochemical localization of tissue-type plasminogen activator inhibitor in radicular cysts. J Oral Patho Med. 2004;33(3):151-6. doi: 10.1111/j.0904-2512.2004.00133.x. [PubMed: 15128057].
  3. Linder A, Karlsson-Parra A, Hirvela C, Jonsson L, Koling A, Sjoberg O. Immunocompetent cells in human nasal polyps and normal mucosa.Rhinology. 1993;31(3):125-9. [PubMed: 8256081].
  4. Hirschberg A, Jókúti A, Darvas Z, Almay K, Répássy G, Falus A. The pathogenesis of nasal polyposis by immunoglobulin E and interleukin-5 is completed by transforming growth factor-beta1. Laryngoscope. 2003;113(1):120-4. doi: 10.1097/00005537-200301000-00022. [PubMed: 12514394].
  5. Bikhazi NB. Contemporary management of nasal polyps. Otolaryngol Clin North Am. 2004;37(2):327-37. doi: 10.1016/S0030-6665(03)00154-3. [PubMed: 15064065].
  6. Riccio AM, Tosca MA, Cosentino C, Pallestrini E, Ameli F, Canonica GW et al. Cytokine pattern in allergic and non-allergic chronic rhinosinusitis in asthmatic children. Clin Exp Allergy. 2002;32(3):422-6. doi: 10.1046/j.1365-2222.2002.01315.x. [PubMed: 11940073].
  7. Wynn R, Har-El G. Recurrence rates after endoscopic sinus surgery for massive sinus polyposis. Laryngoscope. 2004;114(5):811–813. doi: 10.1097/00005537-200405000-00004. [PubMed: 15126735].
  8. Bateman ND, Fahy C, Woolford TJ. Nasal polyps: still more questions than answers. J Laryngol Otol. 2003;117(1):1–9. doi: 10.1258/002221503321046577. [PubMed: 12590849].
  9. Rot A, Krieger M, Brunner T, Bischoff SC, Schall TJ, Dahinden CA. RANTES and macrophage inflammatory protein 1 alpha induce the migration and activation of normal human eosinophil granulocytes. J Exp Med. 1992;176(6) 1489-95. doi: 10.1084/jem.176.6.1489. [PubMed: 1281207].
  10. Ikeda K, Shiozawa A, Ono N, Kusunoki T, Hirotsu M, Homma H, et al. Subclassification of chronic rhinosinusitis with nasal polyp basedon eosinophil and neutrophil. Laryngoscope. 2013;123(11):E1–9.. doi: 10.1002/lary.24154. [PubMed: 23670893].
  11. Chaaban MR, . Walsh EM, Woodworth BA. Epidemiology and differential diagnosis of nasal polyps. Am J Rhinol Allergy. 2013;27(6), 473–478. doi: 10.2500/ajra.2013.27.3981. [PubMed: 24274222].
  12. Wen W, Liu W, Zhang L, Bai J, Fan Y, Xia W, et al. Increased neutrophilia in nasal polyps reduces the response to oral corticosteroid therapy. J Allergy Clin Immunol. 2012;129(6):1522-8.e5. doi: 10.1016/j.jaci.2012.01.079. [PubMed: 22460066].
  13. Lou H, Meng Y, Piao Y, Wang C, Zhang L, Bachert C. Predictive significance of tissue eosinophilia for nasal polyp recurrence in the Chinese population. Am J Rhinol Allergy. 2015;29(5):350-6. doi: 10.2500/ajra.2015.29.4231. [PubMed: 26219765].
  14. Peters AT, Spector S, Hsu J, Hamilos DL, Baroody FM, Chandra RK, et al. Diagnosis and management of rhinosinusitis: a practice parameter update. Ann Allergy Asthma Immunol. 2014;113(4):347-85. doi: 10.1016/j.anai.2014.07.025. [PubMed: 25256029].
  15. Bachert C, Zhang L, Gevaert P.Current and future treatment options for adult chronic rhinosinusitis: Focus on nasal polyposis. J Allergy Clin Immunol. 2015;136(6):1431-1440.doi: 10.1016/j.jaci.2015.10.010. [PubMed: 26654192].
  16. Boztepe OF, Gün T, Demir M, Gür ÖE, Ozel D, Doğru H. A novel predictive marker for the recurrence of nasal polyposis following endoscopic sinus surgery. Eur Arch Otorhinolaryngol. 2015;273(6):1439-44. doi: 10.1007/s00405-015-3753-z. [PubMed: 26285781].
  17. Tosun F, Arslan HH, Karslioglu Y, Deveci MS, Durmaz A. Relationship between postoperative recurrence rate and eosinophil density of nasal polyps. Ann Otol Rhinol Laryngol. 2010;119(7):455–9. doi: 10.1177/000348941011900705. [PubMed: 20734966].
  18. Videler WJ, Van Hee K, Reinartz SM, Georgalas C, Van der Meulen FW, Fokkens WJ. Longterm low-dose antibiotics in recalcitrant chronic rhinosinusitis: a retrospective analysis. Rhinology. 2012;50(1):45-55. doi: 10.4193/Rhino11.123. [PubMed: 22469605].
  19. Dalziel K, Stein K, Round A, Garside R, Royle P. Endoscopic sinus surgery for the excision of nasal polyps: a systematic review of safety and effectiveness. Am J Rhinol. 2006;20(5):506-19. doi: 10.2500/ajr.2006.20.2923. [PubMed: 17063747].
