OBJECTIVE: To compare the histopathology and immunohistochemistry of pediatric and adult chronic rhinosinusitis (CRS). STUDY DESIGN: Cross-sectional study. SETTING: University-affiliated hospital. PATIENTS AND METHODS: Inflamed sinus-mucosal samples of 16 children (mean age, 11.6 +/- 2.9 years) with refractory CRS who underwent endoscopic sinus surgery were studied. Twenty-nine diagnosis-matched adults served as controls. Study analysis covered sinus computed tomography (CT) scores, general pathologic features, eosinophil and T-lymphocyte population, and thickness and integrity of the epithelium. RESULTS: Children had a lower CT score than adults did (P = .005). The inflammatory response of the children, which differed greatly from that of adults, was dominated by cellular infiltration of the lamina propria with chronic inflammatory cells and fibrosis (8/16 had extensive fibrosis); eosinophils were scanty. Adult CRS was characterized by polypoid mucosa and eosinophilia (type A) or glandular hyperplasia (type B). Extensive fibrosis was shown in adult type-B patients (7/13). Assessment of eosinophils in the lamina propria showed marginal statistical significance between children and adults (P = .065). This difference was accentuated when pediatric and adult type A were compared (14.6 +/- 25.3 vs 121.5 +/- 174.2 cell/mm(2); P = .043). Complete epithelial shedding was less significant in children (9.4% +/- 8.2% vs 25.4% +/- 15.1%; P < .001). The number of lamina propria and epithelial T lymphocytes was similar. CONCLUSIONS: The marked differences in the inflammatory response of children and adults with CRS may attest to different pathophysiologic pathways. The significantly reduced epithelial shedding in children is probably associated with diminished tissue eosinophilia. Extensive fibrosis was found in half of adult type-B patients; similar findings were found in children.
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机译：目的：比较儿童和成人慢性鼻鼻窦炎（CRS）的组织病理学和免疫组化。研究设计：横断面研究。地点：大学附属医院。患者和方法：对16例接受内镜鼻窦手术的难治性CRS患儿（平均年龄，11.6 +/- 2.9岁）的鼻窦黏膜发炎进行了研究。 29名经诊断匹配的成年人作为对照。研究分析涵盖了鼻窦计算机断层扫描（CT）评分，一般病理特征，嗜酸性粒细胞和T淋巴细胞群以及上皮的厚度和完整性。结果：儿童的CT评分低于成人（P = .005）。儿童的炎症反应与成人的炎症反应大不相同，主要是固有层的细胞浸润并伴有慢性炎症细胞和纤维化（8/16广泛性纤维化）。嗜酸性粒细胞很少。成人CRS的特征是息肉样粘膜和嗜酸性粒细胞增多（A型）或腺体增生（B型）。在成人B型患者中显示出广泛的纤维化（7/13）。固有层中嗜酸性粒细胞的评估显示儿童和成人之间的边际统计学意义（P = .065）。当比较儿科和成人A型时，这种差异更加明显（14.6 +/- 25.3 vs 121.5 +/- 174.2 cell / mm（2）; P = .043）。儿童的完全上皮脱落较少（9.4％+/- 8.2％vs 25.4％+/- 15.1％; P <.001）。固有层和上皮T淋巴细胞的数量相似。结论：CRS儿童和成人的炎症反应明显不同可能证明了不同的病理生理途径。儿童上皮脱落的明显减少可能与组织嗜酸性粒细胞减少有关。在一半的成人B型患者中发现了广泛的纤维化。在儿童中也发现了类似的发现。
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