Сertain pathomorphological features of isolated sphenoiditis

Aim – to study the pathomorphological features of various forms of isolated sphenoiditis.

Material and methods. We analyzed the data of surgical biopsy material of 23 patients aged 18 to 68 years who were on inpatient treatment at the Regional Clinical Hospital named after N.A. Semashko in the period of 2019–2022.

Results. In our study, it was found that in the structure of isolated sphenoiditis, the most common is the polypous-cystic form of the sphenoidal sinus lesion, which is diagnosed statistically significantly more often than the fungal isolated sphenoiditis (p=0.001). The results of the pathomorphological study in all our observations showed a picture of a nonspecific chronic inflammatory process. As a rule, we observed a mucous membrane lined with atrial respiratory epithelium with varying degrees of edema of the plate. In our observations, as a rule, the structure of the epithelium was normal, and the most frequent change was local desquamation in the polypous and cystic forms and sphenochoanal polyp. In the case of mucocele, a local decrease in epithelial height was revealed without reliable signs of squamous cell metaplasia. In the case of the polypous-purulent form, local desquamation occurs, but with areas of atrophy. In polypous fungal forms, only signs of local desquamation were found. The change in the ratio of goblet, supporting and ciliated cells concerned, as a rule, changes in the number of goblet-shaped cells towards an increased (polypous, cystic forms), normal (sphenochoanal polyp) or reduced (fungal, mucocele, polypous-purulent) quantity. The basement membrane was of the usual structure (in polypous-purulent and fungal forms), in some cases thickened. The most pronounced thickening was registered in the case of sphenochoanal polyp, to a lesser extent, in polypous sphenoiditis with bright eosinophilic infiltration, minimally in mucocele. We observed the most active inflammation in the proper plate (with signs of edema) of the mucous membrane in the polypous form, in other forms of lesion this manifestation was moderate (fungal) or reduced (cyst). Edema of the lamina was most pronounced in the polypous form; minimal edema was seen in the sphenochoanal polyp, polypous-fungal form, and there was no edema in other forms. The data obtained indicate that at the time of the interventions, the process in the sinus was not aggravated. The range of features characteristic exclusively of a particular morphology of the lesion identified in our studies is minimal. The pathomorphological landscape of lesions of the sphenoid sinus, obtained in our study, generally corresponds to the picture of lesions of other groups of paranasal sinuses.

Conclusions. Against the background of a huge number of cases of acute and chronic rhinosinusitis, the absolute prevalence of isolated sphenoiditis, even with a relative magnitude of 5% of the total, is also very significant. Determining the phenotypes of isolated sphenoiditis is very important for building a consistent treatment strategy, especially against the background of a large number of tactical and diagnostic errors. For more effective and visual performance of such data analysis, we have developed a “Checklist for pathomorphological examination in pathology of the sphenoid sinus”. The pathomorphological landscape of lesions of the sphenoid sinus, obtained in our study, generally corresponds to the picture of lesions of other groups of paranasal sinuses. Examination of the autopsy material showed the presence of polypous changes in the sphenoid sinus and obstruction of the anastomosis in almost half of the observations.