Patologìâ (Aug 2016)
Pathomorphological changes of the Schneiderian membrane in the mixed form of iatrogenic maxillary sinusitis of stomatogenic origin
Abstract
Objective: To study the morphological changes of the Schneiderian membrane in the mixed form of iatrogenic maxillary sinusitis of stomatogenic origin. Material and methods. Reactive changes of the mucous membrane of the maxillary sinus were studied in 24 (100 %) patients with the presence of a foreign body in the lumen of the sinus. To differentiate the observed changes in the mucosa Manasse’s pathomorphologic classification was used. Immunohistochemical reaction with monoclonal antibodies CD 8, CD 56, CD 68, CD 138, CD 43 was carried out. Photo documentation was constituted by the computer system, binocular microscope Axiolab, digital camera Axiocam and «AxioVision 4.8» software. Statistical processing of the results was carried out according to the tables of R. B. Strelkov. The significance of differences of the results was estimated using the Student-Fisher method for the confidence level of not less than 95 %, which is common for biological and medical research (p<0.05). Results of the study. Fibrous-form infiltration was noted in 66.7±9.6 % of cases, granulosa – 25.0±8.8 % and cystic in 8.3±5.6 %. Cellular composition of lamina propria mucosae was represented by fibroblasts, fibrocytes, macrophages, lymphocytes, plasma cells. The presence of eosinophils in a large amount indicates the presence of local allergic reaction, the presence of segmented neutrophils infiltrate indicates the presence of the secondary infection. The biopsies revealed CD 8+-lymphocyte cells, numerous CD 68+ macrophages, single CD 43+ and CD 138+ cells. CD 56+ cytotoxic lymphocytes have not been identified. Among the reactive changes in the epithelium absence of the ciliary cover prevails in 83.3±7.6 % of observations, necrosis – 66.7±9.6 %, squamous metaplasia of the epithelium – in 50.0±10.2 % of cases, hyperplasia – in 25.0±8.8 %. Conclusions. Mixed form of iatrogenic sinusitis corresponds to fibrous infiltration, granulosa and cystic patomorphologic forms according to Manasse, cellular composition of lamina propria mucosae was represented by fibroblasts, fibrocytes, macrophages, lymphocytes, plasma cells. The presence of eosinophils in a large amount indicates the presence of local allergic reaction, the presence of segmented neutrophils infiltrate indicates the presence of the secondary infection; among the reactive changes in the epithelium absence of the ciliary cover, necrosis, squamous metaplasia of epithelium and hyperplasia prevail.
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