Endoglin (CD105) expression in sinonasal polyposis

Abstract

Despite appropriate surgical therapy, 5-10 % of patients with chronic rhinosinusitis (CRS) and nasal polyps (NP) experience disease recurrences. It has been suggested that angiogenesis may relate to the pathogenesis and prognosis of CRS with NP. Endoglin (CD105) is a component of the receptor complex of transforming growth factor-beta, a pleiotropic cytokine that modulates angiogenesis. A series of patients treated surgically for CRS with NP was analyzed to assess the relationship between CD105 expression, main clinicopathological features, and recurrence rate. The immunohistochemical expression of CD105 was assessed in 70 patients consecutively operated for CRS with NP. In the univariate setting, the presence of CD105 (1/0) showed a trend towards a significant association with increasing NP dimensions (p = 0.054). Intensity of CD105 reaction was also significantly associated with NP size (0.04) and with an eosinophilic histology (p = 0.048). In our multivariate setting, only asthma (p = 0.016), hypereosinophilia (p = 0.022), and preoperative polyposis score (p = 0.046) retained their independent prognostic significance in relation to NP recurrence. Further efforts are needed to elucidate the biological, angiogenic and proliferative mechanisms behind recurrent NP. Our preliminary results support the clinical utility of extra postoperative care, in terms of closer follow-ups and medication with oral anti-histamines, topical and/or oral steroids, and antileukotrienes in patients with asthma, advanced nasal polyposis at presentation, and serum hypereosinophilia.

Can a panel of clinical, laboratory, and pathological variables pinpoint patients with sinonasal polyposis at higher risk of recurrence after surgery?

“…In this statistical setting, serum eosinophil percentage (trend towards significance) and serum basophil count and percentage correlated directly with recurrence rate in our series. A direct association between CRSwNP recurrence rate and serum hypereosinophilia was recently reported by Ikeda et al [19] and by Ottaviano et al [20] as well. In our series, statistical analysis found significant associations between CRSwNP recurrence and serum basophil count, and between CRSwNP recurrence and serum basophil percentage.…”

“…Adult patients with evidence of polyposis involving at least two recesses without extending to the nasal cavity (multiple polyps occupying the middle meatus, grade 2), or polyps extending beyond the middle meatus (grade 3) [6], were first treated medically for 3 months with local mometasone furoate 200 μg daily (100 μg/nostril), the dosage recommended by Stjarne et al [7], or with fluticasone furoate 110 μg daily (55 μg/nostril), and oral therapy with methylprednisolone (32 mg daily on days 1-5, then 16 mg daily on days 6-10, then 8 mg daily on days [11][12][13][14][15][16][17][18][19][20], as suggested by Van Zele et al [8]. If this medical therapy failed, patients underwent FESS (ethmoidectomy, middle antrostomy, sphenoidectomy and/or frontal sinusotomy, depending on the location of the polyps), with or without septoplasty/turbinoplasty, under general anesthesia.…”

A prospective investigation of predictive parameters for post-surgical recurrences in sinonasal polyposis

“…They concluded that only NSAID intolerance and asthma were independent predictive factors for recurrence in a multivariate setting. A multivariate tailored model was recently used also by Ottaviano et al [14] to analyze the prognosis of 70 patients consecutively operated for CRSwNP: they found that asthma presence, serum hypereosinophilia, and preoperative polyposis score according to EPOS 2012 [3] had an independent prognostic value in relation to CRSwNP recurrence. In our larger cohort of patients, a multivariate model indicated that only an eosinophilic histology retained its independent prognostic significance in relation to sinonasal polyposis recurrence after primary surgery.…”

“…Adult patients with evidence of polyposis affecting at least two recesses without extending to the nasal cavity (multiple polyps occupying the middle meatus, grade 2), or polyps extending beyond the middle meatus (grade 3) [6], after 3 months medical treatment failure with local therapy with mometasone furoate 200 lg daily (100 lg/nostril) according with Stjärne et al [7] dosage or with fluticasone furoate 110 lg daily (55 lg/nostril) and oral therapy with methylprednisolone (32 mg daily on days 1-5, then 16 mg daily on days 6-10, then 8 mg daily on days [11][12][13][14][15][16][17][18][19][20] according to Van Zele et al [8], were subjected to FESS (ethmoidectomy, middle antrostomy, sphenoidectomy and frontal sinusotomy depending upon the location of the polyps) with or without septoplasty under general anesthesia. Patients with polyps confined to only one recess (grade 1) were not treated surgically and were not included in the present study.…”

The role of microvessel density, lymph node metastasis, and tumor size as prognostic factors of distant metastasis in colorectal cancer

“…Sections containing the most invasive areas of colorectal cancer were selected. Staining was performed automatically (BONDIII; Leica Biosystems Melbourne, Melbourne, Victoria, Australia), using a Bond Polymer Refine Detection kit (Leica Biosystems, Newcastle, UK), with mouse monoclonal antibodies to CD105 (clone SN6h; Dako, Kyoto, Japan; working dilution 1:500 for 15 min with bond wash solution buffer) (11).…”