Sunday, May 29, 2011

Histopathology of nasal polyps

Histopathology of nasal polyps

Normal epithelium of the pouch rice is pseudo-stratified ciliated columnar epithelium. Epithelial surface of the sinus is thinner, has goblet cells and cilia are much less when compared with rice pouch.

Based histologisnya there are 4 types of polyps rice:

Eosinophilic edematous. This type is the most common type which includes approximately 85% of cases. This type is characterized by the presence of stromal edema, increased goblet cells in normal amount, which increased the high number of eosinophils, mast cells in the stroma, and basement membrane thickening.

Chronic inflammatory polyps. This type is only found less than 10% of cases of polyps rice. This type is characterized by stromal edema and found no decrease in the number of goblet cells. Thickening of the basement membrane is not real. The sign of the inflammatory response may be found even though the dominant lymphocytes. Stroma consists of fibroblasts.

Polyps with hyperplasia of the gland seromusinous. This type is only found less than 5% of all cases. The main picture of this type is the presence of glands and ducts in large numbers.

Polyps with stromal.Tipe atipia this is the type that are rarely found and can experience misdiagnosis with neoplasms. Stromal cells showed abnormal or atypical picture, but do not qualify to be called as a neoplasm.

In rice polyps, but increase in IgE is the highest type was found even when compared with tonsils and serum though. Levels of IgG, IgA, IgM present in varying amounts, which increased the number shows the presence of infection in the respiratory tract.

Several inflammatory mediators can also be found in the polyps. Histamine is a mediator of the largest concentration in the serum concentrations of stromal polyps 100-1000. Other chemical mediators are involved in the pathogenesis of nasal polyps is a Gamma Interferon (IFN-γ) and tumor growth factor β (TGF-β). IFN-γ causes the migration and activation of eosinophils through the release of toxic responsible for epithelial damage and collagen synthesis by fibroblasts. TGF-β is generally not found in normal mucosa is the most powerful factor in attracting fibroblasts and stimulate extracellular matrix synthesis. Increase in these mediators will ultimately damage the mucosa rinosinusal which will lead to increased permeability of sodium thus trigger the occurrence of submucosal edema on rice polyps.