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Abstract

Rhinoscleroma (RS) is a progressive chronic specific disease of the nose and upper respiratory passages caused by Klebsiella rhinoscleromatis bacilli. It is endemic in Egypt and in sporadic areas worldwide. Diagnosis of RS is based on identification of the pathognomonic Mickulicz cells (MCs) which is most prominent during granulomatous phase but spares or absent during initial catarrhal or late sclerotic phases of the disease. This study aimed to identify the potential diagnostic features of nasal RS when MCs are absent. A total of 125 nasal biopsies from patients complaining of chronic nasal symptoms were retrieved for this study; including 72 chronic nonspecific 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 dominance of plasma cells and absence of oesinophiles were the strongest diagnostic features of RS. The diagnostic model using these two features confirmed or excluded RS in 84.3% of the investigated cases. Based on this study, 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.

Biography

Ahmed Roshdi Hamed Ahmed graduated at Faculty of Medicine, Sohag University, Egypt on 2000. He started his training at Pathology Department, Sohag University Hospitals to get Master of Pathology on 2003. He finished his PhD studies at the Northern Institute for Cancer Research, Newcastle University, UK on 2011 before starting his current career as a Lecturer Pathology, Sohag University. He is a member of Medical Ethics Committee, Sohag Faculty of Medicine since 2013 and an Assistant Consultant of Surgical Pathology at Sohag Cancer Institute since 2012. He published 10 articles in national and international journals and had several conference participations.