Chronic Rhinosinusitis Definition (clinical): Inflammatory response involving the following: mucous membranes, nasal cavity and paranasal sinuses. Fluid within the cavities and/or underlying bones. Symptomatic: nasal obstruction, congestion, discharge, purulent, postnasal drip, facial pressure and pain. Duration: 12 weeks Positive physical signs of nose and face. Ancillary studies: radiology.

Rhinosinusitis: Classification Based on temporal nature: –Acute (<4 weeks) –Subacute (4-12 weeks) –Recurrent acute (> 4 episodes per year) –Chronic (>12 weeks) –Acute exacerbation of chronic

Chronic adult rhinosinusitis Lasting > 12 weeks Diagnostically proven (major and minor clinical features) With or without physical findings

Chronic rhinosinusitis morphologic features: Inflammatory infiltrates Edema Glandular hyperplasia Thickened basement membrane Squamous metaplasia Eosinophils, may be present, can be numerous

Proposed new histologic classification: Polypoid CRS Glandular CRS

Proposed mechanism Polypoid CRS Epithelial Disruption Migration of immature branching epithelium mediatorse.g., IL-5, by eosinophils Exudation Microcavities Fusion of glands Cleavage plane of mucosal surface Disregulation of eosinophils

Proposed mechanism Glandular CRS No eosinophilic activity ↑ sICAM-1 Neutrophils recruitment mediators Release of mucus glycoproteins ? ↑ Glandular hypertrophy/hyperplasia Pathogenic induced (rhinovirus) Prolonged low grade immunologic response

Clinical applications Polyps : Topical steroids: 50-90% success Oral steroids, FESS, polypectomy: recurrence: 40-50%. Glandular : Try conservative approach Long-term topical steroids Macrolide ABx ●Pathogenic (possible infection) ●Reduce mucus hypersecretion

Objectives: Increasing the communication between the clinicians and the pathologists Introducing new clinicopathological concepts Deciding upon clinical applications according to the morphologic findings Which relevant information should the clinicians provide to the pathologists? Should the pathologic report introduce a clinical entity alone (nondescriptive one)?