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hyperplasia of the respiratory epithelium and the basement membrane, which is destroyed in the acute phase, appears considerably thickened in the chronic phase.

Atrophic rhinitis is a chronic inflammation of the nasal mucosa of unknown aetiology characterised by progressive nasal mucosal atrophy and by a thick, dense secretion, with a foetid smell and crusting [178]. Multiple factors may be involved in the pathogenesis, including chronic bacterial infections and nutritional deficiencies. Its incidence has markedly decreased in the last century, and nowadays most cases are secondary to trauma, surgery, granulomatous diseases, infection and radiation exposure [178]. Histologically, there is non-specific chronic inflammatory infiltrate, squamous metaplasia of the surface epithelium and of glandular excretory ducts, and atrophy of mucoserous glands [1, 69].

This term is applied to a condition of unknown aetiology, characterised by thickening of the sinonasal mucosa resulting from chronic inflammatory diseases [28, 71]. Frequently, these patients have undergone several sinus operations, each time with limited success and subsequent recurrence. Recurrent nasal polyposis is often associated.

Chronic sinusitis is a complex, multifactorial disorder resulting from persistent acute inflammation or repeated episodes of acute or subacute sinusitis. There are usually predisposing factors like small sinus ostia, repeated episodes of common cold, allergy or acute sinusitis determining obstruction of the sinus ostia, reduction of ciliary activity (immotile cilia syndrome) and cystic fibrosis. The mucosal changes observed are variable and include basement membrane thickening, goblet cell hyperplasia, oedema of varying extent, inflammation (mostly lymphocytes and plasma cells) and polypoid change of the mucosa [242].

2.3 Sinonasal Polyps

Allergic sinonasal polyps consist largely of myxoid oedematous tissue with pseudocysts containing eo-

sinophilic proteinaceous fluid and infiltrates of inflammatory cells [115]. They are covered by respiratory epithelium with variable ulceration, goblet cell hyperplasia, squamous metaplasia and thickening of the basement membranes. Seromucous glands and mucin-containing cysts may also occur. They arise most frequently in the ethmoidal region and the upper part of the nasal cavity. Allergic polyps usually exhibit heavy infiltration by eosinophils (Fig. 2.1a), marked thickening of the basement membranes and goblet cell hyperplasia. Most sinonasal polyps are of allergic origin. Epithelial dysplasia is present in a few cases. Granulomas may be present in polyps treated with intranasal injection, application of steroids or other oily medications. Atypical fibroblasts with abundant cytoplasm, poorly defined cell borders and large pleo-morphic nuclei are present in a small proportion of cases [183]. These atypical cells occur individually and are more frequently found close to blood vessels (Fig. 2.1b) or near the epithelial surface. Such stromal atypia is a reactive phenomenon and it should not be confused with sarcoma.

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