Histopathology Types of Polyposis in Adam Malik Hospital
KARANGAN ASLI
Histopathology Types of Polyposis in Adam Malik Hospital
Delfitri Munir
Ear Nose Throat, head and Neck Surgery Department
Faculty of Medicine, Sumatera Utara University
Abstract: The treatment of polyposis until now unsatisfied. Recurrent rate are still high by
medicine or surgery, and this problem need to know the type of polyp. The aim of this research
are detect nasal and sinus paranasal polyp type in Adam Malik Hospital Medan. The conclusion
are allergic type (type I) is the most common (62%).
Keywords: allergic, polyposis
Abstrak: Cara pengobatan terhadap polypolis sampai saat ini belum memuaskan. Tingkat
kambuhnya masih tinggi melalui medis atau pembedahan, dan jenis polyp dari masalah ini harus
diketahui. Tujuan dari penelitian ini untuk mendeteksi jenis nasal dan sinus paranasal di Rumah
Sakit Haji Adam Malik Medan. Kesimpulannya adalah jenis alergi (Tipe 1) adalah yang paling
banyak (62%)
Kata kunci: alergi, polypolis
INTRODUCTION
Polyposis management unsatisfied until
now. Its recurrence still high in patient who
under gone medicine or surgery management.
1,2,3
Dhaeng (1996) found 51 cases (25,49 %),
who have undergone more than once
operation and 76,92 % are allergic polyposis
4
(tipe I). Soetjipto (2005) found recurrence 13
5
from 73 cases (17,8 %). Recurrence of
polyposis influence by allergy, so it have to
6,7
detect the polyp type.
Nasal polyposis is chronic inflamation of
nasal mucous has been known since 3000
8,9,10
years ago.
It is 1,3 % populations in East
11
Europe and 1-4 % in North America.
Data
from allergic – immunology Department
Indonesian University reveal that nasal
12
polyposis 2,7 % from 110 alergic rhinitis.
Hellquist (1996) define 4 polyposis
histopathology are alergic polyp (type I), fibro
inflamatory polyp (type II), seromucin
glandula hyperplasia polyp (type III) and
13
polyp with atipical stroma (type IV). Several
researches prove that type I is the most
common cases. Vogels (2001) found type I
94,8 % from 39 cases and Bucholtz (1999)
9,14
found 69 % from 16 cases.
While
Mangunkusumo (2004) found most common
12
type II (74,2 %).
Definite etiologi still unknown. There are
many theory has been presented but it is not
satisfied yet. The theory are allergic, infection
15,16
and Bernaulli theory.
MATERIAL AND METHOD
This research is cross section method was
done in ENT Department Medicine Faculty
North Sumatera University/Adam Malik
Hospital. Sample is patient come to the Hospital
with diagnosis nasal and sinuses paranasal
polyposis from Maret 2004 to February 2005.
Polyposis mass that take durante operation send to
Pathology Anatomi Department, Faculty of
Medicine North Sumatera University.
RESULT
We found 26 patients polyposis nasal and
sinus paranasal
Table 1.
Sex distribution
Sex
Male
Female
Total
Majalah Kedokteran Nusantara Volume 41 y No. 1 y Maret 2008
Amount
17
9
26
%
65
35
100
Universitas Sumatera Utara 1
Karangan Asli
This table show that male 17 cases (65 %)
and female 9 cases (35 %) with ratio 1,8 : 1.
Table 2.
Age group distribution
Age group
5 - 14
15 - 24
25 - 34
35 - 44
45 - 54
Total
Amount
3
6
2
8
7
26
%
12
23
8
30
27
100
The most age group is 34–35 years old
(30 %) and the rare is 25-34 years old (8 %).
Table 3.
Histopathologic
Hellquist criteria
type
Histopathology type
Type I
Type II
Type III
Type IV
Total
distribution
Amount
16
6
3
1
26
according
%
62
23
12
3
100
The commonest histopathologic type is
type I are 16 cases (62 %).
DISCUSION
We have sample 26 consist of male 17 (65
%) and female 9 (35 %) with ratio 1,8 : 1.
Appropriate with another researches that
male more than female. Voegels (2001) and
Soetjipto (2005) found ratio male and female
5,9
17
1,8 : 1. Suheryanto (1999) found 3 : 1.
Dowel (1992) and Wang (2005) found 2,5 :
6,15
Mangunkusumo (2004) found 2 : 1 and
1.
4,12
While Siregar
Dhaeng (1996) 1,5 : 1.
18
(1995) found similar sex ratio 1 : 1. Presence
difference sex ratio may be because difference
sample each research.
The most common age group is 35–44
years old (30 %). The youngest age is 10 years
old and the oldest is 54 years old. Appropriate
with another research that more than 30 and
19
rare under 20 years old. Dowel (1992) found
the youngest is 14 years old and oldest 78
15
years old. Siregar (1995) found the youngest
18
17 years old and the oldest 50 years old.
Soetjipto found the youngest 12 years old and
5
While
the
oldest
65
years
old.
Mangunkusumo (2004) found the youngest is
12
8 years old and the oldest 74 years old.
Be base on histopathology type and
Hellquist criteria, we found the most common
2
is type I (62 %). This result similar with
Voegels (2001) that the most common is type
9
I (94,8 %) from 39 sample. Like wise
Bucholtz (1999) found the most common
14
type is type I (69 %) from 16 sample. While
Mangunkusumo (2004) found the most
12
common is type II (74,2 %). Some researcher
believe that allergy is the importance factor
9,20
The evidence
for polyposis formation.
allergic factor in polyposis is similar
histopathology polyposis and allergic tissue
such as edema, eosiniphilia in blood and nasal
secret. There any close relation between
polyposis and astma, hay fever, urticaria and
eczema. The another evidence that more case
polyposis cure after avoidance allergent and
4,8
hyposensitization. Some researchers found
that eosinophil is predominant in nasal
polyposis. Be base on this fact polyposis
research tend to eosinophil accumulation in
tissue. In allergic tissue, mucosal iritation
20
make edema and polyp formation.
CONCLUSION
The conclusion are allergic type (type I) is
the most common (62%).
REFERENCES
1. Collman BH. Disease of the Nose, Throat
and Ear, Head and Neck. Longman
th
ed. Singapore
Singapore Publishers. 14
1993: 29-34.
2. Wang H, Zhang L, Zhou B, Zhang W, Liu
HC, Liu M. Relationship between allergic
factors and chronic sinusitis with or without
nasal polips, Zhonghuo Er Bi Yan Hou Tou
Jing Wai Ke Za Zhi, 2005, Vol. 40 (3): 16871.
3. Rifki N. Surgical Treatment for Ear, Nose
and Throat Allergic Diseases in Indonesia.
Journal of Oto Rhino Laryngology
Indonesia. Vol XXV. January-April 1994:
277-82.
4. Dhaeng S, Mulyadi U, Saroso S. Rekurensi
Poilp hidung Di Bagian THT RSUP DR.
Sardjito Yogyakarta Periode Januari 1993 –
Desember 1995. Kumpulan Naskah Ilmiah
PIT. PERHATI. Batu-Malang. Oktober
1996: 736-42.
Majalah Kedokteran Nusantara Volume
41 y No.
1 y Maret
2008
Universitas
Sumatera
Utara
Delfitri Munir
Histopathology Types of Polyposis…
The
Importance of Post – Operative Care.
5. Soetjipto.
D,
Nasal
Poliposis:
Indonesian Journal of OtorhinolaryngologyHead and Neck Surgery. 35(2) April-Juni.
2005: 46-50.
6. Wynn R, Har-El G. Recurrence rates after
endoscopic sinus surgery for massive sinus
polyposis. Laryngoscope 2004, Vol. 114 (5):
811-3.
7. Kirtsreekul V. Nasal polyps: the relationship
to allergy, sinonasal infection and
histopathological type. J Med Assoc Thai,
2004, Vol. 87 (3): 277-82.
8. Mabry RL. King HC. Allergic Management
13. Hellquist HB, Nasal polyps update.
Histopathology, Allergy Asthma Proc. 1997.
Vol. 17 (5): 237-42.
14. Bucholtz GA, Ejercito VS, Burmester JK.
The Cystic Fibrosis Conductance Regulator
Gene Exon Sequence is Normal in Patient
With Edematous Eosinophilic Nasal Polyps.
American Journal of Rhinology. 1999. Vol.
13(4): 221-3.
15. Dowell M. Ahmess L.Nasal Polypectomy:
Should Antral Washout be a Routine? The
Journal Of Laryngology and Otology 1992,
Vol. 106: 695-6.
Schaefer Mosby Inc.London 1998: 51-4.
16. Kennedy DW, Bolger WE, Zinrelch SJ.
Polyps. In: Disease of the Sinuses Diagnosis
and Treatment. BC Decker, Inc. London
2001. 39-40.
9. Voegels RL, Santoro P, Butugan O. Nasal
17. Suheryanto R. Efektifitas Pengobatan Poilp
Polyposis and Allergy: Is There a Correlation
?. American Journal of Rhinology 2001.15
hidung
dengan
Menggunakan
Kortikosteroid. Kumpulan Naskah Ilmiah
(1): 9-13.
KONAS XII PERHATI,
Oktober 1999: 578-90
of Nasal Polyps. Rhynology and Sinuse
Diseases A problem-Oriented Approach.
10. Tripathi A, Conley DB, Grammer LC,
Ditto AM, Lowerry MM, Seiberling KA.
Immunoglobulin E to staphilococcal and
streptococcal toxins in patiens with chronic
sinusitis/ nasal polyposis. Laryngoscope
2004, Vol. 114 (10):1822-6.
11. Bert van der Baan. Epidemiology and
natural history, in: Nasal Polyposis an
st
inflamatory disease and its treatment, 1
ed, Munksgaard. Copenhagen. 1997: 1315.
Semarang,
18. Siregar.A. Hubungan total Ig E Dengan
Histopatologi Polip Hidung Di Bagian THT
FK. USU/RSUP H. Adam Malik Medan.
Tesis. 1995.
19. Paparella MM, Shumrick DA, Gluckman
JS. Nasal Polyposis The Aspirin Triad And
Non Allergic Rhinitis. In: Otolaryngology
rd
Head and Neck. Vol.III.3 Ed. WB Saunders
Company. USA 1892.
12. Mangunkusumo E. Hamadi F. Kurniawan.
20. Scavuzzo MC, Fattori B, Rocchi V, Carpi A,
Berni R. Inflammatory mediator and
Histopathologic Characteristics of Nasal
Polyps in Jakarta, Indonesia. The Medical
eosinophilia in atopic and non atopic patiens
with nasal polyposis. Biomed Pharmacother
Journal of Malaysia 2004, Vol. 99: 224.
2005, Vol. 59 (6): 323-9.
Majalah Kedokteran Nusantara Volume 41 y No. 1 y Maret 2008
Universitas Sumatera Utara 3
Histopathology Types of Polyposis in Adam Malik Hospital
Delfitri Munir
Ear Nose Throat, head and Neck Surgery Department
Faculty of Medicine, Sumatera Utara University
Abstract: The treatment of polyposis until now unsatisfied. Recurrent rate are still high by
medicine or surgery, and this problem need to know the type of polyp. The aim of this research
are detect nasal and sinus paranasal polyp type in Adam Malik Hospital Medan. The conclusion
are allergic type (type I) is the most common (62%).
Keywords: allergic, polyposis
Abstrak: Cara pengobatan terhadap polypolis sampai saat ini belum memuaskan. Tingkat
kambuhnya masih tinggi melalui medis atau pembedahan, dan jenis polyp dari masalah ini harus
diketahui. Tujuan dari penelitian ini untuk mendeteksi jenis nasal dan sinus paranasal di Rumah
Sakit Haji Adam Malik Medan. Kesimpulannya adalah jenis alergi (Tipe 1) adalah yang paling
banyak (62%)
Kata kunci: alergi, polypolis
INTRODUCTION
Polyposis management unsatisfied until
now. Its recurrence still high in patient who
under gone medicine or surgery management.
1,2,3
Dhaeng (1996) found 51 cases (25,49 %),
who have undergone more than once
operation and 76,92 % are allergic polyposis
4
(tipe I). Soetjipto (2005) found recurrence 13
5
from 73 cases (17,8 %). Recurrence of
polyposis influence by allergy, so it have to
6,7
detect the polyp type.
Nasal polyposis is chronic inflamation of
nasal mucous has been known since 3000
8,9,10
years ago.
It is 1,3 % populations in East
11
Europe and 1-4 % in North America.
Data
from allergic – immunology Department
Indonesian University reveal that nasal
12
polyposis 2,7 % from 110 alergic rhinitis.
Hellquist (1996) define 4 polyposis
histopathology are alergic polyp (type I), fibro
inflamatory polyp (type II), seromucin
glandula hyperplasia polyp (type III) and
13
polyp with atipical stroma (type IV). Several
researches prove that type I is the most
common cases. Vogels (2001) found type I
94,8 % from 39 cases and Bucholtz (1999)
9,14
found 69 % from 16 cases.
While
Mangunkusumo (2004) found most common
12
type II (74,2 %).
Definite etiologi still unknown. There are
many theory has been presented but it is not
satisfied yet. The theory are allergic, infection
15,16
and Bernaulli theory.
MATERIAL AND METHOD
This research is cross section method was
done in ENT Department Medicine Faculty
North Sumatera University/Adam Malik
Hospital. Sample is patient come to the Hospital
with diagnosis nasal and sinuses paranasal
polyposis from Maret 2004 to February 2005.
Polyposis mass that take durante operation send to
Pathology Anatomi Department, Faculty of
Medicine North Sumatera University.
RESULT
We found 26 patients polyposis nasal and
sinus paranasal
Table 1.
Sex distribution
Sex
Male
Female
Total
Majalah Kedokteran Nusantara Volume 41 y No. 1 y Maret 2008
Amount
17
9
26
%
65
35
100
Universitas Sumatera Utara 1
Karangan Asli
This table show that male 17 cases (65 %)
and female 9 cases (35 %) with ratio 1,8 : 1.
Table 2.
Age group distribution
Age group
5 - 14
15 - 24
25 - 34
35 - 44
45 - 54
Total
Amount
3
6
2
8
7
26
%
12
23
8
30
27
100
The most age group is 34–35 years old
(30 %) and the rare is 25-34 years old (8 %).
Table 3.
Histopathologic
Hellquist criteria
type
Histopathology type
Type I
Type II
Type III
Type IV
Total
distribution
Amount
16
6
3
1
26
according
%
62
23
12
3
100
The commonest histopathologic type is
type I are 16 cases (62 %).
DISCUSION
We have sample 26 consist of male 17 (65
%) and female 9 (35 %) with ratio 1,8 : 1.
Appropriate with another researches that
male more than female. Voegels (2001) and
Soetjipto (2005) found ratio male and female
5,9
17
1,8 : 1. Suheryanto (1999) found 3 : 1.
Dowel (1992) and Wang (2005) found 2,5 :
6,15
Mangunkusumo (2004) found 2 : 1 and
1.
4,12
While Siregar
Dhaeng (1996) 1,5 : 1.
18
(1995) found similar sex ratio 1 : 1. Presence
difference sex ratio may be because difference
sample each research.
The most common age group is 35–44
years old (30 %). The youngest age is 10 years
old and the oldest is 54 years old. Appropriate
with another research that more than 30 and
19
rare under 20 years old. Dowel (1992) found
the youngest is 14 years old and oldest 78
15
years old. Siregar (1995) found the youngest
18
17 years old and the oldest 50 years old.
Soetjipto found the youngest 12 years old and
5
While
the
oldest
65
years
old.
Mangunkusumo (2004) found the youngest is
12
8 years old and the oldest 74 years old.
Be base on histopathology type and
Hellquist criteria, we found the most common
2
is type I (62 %). This result similar with
Voegels (2001) that the most common is type
9
I (94,8 %) from 39 sample. Like wise
Bucholtz (1999) found the most common
14
type is type I (69 %) from 16 sample. While
Mangunkusumo (2004) found the most
12
common is type II (74,2 %). Some researcher
believe that allergy is the importance factor
9,20
The evidence
for polyposis formation.
allergic factor in polyposis is similar
histopathology polyposis and allergic tissue
such as edema, eosiniphilia in blood and nasal
secret. There any close relation between
polyposis and astma, hay fever, urticaria and
eczema. The another evidence that more case
polyposis cure after avoidance allergent and
4,8
hyposensitization. Some researchers found
that eosinophil is predominant in nasal
polyposis. Be base on this fact polyposis
research tend to eosinophil accumulation in
tissue. In allergic tissue, mucosal iritation
20
make edema and polyp formation.
CONCLUSION
The conclusion are allergic type (type I) is
the most common (62%).
REFERENCES
1. Collman BH. Disease of the Nose, Throat
and Ear, Head and Neck. Longman
th
ed. Singapore
Singapore Publishers. 14
1993: 29-34.
2. Wang H, Zhang L, Zhou B, Zhang W, Liu
HC, Liu M. Relationship between allergic
factors and chronic sinusitis with or without
nasal polips, Zhonghuo Er Bi Yan Hou Tou
Jing Wai Ke Za Zhi, 2005, Vol. 40 (3): 16871.
3. Rifki N. Surgical Treatment for Ear, Nose
and Throat Allergic Diseases in Indonesia.
Journal of Oto Rhino Laryngology
Indonesia. Vol XXV. January-April 1994:
277-82.
4. Dhaeng S, Mulyadi U, Saroso S. Rekurensi
Poilp hidung Di Bagian THT RSUP DR.
Sardjito Yogyakarta Periode Januari 1993 –
Desember 1995. Kumpulan Naskah Ilmiah
PIT. PERHATI. Batu-Malang. Oktober
1996: 736-42.
Majalah Kedokteran Nusantara Volume
41 y No.
1 y Maret
2008
Universitas
Sumatera
Utara
Delfitri Munir
Histopathology Types of Polyposis…
The
Importance of Post – Operative Care.
5. Soetjipto.
D,
Nasal
Poliposis:
Indonesian Journal of OtorhinolaryngologyHead and Neck Surgery. 35(2) April-Juni.
2005: 46-50.
6. Wynn R, