Immunopathology of Chronic Rhinosinusitis in Young Children

Received 18 July 2008; received in revised form 29 September 2008; accepted 17 November 2008. published online 22 January 2009.

Objective

Previous investigation demonstrated predominantly lymphocytic inflammation in sinus mucosa of young children with chronic rhinosinusitis (CRS) rather than eosinophilic inflammation typical of adult CRS. Immunohistopathological study was undertaken to define further the cellular response in pediatric CRS.

Study design

Maxillary mucosal biopsies from children and adults with CRS were stained for CD3 (T lymphocytes), CD4 (helper T lymphocytes), CD8 (cytotoxic T lymphocytes), CD20 (B lymphocytes), CD68 (monocytes/macrophages), CD56 (natural killer cells), κ and λ (plasma cells), and myeloperoxidase (MPO; neutrophils).

Results

Nineteen children with CRS (median age, 3.0 years; range, 1.4-8.2 years) had more CD8+, MPO+, and CD68+ cells (P ≤ .03) and a trend toward more CD3+ and CD4+ cells (P = .06) in their epithelium and more CD20+, κ+ and λ+, MPO+, and CD68+ cells (P ≤ .05) and a trend toward more CD4+ cells (P = .06) in their submucosa compared with adult control subjects. Immunostains from children with positive sinus cultures were similar to those with negative cultures except for more MPO+ cells in the submucosa (P = .04).

Conclusion

The inflammatory response of young children with CRS is characterized by a mixed lymphocyte population, macrophages, and neutrophils. Differences between pediatric and adult CRS suggest differing pathogenic mechanisms or progression in the inflammatory response with protracted disease.

Abbreviations: CRS, Chronic rhinosinusitis, H & E, Hematoxylin and Eosin, MPO, Myeloperoxidase

a Service ORL, Hopital Central, Nancy, France

b Department of Otolaryngology–Head and Neck Surgery, University of Colorado at Denver School of Medicine, The Children's Hospital, Denver, CO

c Department of Pediatrics (Section of Infectious Diseases), University of Colorado at Denver School of Medicine, The Children's Hospital, Denver, CO

d Department of Pediatrics (Section of Allergy/Immunology), University of Colorado at Denver School of Medicine, The Children's Hospital, Denver, CO

e Department of Pathology, University of Colorado at Denver School of Medicine, The Children's Hospital, Denver, CO

f National Jewish Health, Denver, CO

Reprint requests: Kenny H. Chan, MD, Department of Pediatric Otolaryngology, The Children's Hospital, 13123 East 16th Ave, B455, Aurora, CO 80045

This research was supported in part by grants from the General Clinical Research Centers Program (#MO1 RR00069), National Center for Research Resources, National Institutes of Health (Dr Chan); The Research Institute, The Children's Hospital, Denver, Colorado (Dr Chan); and National Institutes of Health (#K23-HL-04272; Dr Liu). The authors declare no conflict of interest, real or perceived.

PII: S0022-3476(08)01035-4

doi:10.1016/j.jpeds.2008.11.035

39 of 54