Nazal polipoziste histopatolojik bulgular ile klinik ölçütler ile arasındaki ilişki

Clinical Research ENT Updates 2015;5(1):1–8 doi:10.2399/jmu.2015001002 The correlation of clinical measures with the histopathological findings in nasal polyposis Zeynep Alt›n Kule1, Hande Senem Deveci2, Mustafa Kule1, Tülay Erden Habeflo¤lu2, Adnan Somay3, Ali Okan Gürsel2 1 Department of Otorhinolaryngology, Mu¤la Government Hospital, Mu¤la, Turkey Department of Otorhinolaryngology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey 3 Department of Pathology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey 2 Abstract Özet: Nazal polipoziste histopatolojik bulgular ile klinik ölçütler ile aras›ndaki iliflki Objective: The aim of this study was to outline the histopathological findings of nasal polyposis and to investigate whether these findings were associated with the severity of the disease and co-existing morbidities as well as hematological parameters. Amaç: Bu çal›flmada nazal polipozisli hastalarda histopatolojik bulgular›n detayl› olarak tan›mlanarak bu bulgular›n hastal›¤›n fliddeti ve ast›m, alerji ve kan eozinofil düzeyi gibi baz› efllik eden faktörlerle iliflkisinin araflt›r›lmas› amaçlanm›flt›r. Methods: Seventy-seven nasal polyposis (52 male, 25 female; mean age: 46.99±13.27 years) patients who underwent endoscopic sinus surgery between 2007 and 2011 were included in the study. Data was extracted from medical files and endoscopy scores, and Lund-Mackay Computed Tomography scores, Nasal Obstruction Symptom Evaluation (NOSE) scales, presence of allergy and asthma, and blood eosinophil levels were noted. Correlation of this data with histopathological findings (such as basement membrane thickness, goblet cell hyperplasia, subepithelial edema, submucous gland formation, eosinophilic infiltration, lymphocytic infiltration and polymorphonuclear leukocyte infiltration) was analyzed. Yöntem: Çal›flmada 2007–2011 y›llar› aras›nda endoskopik sinüs cerrahisi uygulanan yetmifl-yedi nazal polipozisli hastan›n (52 erkek, 25 kad›n; yafl ortalamas›: 46.99±13.27) verileri incelenmifltir. Yap›lan retrospektif de¤erlendirmede endoskopik skorlar›, Lund-Mackay bilgisayarl› tomografi skorlar›, nazal obstrüksiyon semptom de¤erlendirme skalalar›, alerji ve ast›m varl›¤› ve kan eozinofil düzeyleri kaydedilmifltir. Bu veriler histopatolojik bulgularla (bazal membran kal›nl›¤›, goblet hücre hiperplazisi, subepitelyal ödem, submukozal gland formasyonu, eozinofilik infiltrasyon, lenfositik infiltrasyon ve polimorfonükleer infiltrasyon) karfl›laflt›r›lm›flt›r. Results: Analysis of our findings yielded that the only statistically significant finding was the correlation of eosinophilic infiltration with the blood eosinophil level (p<0.01). No other statistically significant differences were found between histopathological findings and accompanying clinical or hematological parameters under investigation. Bulgular: Bulgular de¤erlendirildi¤inde eozinofil infiltrasyonu ve kan eozinofil düzeyleri aras›nda istatistiksel aç›dan anlaml› bir iliflki saptanm›flt›r (p<0.01). Bunun d›fl›nda histopatolojik bulgular ve efllik eden faktörler aras›nda herhangi bir anlaml› ba¤lant› saptanmam›flt›r. Conclusion: Results of the current study have shown that histopathological features of nasal polyposis do not exhibit correlation with the severity or extent of the disease. Sonuç: Çal›flmam›z›n bulgular›na bak›ld›¤›nda nazal poliplerin histopatolojik özellikleri ile hastal›¤›n fliddeti, yayg›nl›¤› veya efllik eden klinik veya hematolojik parametrelerle anlaml› bir iliflkili bulunmam›flt›r. Keywords: Nasal polyposis, histopathology, eosinophilia, severity, correlation. Anahtar sözcükler: Nazal polipozis, histopatoloji, eozinofili, fliddet, korelasyon. Nasal polyps which are hyperplastic swellings of the nasal mucous membranes are the most common cause of nasal masses located in the nasal cavity. Nasal polyposis (NP) is a multifactorial disease that affects 2–4% of the general Correspondence: Hande Senem Deveci, MD. Fatih Sultan Mehmet Training and Research Hospital, Bostanci, 34744 Istanbul, Turkey. e-mail: Received: January 19, 2015; Accepted: February 22, 2015 ©2015 Continuous Education and Scientific Research Association (CESRA) Online available at: www.entupdates.org doi:10.2399/jmu.2015001002 QR code: Alt›n Kule Z et al. population.[1,2] Although there are many studies investigating the etiopathogenesis of NP, the exact reason has not been known yet. A complete evaluation of a patient with NP must include some clinical measures such as severity of nasal obstruction, endoscopic and radiological evaluation as well as presence of allergy and asthma. Although many studies have been conducted about the histopathology of the NP, to the best of our knowledge, none of them has evaluated the relationship between histopathological changes with the allergy, asthma and some other accompanying factors. Since nasal polyps may be associated with many diseases, histological features may vary according to these factors and clinical measures. In this study, we aimed to investigate histopathological findings in nasal polyps of patients with NP and to investigate the relationship between histopathological features of NP and disease severity as well as the concomitant clinical and hematological factors. Materials and Methods The study group consisted of 77 patients with nasal polyposis who underwent endoscopic sinus surgery (ESS) at a tertiary care center between 2007 and 2011. The study protocol was reviewed and approved by the research ethical committee in Fatih Sultan Mehmet Education and Research Hospital. Nasal polyposis was diagnosed by endoscopic findings and computerized tomography (CT) views. Patients with sinonasal malignancy and antrochoanal polyps were excluded from the study. Outcome Parameters Allergy and asthma: Skin prick tests with commercial extracts of the main airborne allergens were performed. Blood eosinophil counts were obtained through routine blood analysis. Patients were consulted to a chest disease specialist for the diagnosis of asthma by means of clinical symptoms, physical findings and pulmonary function tests. Nasal symptom score: Nasal obstruction was evaluated by Nasal Obstruction Symptom Evaluation (NOSE) scale.[3] Polyp size: Endoscopic score of polyposis was calculated from 0 to 3 for each nasal cavity: 0, no polyp; 1, mild polyposis limited to middle meatus; 2, moderate polyposis reaching below middle concha; 3, diffuse polyposis (complete involvement of ipsilateral nasal cavity).[4] 2 ENT Updates Radiological score: Paranasal sinus CT scans were performed routinely in all patients and staging was made according to the Lund-Mackay score system as follows:[5] 0, no opacity; 1, partial opacity; and 2, total opacity for each sinuses. The osteomeatal complex scores 0 for no obstruction or 2 when obstructed. The total score of the system was 24 bilaterally. Endoscopic sinus surgery (ESS) was performed using standard technique under general anesthesia. (...truncated)