Distinct histopathologic features of radiation‐induced chronic sinusitis

Kuhar, Hannah N.; Tajudeen, Bobby A.; Heilingoetter, Ashley; Mahdavinia, Mahboobeh; Gattuso, Paolo; Ghai, Ritu; Gunawan, Ferry; Diaz, Aidnag; Tolekidis, G.; Batra, Pete S.

doi:10.1002/alr.21989

Cited by 42 publications

(52 citation statements)

References 17 publications

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“…Epithelial sloughing, ciliary loss, intercellular and intracellular vacuolization, and ciliary dysmorphism were present in histologic examination of nasal epithelium after RT. Greater SM was also observed in histologic examination of nasal biopsied tissue from patients with CRSr compared to CRS patients without RT [18]. In this study, we demonstrated for the rst time that increased SM and expression of p63 + Krt5 + basal cells, together with loss of cilia and goblet cells, in nasal epithelium from patients with CRSr compared to both patients with CRSsNP and healthy controls.…”

Section: Discussionsupporting

confidence: 56%

“…Radiation-induced mucositis is initiated by direct injury to epithelial cells and the underlying submucosal tissue [21]. Histologic examination of post radiation nasal tissue has shown increased brosis in the lamina propria, epithelial sloughing, ciliary loss, and intercellular and intracellular vacuolization, resulting in destruction of nasal epithelial barrier and subsequent epithelial remodeling [18]. In the present study, SM occurred more frequently in nasal epithelium from CRSr patients compared to CRSsNP patients without RT.…”

Section: Discussionmentioning

confidence: 42%

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p63+Krt5+ Basal Cells are Increased in the Squamous Metaplastic Epithelium of Patients with Radiation-induced Chronic Rhinosinusitis

Huang

Tan

Zhou

et al. 2020

Preprint

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Background: Squamous metaplasia (SM) is an irreversible form of airway epithelial remodeling. Hyperproliferation of basal cells was observed in squamous metaplastic epithelium of chronically inflamed airway. However, the association of such aberrant proliferation of basal cells with SM in the nasal epithelium after radiation damage remains unclear. The aim of this study was to investigate SM and accompanying levels of p63+Krt5+ (basal cell markers) cells in the nasal epithelium of patients with radiation-induced chronic rhinosinusitis (CRSr) and patients with chronic rhinosinusitis without nasal polyps (CRSsNP) compared to healthy controls.Methods: We assessed the prevalence of SM and the expression of p63+, Krt5+, p63+Krt5+, and Ki67+ cells through immunofluorescence(IF) staining of the inferior turbinate (IT) tissues from patients with CRSr (n = 36) , CRSsNP (n = 33) and controls (n = 28).Results: The prevalence of SM and the number of p63+Krt5+ cells were both significantly increased in patients with CRSr compared to patients with CRSsNP and controls. The number of Ki67+ cells were both significantly increased in patients with CRSr and CRSsNP compared to controls, but the ratio of Ki67+ cells to p63+Krt5+ cells was significantly lower in patients with CRSr compared to patients with CRSsNP. In patients with CRSr, an increased number of p63+Krt5+ basal cells was observed in SM epithelium compared to non-SM epithelium.Conclusion: SM is increased in the nasal epithelium of patients with CRSr, in which aberrant levels of p63+Krt5+ basal cells serves as an important pathologic feature in the squamous metaplastic epithelium.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 42%

p63+Krt5+ Basal Cells are Increased in the Squamous Metaplastic Epithelium of Patients with Radiation-induced Chronic Rhinosinusitis

Huang

Tan

Zhou

et al. 2020

Preprint

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“…Structured histopathology allows the physician to profile a patient based on histopathologic features of disease without the burden of variability in phenotypic evaluation. Numerous previous studies have been reported utilizing this profiling methodology . To date, little is known regarding how histopathologic profiles affect CRS disease management.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous previous studies have been reported utilizing this profiling methodology. [9][10][11][12] To date, little is known regarding how histopathologic profiles affect CRS disease management. Oral corticosteroid utilization after FESS can provide insight into steroid necessity after surgery, and can potentially identify disease profiles that have increased steroid requirements postoperatively to control mucosal inflammation.…”

Section: Discussionmentioning

confidence: 99%

The presence of eosinophil aggregates correlates with increased postoperative prednisone requirement

