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Sinonasal Ultrastructure of the Hematopoietic Stem Cell Transplant and Chronic Graft-versus-host Disease with Rhinosinusitis

Érica Ortiz, Luciana R Meirelles, Afonso C Vigorito, Eulália Sakano and Ester Maria Danielli Nicola

Introduction: It is believed that immunosuppression is the sole cause for the occurrence of rhinosinusitis in hematopoietic stem cell transplant (HSCT). There is a high incidence of sinusitis in recipient patients, especially in those with Chronic Graft Versus Host disease (GVHD). Histopathological abnormalities were described in recipients’ sinus mucosa compared to immunocompetent patients. There were also mucosal abnormalities related to cytotoxicity in the transplanted patients with chronic GVHD but no difference in ultrastructure between HSCT patients with and without GVHD, except for increased goblet cells in patients without GVHD. The relation between the sinonasal mucosa abnormalities of these patients and rhinosinusitis is not well established yet. Objective: To verify the ultrastructure of the sinonasal mucosa of HSCT with and without GVHD with rhinosinusitis to understand the cause of high Sinusitis incidence. Method: prospective study with statistical analysis of data obtained from the evaluation of the uncinate process mucosa of patients transplanted with (16) and without GVHD (8) with rhinosinusitis by transmission electron and optical microscopy. Results: Of the patients, 47% (14) had only 1 or 2 episodes, and 33% had more than 3 episodes of rhinosinusitis. Only the presence of microvilli was significantly higher in patients without GVHD. There was no significant difference in the amount of cilia, ciliary ultrastructure, squamous metaplasia, goblet cells, vacuolization, density of the inflammatory infiltrate, intraepithelial lymphocytes, eosinophils, mucous glands, apoptotic corpuscles intraepithelial basement membrane thickness, edema and subepithelial fibrosis between groups. There was a significant decrease of cilia with Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation higher recurrence of rhinosinusitis. Conclusion: There was an increase in microvilli HSCT without GVHD with rhinosinusitis, and the ultrastructure and histological changes of HSCT with and without GVHD did not change with the recurrence of rhinosinusitis. However, there was a decrease of cilia in the epithelium of the sinonasal HSCT with higher recurrence of rhinosinusitis.