Chronic Rhinosinusitis Definition (clinical) :

• Inflammatory response involving the following: mucous membranes, nasal cavity and paranasal sinuses.

• Fluid within the cavities and/or underlying bones. • Symptomatic: nasal obstruction, congestion,

discharge, purulent, postnasal drip, facial pressure and pain.

• Duration: 12 weeks• Positive physical signs of nose and face.• Ancillary studies: radiology.

Rhinosinusitis: Classification

• Based on temporal nature:– Acute (<4 weeks)– Subacute (4-12 weeks)– Recurrent acute (> 4 episodes per year)– Chronic (>12 weeks)– Acute exacerbation of chronic

Chronic adult rhinosinusitis

• Lasting > 12 weeks

• Diagnostically proven (major and minor clinical features)

• With or without physical findings

Chronic rhinosinusitismorphologic features:

• Inflammatory infiltrates

• Edema

• Glandular hyperplasia

• Thickened basement membrane

• Squamous metaplasia

• Eosinophils, may be present, can be numerous

Proposed new histologic classification :

• Polypoid CRS

• Glandular CRS

Proposed mechanism Polypoid CRS

Epithelial Disruption

Migration of immature branching epithelium

mediators e.g., IL-5, by eosinophils

Exudation

Microcavities

Fusion of glands

Cleavage plane of mucosal surface

Disregulation of eosinophils

Proposed mechanismGlandular CRS

No

eo

sin

oph

ilic

act

ivity

↑ sICAM-1

Neutrophils recruitment

mediators

Release of mucus glycoproteins

? ↑ Glandular hypertrophy/hyperplasia

Pathogenic induced

(rhinovirus)

Prolonged low grade immunologic response

Clinical applications

Polyps: • Topical steroids: 50-90% success• Oral steroids, FESS, polypectomy:

recurrence: 40-50%.

Glandular: Try conservative approach

• Long-term topical steroids• Macrolide ABx ●Pathogenic (possible infection) ●Reduce mucus hypersecretion

Objectives:

• Increasing the communication between the clinicians and the pathologists

• Introducing new clinicopathological concepts• Deciding upon clinical applications according to

the morphologic findings • Which relevant information should the clinicians

provide to the pathologists?• Should the pathologic report introduce a clinical

entity alone (nondescriptive one)?