Representation of Lymphocytes in Sinonasal Tissue of Chronic Rhinosinusitis Patients
Abstract
Chronic rhinosinusitis is divided into nasal polyp subtype and non-nasal polyp subtype. Among those subtypes, there are different histopathologic patterns. One of the criteria of the histopathological parameter is inflammatory cells pattern in sinonasal tissue which can be assessed by counting lymphocytes in sinonasal tissue. This study aims to describe the representation of lymphocytes in sinonasal tissue of chronic rhinosinusitis patients. This descriptive observational study included 21 chronic rhinosinusitis patients in otolaryngology clinic of Dr. Sardjito Hospital Yogyakarta, Indonesia who had undergone endoscopic sinus surgery during the year 2013 and fulfilled the criteria. Information about sample subtypes was obtained from medical record while data about lymphocytes count in sinonasal tissue was obtained from counting microscopically using the light microscope in 5 zigzag consecutive high-power fields (HPF). Nasal polyp subtype was found in 20 (95.24 %) cases while nonnasal polyp subtype was in 1 case (4.76 %). Representation of lymphocytes in nasal polyp subtype was higher than that in non-nasal polyp subtype. Mean, standard deviation, median, minimum count, and maximum count of tissue lymphocyte in nasal polyp subtype were 78 cells/HPF, 46 cells/HPF, 65 cells/HPF, 25 cells/HPF, and 207 cells/HPF respectively while tissue lymphocyte count in non-nasal polyp subtype was 21 cells/HPF. Using Hellquist classification, the histopathological characteristics of nasal polyp subtype were described. The highest count of tissue lymphocytes was found in Hellquist type IV. Within one disease entity, two subtypes, and four histological types, chronic rhinosinusitis has a highly variable amount of tissue lymphocytes.
Keywords: Chronic rhinosinusitis, Histopathology, Lymphocyte(s), Nasal polyps, Hellquist classification.
References
[1] Budiman BJ, Rosalinda R. Bedah sinus endoskopi fungsional revisi pada rinosinusitis kronis. [Surgical sinus endoscopy revision function in chronic rhinosinusitis]. Repository Universitas Andalas;2014.p. 1. [in Bahasa Indonesia]. [Online] from http: //repository.unand.ac.id/18398/ [Accessed on 2015 May 24].
[2] Perić A, Gaćeša D. Etiology and pathogenesis of chronic rhinosinusitis. Vojnosanitetski Pregled 2008;65(9):699–702. https://www.ncbi.nlm.nih.gov/pubmed/18814507
[3] Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: National Health Interview Survey, 2012, National Center for Health Statistics. Vital and Health Statistics 2014;10(260):121–122. https://www.ncbi.nlm.nih.gov/pubmed/24819891
[4] Multazar A, Nursiah S, Rambe A, Harahap IS. Ekspresi cyclooxygenase-2 (COX-2) pada penderita rinosinusitis kronis. [Cyclooxygenase-2 (Cox-2) expression on crinic rinosinusitis patients]. ORLI 2012;42(2):96–103. [in Bahasa Indonesia]. http://www. orli.or.id/index.php/orli/article/view/25
[5] Arivalagan P, Rambe A. Gambaran rinosinusitis kronis di RSUP Haji Adam Malik pada tahun 2011. [Description of chronic rhinosinusitis in RSUP Haji Adam Malik in 2011]. E-Journal FK-USU 2013;1(1):1. [in Bahasa Indonesia]. [Online] from https://jurnal.usu.ac. id/index.php/ejurnalfk/article/view/1342 (2013) [Accessed on 2015 May 24].
