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Rhinoscleroma: a detailed histopathological diagnostic insight
#MMPMID26339415
Ahmed AR
; El-Badawy ZH
; Mohamed IR
; Abdelhameed WA
Int J Clin Exp Pathol
2015[]; 8
(7
): 8438-45
PMID26339415
show ga
Rhinoscleroma (RS) is a chronic specific disease of nose and upper respiratory
passages caused by Klebsiella rhinoscleromatis bacilli. It is endemic in Egypt
and in sporadic areas worldwide. Diagnosis of RS depends on identification of the
pathognomonic Mickulicz cells (MCs) which is most prominent during granulomatous
phase but spares or absent during catarrhal or sclerotic phases of the disease.
This study aimed to identify the potential diagnostic features of nasal RS when
MCs are absent. Nasal biopsies from 125 patients complaining of chronic nasal
symptoms were retrieved for this study; including 72 chronic non specific
inflammatory lesions and 53 RS diagnosed by PAS and Geimsa stains. The detailed
histological differences among the two groups were measured statistically. RS was
frequently a bilateral disease (P < 0.05) of young age (P < 0.001) with a female
predominance (P < 0.05) and usually associated with nasal crustations (P <
0.001). Five strong histological indicators of RS were specified by univariate
binary logistic regression analyses including squamous metaplasia (OR 27.2, P <
0.0001), dominance of plasma cells (OR 12.75, P < 0.0001), Russell bodies (OR
8.83, P < 0.0001), neutrophiles (OR 3.7, P < 0.001) and absence of oesinophiles
(OR 12.0, P < 0.0001). According to Multivariate analysis, the diagnostic
features of RS in absence of MCs can be classified into major criteria including
dominance of plasma cells infiltration and absence of oesinophiles and minor
criteria including young age, female gender, bilateral nasal involvement, nasal
crustation, squamous metaplasia, Russell bodies, and neutrophiles. The diagnostic
model using the two major criteria confirmed or excluded RS in 84.3% of the
investigated cases.
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