Tajudeen¹,

Ganti

Kuhar

et al. 2018

The Laryngoscope

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Objectives/Hypothesis Failure after sinus surgery is multifactorial, but often due to recurrence of inflammatory mucosal disease. Postoperative steroid requirements for controlling mucosal inflammation may provide insight into predicting which patients require more aggressive medical therapy to prevent disease relapse. Study Design Retrospective chart review. Methods A review was performed of patients who underwent functional endoscopic sinus surgery (FESS) for refractory chronic rhinosinusitis (CRS). Sino‐Nasal Outcome Test‐22 scores and cumulative prednisone dose (milligrams) requirements at 1, 3, and 6 months postoperatively were reviewed. A structured histopathology report of 11 variables was accessed to correlate histopathology with postoperative steroid requirements. Results One hundred one patients were reviewed including 42 CRS with nasal polyps and 59 CRS without nasal polyps patients. CRS patients with eosinophilia required greater cumulative steroids to control disease at 1‐, 3‐, and 6‐month postoperative intervals (P < .026, P < .007, P < .013, respectively) compared to patients without eosinophilia. Patients with tissue eosinophil aggregates required the highest cumulative steroids at 1‐, 3‐, and 6‐month postoperative intervals (P < .003, P < .001, P < .001, respectively). When removing patients with eosinophil aggregates from the eosinophilia group, no difference persisted between patients with eosinophilia and those without eosinophilia at all intervals (P = .664, P = .735, P = .800, respectively). No other histopathology variable correlated with postoperative steroid requirement. Conclusions Tissue eosinophil aggregates appear to be the largest driving factor for increased prednisone requirements after sinus surgery to control mucosal disease than mere presence of eosinophils. This key finding may identify patients at high risk for failure after sinus surgery and guide more proactive postoperative management. Level of Evidence 4 Laryngoscope, 129:794–799, 2019

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“…Cilia become more sparse and dysmorphic after radiation . Increased squamous metaplasia occurs in the sinonasal epithelium, along with reorganization to a stratified as opposed to pseudostratified columnar pattern, subepithelial edema, and increased collagen density in the lamina propria . Patients in turn develop sinus mucosal thickening and opacification, and clinical symptoms of CRS .…”

Section: Discussionmentioning

confidence: 99%

Incidence, risk factors, and outcomes of endoscopic sinus surgery after endoscopic skull‐base surgery

Shah

Maina

Patel

et al. 2020

Int Forum Allergy Rhinol

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Background Patients undergoing endoscopic resection of neoplasms with both sinonasal and skull base involvement can develop chronic rhinosinusitis (CRS) after treatment and may occasionally benefit from additional endoscopic sinus surgery (ESS). We investigate risk factors and outcomes associated with revision ESS (rESS) after endoscopic skull‐base surgery (SBS) for neoplasms with combined sinonasal and skull base involvement. Methods A retrospective review of patients with neoplasms with both sinonasal and skull base involvement who underwent endoscopic resection at a single tertiary care academic institution from 2004 through 2017 was performed. Eighty‐three patients were included. Main outcome measures included incidence and timing of revision surgery, Lund‐Mackay (LM) scores, and 22‐item Sino‐Nasal Outcome Test (SNOT‐22) scores. Results rESS was performed in 21 (25%) cases, 15 (18%) of which were due to CRS. Time between initial resection and rESS was an average of 42 months (range, 6 to 142 months). Pre‐SBS and post‐SBS LM scores were not significantly different (5.0 vs 4.7, p = 0.640), although pre‐SBS and post‐SBS SNOT‐22 scores showed significant improvement (32.6 vs 24.5, p = 0.030). Malignant pathology correlated with need for rESS (odds ratio [OR] 5.07, p = 0.04), as well as treatment including chemotherapy (OR 5.10, p = 0.003) and radiation (OR 4.15, p = 0.013). Conclusion A significant proportion of patients develop clinically significant sinusitis after endoscopic SBS for neoplasms with combined sinonasal and skull base involvement and may benefit from rESS. Intervention occurred, on average, 3.5 years after initial tumor resection. Malignant pathology, radiation therapy, and chemotherapy correlate with need for rESS.

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Distinct histopathologic features of radiation‐induced chronic sinusitis

Cited by 42 publications

References 17 publications

p63+Krt5+ Basal Cells are Increased in the Squamous Metaplastic Epithelium of Patients with Radiation-induced Chronic Rhinosinusitis

p63+Krt5+ Basal Cells are Increased in the Squamous Metaplastic Epithelium of Patients with Radiation-induced Chronic Rhinosinusitis

The presence of eosinophil aggregates correlates with increased postoperative prednisone requirement

Incidence, risk factors, and outcomes of endoscopic sinus surgery after endoscopic skull‐base surgery

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