  20. Gevaert P, Bachert C, Holtappels G, Perez Novo C, Van der Heyden J, Fransen L, et al. Enhanced soluble interleukin 5 receptor alpha expression in nasal polyposis. Allergy. 2003;58(5):371-9. doi: 10.1034/j.1398-9995.2003.00110.x. [PubMed: 12752323].
  21. Simon HU, Yousefi S, Schranz C, Schapowal A, Bachert C, Blaser K. Direct demonstration of delayed eosinophil apoptosis as a mechanism causing tissue eosinophilia. J Immunol. 1997;158(8):3902-8. [PubMed: 9103460].
  22. Akhtar S, Ikram M, Azam I, Dahri T. Factors associated with recurrent nasal polyps: a tertiary care experience. J Pak Med Assoc.2010;60(2):102–4. [PubMed: 20209694].
  23. Tecimer SH, Kasapoglu F, Demir UL, Ozmen OA, Coskun H. Correlation between clinical findings and eosinophil/neutrophil ratio in patients with nasal polyps. European Archives of Oto-Rhino-Laryngology.2015;272(4):915-21. doi: 10.1007/s00405-014-3174-4. [PubMed: 25007735].
  24. Balouchi M, Berjis N, Okhovvat A, Abbasi H, Talebi S, Pathologic findings in sinonasal polyposis and predisposing factors. J Isfahan Med Sch. 2007;24(83):44-8.
  25. Cohen, J. Statistical Power Analysis of the Behavioral sciences. 2nd Ed. New York: Academic Press; 1988.
  26. Bezerra TF, Piccirillo JF, Fornazieri MA, Pilan RR, Pinna FD, Padua FG, et al. Assessment of quality of life after endoscopic sinus surgery for chronic rhinosinusitis. Braz J Otorhinolaryngol. 2012;78(2):96-102. [PubMed: 22499376].
  27. Moghadasi H, Sanei Taheri M, Jalali AH, Shakiba M. Correlation of Lund-Mackay and SNOT-20 before and after fanctional endoscopic Sinus Surgery (FESS): Does the baseline data predict the response rate? Iran J Radiol. 2009;6(4):207-14.
  28. Piccirillo JF, Merritt Jr MG, Richards ML. Psychometric and clinimetric validity of the 20-Item Sino-Nasal Outcome Test (SNOT20). Otolaryngol Head Neck Surg. 2002;126(1):41-7. doi: 10.1067/mhn.2002.121022. [PubMed: 11821764].
  29. Pynnonen MA, Kim HM, Terrell JE. Validation of the sino-nasal outcome test 20 (SNOT-20) domains in nonsurgical patients. Am J Rhinol Allergy. 2009;23(1):40-5. doi: 10.2500/ajra.2009.23.3259. [PubMed: 19379611].
  30. Hopkins C, Browne JP, Slack R, Lund V, Brown P. The Lund-Mackay staging system for chronic rhinosinusitis: How is it used and what does it predict? Otolaryngology Head Neck Surg. 2007;137(4):555-61. doi: 10.1016/j.otohns.2007.02.004. [PubMed: 17903570].
  31. Naghdi S, Anjeie F, Nakhostin Ansari N, Fathali M. Development, cultural adaptation, reliability and validity of Persian version of sino-nasal outcome test in chronic rhinosinusitis: a brief report. Tehran Univ Med J. 2013;70(11) :735-740.
  32. Rosai J. Rosai and Ackerman's, Surgical Pathology. 10th Edition. Elsevier;2011. P: 292.
  33. Hoseinalipoor Z, Yarmohammadi M, Jalali Nadooshan M, Yaraee R. Pathologic and clinical findings in sinonasal polyposis patients with or without nasal septal deviation. J Adv Med Biomed Res. 2014;22(91):109-20.
  34. keda K, Shiozawa A, Ono N, Kusunoki T, Hirotsu M, Homma H, et al. Subclassification of chronic rhinosinusitis with nasal polyp basedon eosinophil and neutrophil. Laryngoscope. 2013;123(11):E1–9. doi: 10.1002/lary.24154. [PubMed: 23670893].
  35. Chaaban MR, Walsh EM, Woodw orth BA. Epidemiology and differential diagnosis of nasal polyps. Am J Rhinol Allergy. 2013;27(6): 473–478. doi: 10.2500/ajra.2013.27.3981. [PubMed: 24274222].
  36. Hoseinalipoor Z, Yarmohammadi M, Jalali Nadooshan M, Yaraee R. Pathologic and clinical findings in sinonasal polyposis patients with or without nasal septal deviation. J Adv Med Biomed Res. 2014;22(91):109-20.
  37. Gevaert P, Van Bruaene N, Cattaert T, Van Steen K, Van Zele T, Acke F, et al. Mepolizumab, a humanized anti-IL-5 mAb, as a treatment option for severe nasal polyposis. J Allergy Clin Immunol. 2011;128(5):989-95.e1-8. doi: 10.1016/j.jaci.2011.07.056. [PubMed: 21958585].
  38. Bassiouni A, Wormald PJ. Role of frontal sinus surgery in nasal polyp recurrence. Laryngoscope. 123(1):36–41. doi: 10.1002/lary.23610. [PubMed: 23070897].
  39. Matsuwaki Y, Ookushi T, Asaka D, Mori E, Nakajima T, Yoshida T, et al. Chronic rhinosinusitis: risk factors for the recurrence of chronic rhinosinusitis based on 5-year follow-up after endoscopic sinus surgery