Histopathological Examinations of nasal polyps of different etiology

A safe differentiation between allergic and non-allergic polyps appears impossible by means of light or electron microscopical examination of polyp tissue. There are some indications, however, which point to the allergic or non-allergic origin and it seems that the relationship between eosinophils and plasma cells with a low index is characteristic for polyps of allergic origin. Eosinophils and round-cell infiltrations are present in all types of polyps. An index of eosinophils to plasma cells below 5 is indicative for allergy and should induce the pathologist to give a hint to the clinican for allergological work-up. An index above 5 is more corresponding with infective etiology. Any changes of the basement membrane, i.e., smaller or larger gaps or even absence, are found only very irregularly and are not typical findings in either way. An increased number of glands and collagenic fibres, especially under the epithelium, are more an expression of the age of the polyp. Since the conservative therapy as mentioned above leads to good therapeutical results, it is desirable that an allergological work-up should be done in any case which shows the histological findings indicative for allergic etiology. Thus, repeated operations with all the risks and uncertain therapeutical benefit can be avoided.

Atypical cilia of the human nasal mucosa

Typical and atypical ultrastructural features of the cilia in the human nasal mucosa are reported in this paper. The specimens were taken from patients with the diagnosis of allergic rhinitis or chronic sinusitis. Most of the cilia showed a typical 9 + 2 arrangement of the axial filament complexes, but atypical axonemes such as 9 + 4, 8 + 2 and 10 + 2 patterns were found in six cilia of three patients. The supernumerary central fibrils were observed in one cilium only, whereas atypical patterns of the peripheral fibrils were found in five cilia. Cilia which contained a multiple axial filament complex, so-called compound clia, were also found in the mucosa of the chronic sinusitis cases. On the basis of their ultrastructural appearance, we classified these cilia into two groups, an "adhesive type" and a "bulging type." The former had a columnar shape of variable diameter, whereas the latter had a balloon-like form. The former contained closely packed multiple axial filament complexes whereas the latter possessed only sparse and irregularly oriented complexes. Electron-lucent lumina which were formed by the remnants of the ciliary membrane were frequently found in the former's transitional portion, but never in the latter.

Electron microscope study of basophilic cells in allergic nasal secretions

In order to elucidate whether basophilic cells in nasal secretion belong to blood basophil or tissue mast cell, basophilic cells in the blood, nasal secretion, and nasal mucous membrane were electron microscopically observed in patients with house dust nasal allergy. The majority of basophilic cells in the nasal secretion was identical with the blood basophil in structure. The blood basophils pass through the vessels and emigrate in the mucous blanket in allergy.

[Histological and immunological aspects of allergic and non allergic nasal mucosae. A study of 64 biopsies (author's transl)]

Optical and immunofluorescent microscopy was used to examine 52 pathological nasal mucosae (41 allergic, 11 non-allergic), and the results were compared to the clinical, biological and allergic findings. It was noted that there were a large variety of histological lesions in each group of patients, their extent being related much more to the duration and severity of the aggression than to their nature. There appears to be a relation between the extent of the anatomical lesions and immunological activity, non-allergic mucosae being low in immunoglobulin levels.

The mast cell and eosinophil in nasal secretion

With an improvement of Hansel staining it became possible to identify mast cells, eosinophils and other cells in nasal smears. By this improved method 87% of children and 95% of adult patients who visited our allergy clinic proved to have mast cells in their nasal smears.

Eosinophilic leucocytes in nasal allergy--movement of enzymes

The changes in peroxidase of the granules of eosinophils were examined in cells in the nasal mucous membranes of persons allergic to house dust. There was a slight leakage of peroxidase from eosinophil granules immediately after placing an antigen-treated disc (house dust, Torii, 2560 microgram/disc) on the nasal mucous membrane. Leakage of peroxidase from the eosinophil granules into the cytoplasm, and extracellular release from some eosinophils, was greater 20 min after provocation, than at 30 sec. There were two forms of peroxidase release from the plasma membrane. In one, the granule membrane fused with the plasma membrane and the peroxidase was released from the cell through destruction of the two fused membranes. This was considered to be active secretion. In the other form, the plasma membrane was damaged by peroxidase released from the granules into the cytoplasm. This was considered to be passive release following degeneration of the cell.

Nasal glands in nasal allergy

The entire nasal mucosa from a patient with nasal allergy and hay fever was studied by the whole mount method, and the density of submucous glands was determined. Their density was essentially greater than in normal noses in all parts of the nose, especially on the conchae. This finding indicates that new-abnormal-glands form in the course of the disease, glands which also differ morphologically from the normally occurring glands. As this greatly increases the secretory capacity of the mucous membrane, there is a patho-anatomical basis for assuming that the nasal secretion in allergy is formed exclusively by the existing glands. Other sources of nasal secretion, such as exudation and transudation under normal conditions and in allergy, as well as the mode and causes of gland formation, are discussed.

[Scanning electron microscopic pattern on normal and pathological nasal mucosa (author's transl)]

Nasal mucosa from animals and men were investigated by scanning electron microscopy. The findings resulting from normal nasal mucosa and mucosa chronically alterated by inflammation (rhinitis chronica hyperplastica, rhinitis allergica, rhinitis chronica atrophicans, and nasal polyps) were compared. The patterns of the surface-behavior of the mucociliary apparatus and the structure of the epithelium--as well as the findings were discussed. The three-dimensional observation of mucosal surface structure completes the light and electron microscopic examination procedures allowing further insights into morphology and physiological function of the mucosa in the upper respiratory tract.

Relative value of peripheral blood, secretion and tissue eosinophilia in the diagnosis of different patterns of allergic rhinitis

Eosinophil count in peripheral blood, nasal secretion and nasal mucosa were studied in 20 controls and 38 patients with different patterns of allergic rhinits. Secretion and tissue eosinophilia were pathologically high in a greater number of patients than peripheral blood eosinophilia. This trend was seen in all patterns of allergic rhinitis but was more evident in seasonal allergic rhinitis. The conclusion was reached that examination of local site and local secretions for eosinophilia is helpful in the diagnosis and differential diagnosis of allergic rhinitis.