[6] Multazar A. Karakteristik penderita rinosinusitis kronis di RSUP H. Adam Malik Medan Tahun 2008. [Characteristics of patients with chronic rhinosinusitis in RSUP H. Adam Malik Medan Year 2008]. [Thesis]. Universitas Sumatera Utara, Medan;2011.p. 2. [in Bahasa Indonesia]. https://id.123dok.com/document/download/lzgw1p7y
[7] Harowi MR, Soekardono S, Djoko R BU, Christanto A. Kualitas hidup penderita rinosinusitis kronis pasca-bedah. [Quality of life for chronic rhinosinusitis patients post-surgery]. CDK 187 2011;38(6):429–434. [in Bahasa Indonesia]. http://www.kalbemed.com/Portals/6/09_187Kualitas%20hidup%20penderita% 20Rinosinusitis%20Kronik%20Pasca%20Bedah.pdf
[8] Van Crombruggen K, Zhang N, Gevaert P, Tomassen P, Bachert C. Pathogenesis of chronic rhinosinusitis: Inflammation. The Journal of Allergy and Clinical Immunology 2011;128(4):728–732. https://www.ncbi.nlm.nih.gov/pubmed/21868076
[9] Setiadi M. Analisis hubungan antara gejala klinik, lama sakit, skin prick test, jumlah eosinofil dan neutrofil mukosa sinus dengan indeks lund-mackay CT scan sinus paranasal penderita rinosinusitis kronis. [Analysis of the relationship between clinical symptoms, duration of illness, skin prick test, eosinophil count and sinus mucosa neutrophils with lund-mackay index CT scan of paranasal sinus chronic rhinosinusitis]. [Thesis]. Semarang Universitas Diponegoro, Semarang (2009). p. 2–3. http://eprints.undip.ac.id/24724/1/M._Setiadi.pdf
[10] Polzehl D, Moeller P, Riechelmann H, Perner S. Distinct features of chronic rhinosinusitis with and without nasal polyps. Allergy 2006;61:1275–1279. https:// www.ncbi.nlm.nih.gov/pubmed/17002702
[11] Baudoin T, Kalogjera L, Geber G, Grgić M, Čupić H, Tiljak MK. Correlation of histopathology and symptoms in allergic and non-allergic patients with chronic rhinosinusitis. European Archives of Otorhinolaryngology 2008;265:657–661. https: //www.ncbi.nlm.nih.gov/pubmed/18004580
[12] Hellquist HB. Histopathology. Allergy and Asthma Proceedings 1996;17(5):237–242. https://www.ncbi.nlm.nih.gov/pubmed/8871736
[13] Chin D, Harvey RJ. Nasal polyposis: An inflammatory condition requiring effective anti-inflammatory treatment. Current Opinion in Otolaryngology and Head and Neck Surgery 2013;21:23–30. https://www.ncbi.nlm.nih.gov/pubmed/23172039
[14] Zhang LP, Lin L, Zheng CQ, Shi GY. T-lymphocyte subpopulations and B7-H1/PD1 expression in nasal polyposis. The Journal of International Medical Research 2010;38(2):593–601. https://www.ncbi.nlm.nih.gov/pubmed/20515572
[15] Meltzer EO, Hamilos DL. Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines. Mayo Clinic Proceedings 2011;86(5):427– 443. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084646/
[16] Kumar V, Abbas AK, Aster JC. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Philadelphia: Elsevier Saunders; 2015:93–97. https://studentconsult.inkling.com/ read/robbins-cotran-pathologic-basis-disease-kumar-9/chapter-3/inflammationand-repair
[17] Couto LGF, Fernades AM, Brandão DF, de Santi Neto D, Valera FCP, Anselmo-Lima W. Histological aspects of rhinosinusal polyps. Brazilian Journal of Otorhinolaryngology 2008;74(2):207–212. https://www.ncbi.nlm.nih.gov/pubmed/18568198
[18] Kirtsreesakul V. Update on nasal polyps: Etiopathogenesis. Journal of the Medical Association of Thailand 2005;88(12):1966–1972. https://www.ncbi.nlm.nih.gov/ pubmed/16519003
[19] Lacroix JS, Zheng CG, Goytom SH, Landis B, Szalay-Quinodoz I, Malis DD. Histological comparison of nasal polyposis in black African, Chinese and Caucasian patients. Rhinology 2002;40(3):118–121. https://www.ncbi.nlm.nih.gov/pubmed/12357710
[20] Souza BB, Serra MF, Dorgam JV, Sarreta SMC, Melo VR, Anselmo-Lima WT. Polipose nasossinusal: Doença inflamatória crônica evolutiva. Revista Brasileira de Otorrinolaringologia 2003;69(3):318–325. [in Portuguese].. http://www.scielo.br/ scielo.php?script=sci_arttext&pid=S0034-72992003000300004