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  IN THIS Article
 ::  Abstract
 ::  Introduction
 ::  Material and Methods
 ::  Results
 ::  Discussion
 ::  Acknowledgements
 ::  References
 ::  Article Figures
 ::  Article Tables

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ARTICLE
Year : 1978  |  Volume : 24  |  Issue : 4  |  Page : 231-234

Histology and histochemistry of nasal polyps


Department of Pathology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Bombay-400 012, India

Correspondence Address:
Shaila A Nimbkar
Department of Pathology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Bombay-400 012
India
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PMID: 745152

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 :: Abstract 

Surgically removed nasal polyps have been studied histologi­cally and histochemically. Out of the 70 specimens studied, 55 polyps (77.2%) were of edematous type with allergy and infection as the etiological factors while 15 (22.8%) constituted rest of the types which are not likely to be allergic in nature. The stand­ard line of treatment of nasal polyps is combined anti-allergic and anti-inflammatory, but for the polyps which are not allergic in nature, we propose that mere surgical resection without anti­allergic therapy would suffice for the complete cure.



How to cite this article:
Nimbkar SA, Sane SY. Histology and histochemistry of nasal polyps. J Postgrad Med 1978;24:231-4

How to cite this URL:
Nimbkar SA, Sane SY. Histology and histochemistry of nasal polyps. J Postgrad Med [serial online] 1978 [cited 2014 Oct 31];24:231-4. Available from: http://www.jpgmonline.com/text.asp?1978/24/4/231/42653



 :: Introduction Top


Nasal polyp is a routine out patient problem. Though it is a common condi­tion the exact structure and etiology is debatable. Virchow and his pupils [11] be­lieved polyp to be myxomatous tumour. Eggston and Wolff [4] view it as passive edema of mucosa. Anderson and Bing' have shown it as proteinaceous exudate, while Weisskopf and Burn [12] consider that it has acid mucopolysaccharides. The pre­sent work was undertaken to reassess the histological and histochemical features of nasal polyps, which may help to under­stand the nature and plan the treatment.


 :: Material and Methods Top


Two hundred and fifty tumours and and tumour-like lesions obstructing nasal passage were received at the Surgical Pathology Department during two years. Out of these 70 (27%) were nasal polyps with a pedicle attached in nose or para­nasal sinuses.

Gross appearance of the polyps was noted down. Two to three sections were taken from each polyp including the stalk. Paraffin sections were prepared. Apart from routine staining with haematoxylin and eosin the following stains were used wherever indicated.

  1. The periodic acid-Schiff (PAS) method for the demonstration of poly­saccharides.
  2. Van Gieson Orcein stain for demon­stration of collagen and reticulin.
  3. Toluidine blue stain to demonstrate metachromasia of the mast cells and mucin.
  4. Congo red stain to demonstrate amyloid.
  5. Alcian blue for acid mucipolysac­charide.
  6. Best's carmine stain for glycogen.


Histologically polyps were studied with special reference to the changes in the mucosa and in the basement membrane, type of inflammatory cells, glands, vessels and stroma.


 :: Results Top


The size of the polyp varied from about 1 cm. to 10 cm. They were oval or pear shaped with a pedicle. Covering mucosa was smooth, translucent or opaque and partly ulcerated. Cut surface of most of the polyps showed grey semitranslucent, edematous, jelly like material. A few specimens showed areas of congestion and haemorrhage while some others showed cystic changes.

The polyps were histologically typed into five groups as shown in [Table 1].

Edematous polyps

See [Figure 1] on page 230B

This is the commonest type of polyp. Fifty four out of seventy were of this group. The main feature of the polyp was severe edema of tunica propria. The covering epithelium varied from normal respiratory mucosa to partial or complete denudation. Squamous metaplasia was seen in 8 polyps, while 5 showed papillary hyperplasia of the epithelium. The base­ment membrane was thickened in 31 polyps. It was PAS positive. The ciliated columnar epithelium showed PAS posi­tive material in the cells. It was diastase resistant and was positive with Alcian blue and mucicarmine, indicating the presence of acid mucopolysaccharides and mucoprotein, but no glycogen. In areas of squamous metaplasia, the deepest layer was PAS negative, while PAS positivity appeared towards the surface.

Unlike normal respiratory epithelium, the surface epithelium of the polyp occasionally invaginated into the stroma and produced inclusion glands. The cells lining the glands were cilliated, columnar, cuboidal to flattened. The histochemical characters were similar to those of the surface epithelium. The PAS positive­ness decreased as the cells became flat­tened.

The stroma consisted of reticular net­work, ground substance with inflamma­tory cells and vessels. The ground sub­stance was negative with PAS and Alcian blue indicating the absence of carbohy­drate and acid mucopolysaccharide. The organization of edematous polyp was ac­companied by fibroblastic proliferation with formation of collagen and reticulin specially in subepithelial layer and around vessels and glands. This was well demonstrated by Elastic Van Gieson stain. It also showed PAS positivity due to collagen.

The inflammatory cells were predo­minent in the subepithelial layer and around vessels. They were mainly eosinophils, plasma cells, lymphocytes and mononuclear cells. Polymorphs were seen only in ulcerated areas. Toluidine blue stain showed significant number of mast cells in edematous polyps.

Fibrous polyps

Ten per cent of the polyps were of fibrous type. The main core of these polyps was formed by collagenous con­nective tissue, demonstrated by Masson's trichrome and Van Gieson stains. Most of the surface was covered by stratified squamous epithelium. At places colum­nar epithelium was present without cilia, Inflammatory cell infiltration was scanty.

Glandular polyps See [Figure 2] on page 230B

Six polyps were of this variety. The invagination of the surface epithelium into the lamina propria produced gland like structures, which were seen in polyps of all varieties while glandular polyps were mainly formed by seromucinous glands. The mucous glands were distend­ed with secretions. Extreme distension of glands formed degenerating cysts, which are classified as cystic polyps by Cameran. [3] The lining epithelium as well as secretions showed strong PAS posi­tivity, resistant to diastase. The staining characters of invagination type glands were similar to those of surface epithelium; of normal nasal mucosa.

Angiectatic polyps

Four polyps were characterised by presence of many dilated capillary spaces lined by endothelium and filled with red blood cells suggesting angiomat­ous polyps. The inflammatory cells wept scanty in this type of polyps.

Congo red stain was done on four polyps which were suspected to have amyloid material on haematoxylin and eosin stain but these polyps were negative for amyloid.


 :: Discussion Top


The histological study reveals that the commonest variety of nasal polyps is oedematous which is shown to have allergic basis by many workers while other types which together form about one third of polyps have different etio­logy. We perceive our environment through our sensory receptors of nose. The mucosa of the ethmoid region is the most common target organ for the aller­gic reaction leading to the formation of polyp. The polyps also arise in the para­nasal sinuses and pass via the osteum to the choana. Rarely the mucosal cover­ing of the turbinates and septum show polyp formation. Eggston's [4] concept of the etiology of polyp is that it arises due to basic vascular changes in the nasal mucosa induced by repeated attacks of sinusitis, periphlebitis, obstruction of return flow of interstitial tissue fluid leading to passive congestion and edema. The pioneer work of Kern and Schenck [6] introduced the concept that the nasal polyp is allergic in origin. Berdal [2] states that accumulation of reagins and ample edema in polyp is due to allergic inflam­mation. Schenck [7] observed that during active nasal allergy there is degranulation of mast cells with release of histamine. This attracts eosinophils. Tandon et al [10] observed no difference in the histological appearance of allergic and infective polyps.. While Kaker [5] assessed the effect of cortisone therapy in nasal polyps and he found good response specially in small ethmoidal polyps with edematous mucosa.

In the present study, ground substance of nasal polyps was PAS negative and did not stain with alcian blue indicating that the stroma did not contain acid mucopolysacharide. This agrees with the findings of Taylor [9] while it is in direct contrast to Weisskopf and Burn [12] who observed the constant presence of acid mucopolysaccharides in all polypoid tissue indicating that the polyp is an active progressive growth of connective tissue, rather than due to mechanical engorgement of extravasated edema fluid.

The glandular polyps are mainly form­ed by the disease of the glands of respira­tory mucosa. The ducts of the infected glands become obstructed. cystic and pro­duce periglandular irritation with polyp formation.

Angiectatic polyps are comparatively rare. These usually present as peduncu­lated haemorrhagic masses arising from Little's area of the nasal septum. Hyper­trophy of the nasal spur causes repeated trauma to the septal vessels. This leads to proliferation of septal vessel with exudation of plasma like fluid and forma­tion of polyp.


 :: Acknowledgements Top


We are grateful to Dr. C. K. Desh­pande, M.D., F.R.C.P. Dean, Seth G.S. Medical College and K.E.M. Hospital, Bombay 400 012 for permitting us to publish the hospital material.

We are also grateful to Dr. (Mrs.) S. M. Sant, M.D. Head and Professor of Pathology, Seth G.S. Medical College, for allowing us to use the surgical Pathology material.

 
 :: References Top

1.Anderson, H. C. and Bing, J.: Acta. Path. Microbiol. Scand., 21: 455, 1944. Cited by Taylor.9  Back to cited text no. 1    
2.Berdal, P.: Investigations on nasal polyps and their genesis. Acta. Otolaryng. (Stockh) Suppl., 95: 138.145, 1951.  Back to cited text no. 2    
3.Cameron-Munro. J. A.: J. Laryngol., 54: 883, 1934. Cited by Sinha.S  Back to cited text no. 3    
4.Eggston, A. A. and Wolff, D.: "Histopatho­logy of Ear, Nose and Throat", The Williams and Wilkins Co., Baltimore, 1947, p. 763.  Back to cited text no. 4    
5.Kaker, P.: Cortisone treatment of nasal polyps. Ind. J. Otolaryngol., 20: 119-120, 1968.  Back to cited text no. 5    
6.Kern, R. A. and Schenck, H.: Allergy, a constant factor in the etiology of the so­called mucous nasal polyps. J. Allergy, 4: 485-489, 1932.  Back to cited text no. 6    
7.Schenck, H. P.: Mast cells in the upper respiratory tract. Ann. Otol. Rhinol, and Laryngol., 74: 863-873, 1965.  Back to cited text no. 7    
8.Sinha, S. N.: Observation on histology of nasal polypi. Ind. J. Otolaryngol., 19: 164­168, 1967.  Back to cited text no. 8    
9.Taylor, M.: Histochemical studies on nasal polypi. J. Laryngol. & Otolaryngol., 77: 326-341, 1833.  Back to cited text no. 9    
10.Tandon, P. L.. Gulati, J. and Mehta, N.:Histological study of polypoidal lesions in the nasal cavity. Ind. J. Otolaryngol., 23:3-10, 1971.  Back to cited text no. 10    
11.Virchow, R.: Cited in "Histopathology" of Ear, Nose and Throat", Eggston, A. A. and Wolff, D., The Williams and Wilkins Co., Baltimore, 1947, p. 763.  Back to cited text no. 11    
12.Weisskopf, A. and Burn, H. F.: Histo­chemical studies of the pathogenesis of nasal polyps (1959). Cited by Taylor, M., Ann. Otol. (St. Louis), 63: 509-523, 1963.  Back to cited text no. 12    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

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