Histopathologic differences between adult and pediatric patients with chronic rhinosinusitis

Abstract

Background Adult and pediatric patients with chronic rhinosinusitis (CRS) may have differing philosophies in therapeutic management. Few studies have examined sinonasal tissue‐level comparisons of these groups. This study examines histopathologic differences between children and adults with CRS, with the goal of understanding disease pathogenesis and optimizing medical management for both populations. Methods In a retrospective cohort of CRS patients who underwent functional endoscopic sinus surgery (FESS), demographic factors, pertinent comorbidities, and a structured histopathologic report of 13 variables were compared across pediatric and adult CRS patients with and without nasal polyps (pCRSwNP, pCRSsNP, aCRSwNP, aCRSsNP, respectively). Results A total of 378 adult (181 aCRSsNP, 197 aCRSwNP) and 50 pediatric (28 pCRSsNP, 22 pCRSwNP) patients were analyzed. Significantly more children compared with adults had a comorbid asthma diagnosis (64.5% vs. 37.2%, p = 0.003). Adults with CRS exhibited significantly more tissue neutrophilia (28.9% vs. 12.0%, p = 0.006), basement membrane thickening (70.3% vs. 44.0%, p < 0.001), subepithelial edema (61% vs. 30.0%, p < 0.001), squamous metaplasia (22.0% vs. 4.0%, p < 0.001), and eosinophil aggregates (22.8% vs. 4.0%, p < 0.001) than children with CRS. The majority (66.5%) of adult CRS patients exhibited a lymphoplasmacytic‐predominant inflammatory background, whereas the majority (57.8%) of children with CRS exhibited a lymphocyte‐predominant inflammatory background. Conclusions Sinonasal tissue of adult and pediatric CRS patients demonstrates clear histopathologic differences. Our findings provide insight into differing pathophysiology, which may enable optimization of targeted therapies for patients in each of these unique clinical groups.

Histologic characterization of primary ciliary dyskinesia chronic rhinosinusitis

“…A second disease control was selected that contained idiopathic CRSsNP because the typical PCD‐related CRS has significant edema and mucus but does not result in polyp formation. The SHR findings in our CRSsNP cohort resembled those reported in larger sample size by Brown et al., 6,7 which indicated a none to mild degree of inflammation, absence of neutrophil infiltration, absence of mucosal ulceration, absence of squamous metaplasia, and minimal fibrosis.…”

Tissue eosinophilia and computed tomography features in paediatric chronic rhinosinusitis with nasal polyps requiring revision surgery

“…. Brown et al recently reported that the majority (57.8%) of paediatric CRS cases had a lymphocyte-predominant inflammatory background, whereas the majority (66.5%) of adult CRS had a lymphoplasmacytic-predominant inflammatory background (26) . Differences in age, ethnic groups, environmental area, and the presence of polyps may be attributed to the different mechanisms and immunopathologic features of CRSwNP in the paediatric population (10) .…”

Upper and lower airway interactions in children

“…Children exhibited significantly less tissue neutrophilia (12 vs. 29%), basement membrane thickening (44 vs. 70%), subepithelial oedema (30 vs. 61%), squamous metaplasia (4 vs. 22%), and eosinophil aggregates (4 vs. 23%). Unlike adults, the majority (58%) of children exhibited a lymphocyte-predominant inflammatory background [33].…”