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2020, vol. 77, br. 8, str. 784-788
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Nazalna polipoza - semikvantitativna morfometrijska patohistološka studija
Nasal polyposis: A semiquantitative morphometric histopathological study
aKlinički centar Srbije, Klinika za ORL i MFH, Beograd + Univerzitet u Beogradu, Medicinski fakultet bUniverzitet u Beogradu, Medicinski fakultet + Univerzitet u Beogradu, Medicinski fakultet, Institut za patološku anatomiju cUniverzitet u Beogradu, Medicinski fakultet + Univerzitet u Beogradu, Medicinski fakultet, Institut za mikrobiologiju i imunologiju dUniverzitet u Beogradu, Stomatološki fakultet, Klinika za maksilofacijalnu hirurgiju eVojnomedicinska akademija, Klinika za stomatologiju, Beograd + Univerzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd
e-adresa: drcole@sbb.rs
Sažetak
Uvod/Cilj. Nazalni polipi predstavljaju inflamatorne izrasline hipertrofične respiratorne sluznice i sačinjeni su od epitelnih i stromalnih elemenata. Cilj ove studije bio je da odredimo patohistološka obeležja nazalnih polipa kroz semikvantitativnu morfometrijsku studiju. Metode. Izvršena je semikvantitvna morfometrijska analiza uzoraka nazalne sliznice uzetih od 77 bolesnika sa hroničnim rinosinuzitisom i nazalnim polipima. Kontrolnu grupu sačinjavali su uzorci nazalne sluznice, uzeti od 9 pacijenta bez nazalne polipoze koji su bili podvrgnuti funkcionalnoj i estetskoj hirurgiji. Kod svih bolesnika je učinjena funkcionalna endoskopska sinonazalna hirurgija od strane istog hirurga. Morfometrijska analiza je uključivala gradaciju edema tkiva sa polipima, debljinu bazalne membrane, stepen inflamacije, prisustvo/odsustvo metaplazije u epitelu, stepen fibroze, kao i procenat zapaljenskih ćelija sa zapaljenskim infiltratom (limfocite, makrofage, plazma ćelije, neutrofile i eozinofile). Rezultati. Kao što je i očekivano, uzorci iz ispitivane grupe su imali značajno veći stepen inflamacije u odnosu na kontrolnu grupu (ch2 = 35.89, p < 0.01). Stepen fibroze kod polipa nosa je bio u pozitivnoj korelaciji sa trajanjem dužine simtoma (r = 0.25, p < 0.05) i sa procentom makrofaga u zapaljenskom infiltrate (r = 0.26, p < 0.05). Bolesnici sa nazalnom polipozom imali su značajno veći broj limfocita (r = - 7.66, p < 0.01), ali i značajno veći broj eozinofila (r = 3.84, p < 0.01), makrofaga (r = 3.34, p < 0.01) i plazma ćelija (r = 3.14, p < 0.01) nego kontrolna grupa (p < 0.01). Zaključak. Uzorci tkiva kod bolesnika sa nazalnom polipozom pokazuju značajne promene koje se ogledaju u različitom stepenu inflamacije, fibroze i zadebljanja bazalne membrane što može značajno otežavati hirurški zahvat, kao i uticati na veći stepen perioperativnih komplikcija kao što je krvarenje.
Abstract
Background/Aim. Nasal polyps are inflammatory hypertrophic proliferations of the sinonasal mucosa composed of both epithelial and stromal elements. The aim of this study was to determine histopathological hallmarks of nasal polyposis via semiquantitative morphometric study. Methods. The study comprised 77 patients with chronic rhinosinusitis and nasal polyposis (CRSwNP) that underwent functional endoscopic sinonasal surgery performed by the same surgeon. The control group consisted of 9 different nasal mucosal samples that were taken from patients without CRSwNP that underwent functional and esthetic surgery. Morphometric analysis included gradation of tissue edema within polyps, thickening of epithelial basal membrane, degree of inflammation, presence/absence of metaplasia within epithelium, degree of fibrosis within polyps, and percentage of inflammatory cells within inflammatory infiltrate (lymphocytes, macrophages, plasma cells, neutrophils and eosinophils). Results. As expected, samples from the study group showed significantly higher degree of inflammation than samples from the control group (ch2 = 35.89, with p < 0.01). Degree of fibrosis in nasal polyposis was in positive correlation with duration of symptoms (r = 0.25, p < 0.05) and with percentage of macrophages in inflammatory infiltrate (r = 0.26, p < 0.05). Patients with nasal polyposis had significantly lower number of lymphocytes (r = -7.66, p < 0.01), but significantly higher number of eosinophils (r = 3.84, p < 0.01), macrophages (r = 3.34, p < 0.01) and plasma cells (r = 3.14, p < 0.01) than controls (p < 0.01). Conclusion. Tissue samples from patients with nasal polyposis show significant changes that reflect in various degrees of inflammation, fibrosis and basement membrane thickening which may contribute to more difficult surgical management and perioperative complications such as bleeding.
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