Case 233 -- Chronic Sinusitis

Contributed by Jason C. Fowler, BS and Michael J. Becich, MD, PhD
Published on line in June 2000


PATIENT HISTORY:

This patient is a 40 year old man with a history of chronic sinusitis and chronic productive cough. Patient was repeatedly treated with antibiotics and nasal steroids. Endoscopy revealed nasal polyposis of the right inferior and middle turbinates. Family history is significant for a sister with similar chronic sinusitis problems. It should also be noted that the patient has no children of his own.

GROSS DESCRIPTION:

The specimen was received in buffered formalin labeled "right inferior turbinate, normal and polyp." The specimen consisted of four irregular fragments of tan-pink, hemorrhagic soft tissue ranging from less than 0.1 to 0.4cm in greatest dimension. A portion of the specimen was placed in glutaraldehyde for future electron microscopy studies.

MICROSCOPIC DESCRIPTION:

Nasal turbinate biopsy revealed ciliated pseudo-stratified respiratory epithelium with focal basement membrane thickening and squamous metaplasia (Figs 1 and 2). Specimen was also notable for mild chronic inflammation.

ELECTRONIC MICROSCOPIC DESCRIPTION:

Electron microscopy revealed a majority of cilia with microtubules lacking inner and outer dynein arms (Figs 3 and 4). Out of one hundred and sixty five cilia examined, only five showed evidence of dynein arms present Fig 5).

FINAL DIAGNOSIS


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