Nasalpolyp pathology

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This presentation discusses the topic "Pathology of nasal polyp"

This presentation discusses the topic "Pathology of nasal polyp"

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  • 1. Pathology of nasal polyp Dr T Balasubramanian
  • 2. Introduction
    • Macroscopically polyp appears to arise like a pedicled tissue from the nasal mucosa
    • 3. Histopathologically these polyp can be very diverse ranging from simple inflammatory to bening / malignant neoplasm
    • 4. Polyp due to chronic rhinosinusitis can be described as non granulomatous inflammatory tissue projecting from the nasal mucosa
  • 5. Histology of normal sinonasal mucosa 1
    • Components of normal sinonasal mucosa can be categorized under two heads (Structural / Non structural) components
    • 6. Structural components – Surface epithelium, basement membrane and submucosal tissue
    • 7. Non structural components – Resident / Non resident cells of lymphoid / Myeloid origin
  • 8. Histology of normal sinonasal mucosa Epithelium
    • Anterior 2 cm of nasal cavity is lined by skin i.e. Keratinized stratified squamous epithelium with fibrocollagenous dermis and adnexal glands
    • 9. The rest of the nasal cavity is lined by respiratory type of epithelium (Schneiderian membrane)
    • 10. The lining mucosa of paranasal sinuses is rather thinn when compared to that of nasal cavity
  • 11. Schnederian membrane
    • Sinonasal mucosa is also known as Schnederian membrane
    • 12. It is composed of 4 cell types – ciliated columnar / cuboidal cells, interspaced goblet cells, nonciliated columnar cells with microvilli and basal cells
    • 13. The ratio of columnar : goblet cells is 5:1
    • 14. Columnar epithelium contains tight junctions and rest on the basement membrane
    • 15. Squamous metaplasia is common due to exposure
  • 16. Point to remember Whitish fleshy nasal polyp indicates Squamous Metaplasia due to drying effects caused by Exposure to atmosphere
  • 17. Basement membrane
    • The basement membrane contains following collagen types (I, III, IV, V, VI, & VII)
    • 18. Other constituents include: Heparan sulfate proteoglycan, laminin and Nidogen
    • 19. The basement membrane is thin and delicate in the whole of nasal cavity except for inferior turbinate area.
  • 20. Olfactory epithelium
    • Responsible for the sense of smell
    • 21. Lines superior turbinate, superior portion of nasal septum, roof of nasal cavity and medial portions of middle turbinate
    • 22. This epithelium is also pseudostratified ciliated columnar containing bipolar olfactory cells, microvillar cells and supporting sustentacular cells
  • 23. ! Note Due to aging / infections olfactory Epithelium could be replaced by Normal nasal mucosa
  • 24. Submucosa
    • Lies under the basement membrane
    • 25. Overlies the cartilagenous / bony framework of nasal cavity
    • 26. Contains loose fibrovascular connective tissue, seromucinous / minor salivary glands, blood vessels, nerves, myeloid and lymphoid cells
    • 27. Blood vessels contains many av anastomosis
    • 28. Blood vessels communicate with venous erectile tissue which are prominent over inferior turbinates
  • 29. Non structural components
    • Lymphoid tissue is the most important of these components
    • 30. Components of lymphoid tissue include single lymphocytes scattered among the epithelial cells and lamina propria and NALT
  • 31. NALT
    • Acronym for Nasal associated lymphoid follicles
    • 32. Similar to Payer's patch of intesting
    • 33. Unencapsulated
    • 34. Becomes enlarged during nasal infections
  • 35. Lymphoid cells of nasal cavity
  • 39. Causes of nasal polyp
    • Chronic rhinosinusitis (still not proved)
    • 40. Samter's triad (Bronchial asthma, aspirin hypersensitivity and nasal polyposis)
    • 41. Eosinophilic chronic rhinosinusitis including AFRS
    • 42. Cystic fibrosis
    • 43. Young's syndrome
    • 44. Churg – Strauss disease
  • 45. Macroscopic features
    • Pale smooth shining and oedematous mass
    • 46. Soft in consistency when compared to surrounding nasal mucosa
    • 47. Long standing nasal polypi could be firm and whitish due to squamous metaplasia
    • 48. Firmness of long standing nasal polypi could also be caused by fibrosis
    • 49. Presence of surface ulceration on the polyp should arouse suspicion of other pathologies
  • 50. TIP Presence of thick tenaceous secretions along with Nasal polypi is caused by eosinophilic mucous chronic rhinosinusitis
  • 51. Microscopic feature of nasal polypi
    • Structural changes involve lining epithelium, submucosa and rarely underlying bone / cartilage
    • 52. Presence of inflammatory exudate
    • 53. Lining mucosa is ciliated columnar epithelium. Basement membrane is thickened. The stroma contains lymphocytes
  • 54. Histological classification
    • Oedematous allergic nasal polypi
    • 55. Chronic inflammatory nasal polypi
    • 56. Seromucinous / glandular polypi
  • 57. Oedematous allergic nasal polypi
    • Commonest variety
    • 58. Seen in pts with allergy
    • 59. Lined by ciliated columnar epithelium
    • 60. Ulceration of mucosa, mucositis, epithelial hyperplasia and squamous metaplasia may be seen
    • 61. Basement membrane is thickened, submucosa is oedematous. Mucous retention cyst+
    • 62. Eosinophils / plasmacells/ lymphocytes infiltrate+
  • 63. Allergic nasal polyp vs cystic fibrosis nasal polyp Allergic nasal polyp Nasal polyp due to cystic fibrosis Thick basement membrane Thin basement membrane Stroma contains predominat eosinophils Stroma contains predominantly neutrophils Mucous secretions thin Mucous secretion thick
  • 64. Chronic inflammatory polyp
    • Also known as fibroinflammatory polyp
    • 65. This type is less common
    • 66. May be caused when oedematous polypi are traumatized
    • 67. Stroma may show secondary inflammatory change
    • 68. Stroma may show myofibroblastic proliferation
    • 69. Submucosal fibrosis +
    • 70. Squamous metaplasia +
  • 71. Seromucinous polypi
    • Caused by hyperplasia of seromucinous glands
    • 72. This type of nasal polyp is rare
    • 73. This is a true neoplasm
    • 74. Underlying bone remodelling can also be seen
  • 75. Histology of A/C polyp
    • Antral component is soft and cystic
    • 76. Nasal and choanal components are solid
    • 77. Lined by pseudostratified columnar epithelium
    • 78. Basement membrane appears thinned out
    • 79. Stroma shows evidence of myxoid degeneration
    • 80. Inflammatory cells are few in number
    • 81. Degenerative changes are common
  • 82. Thank you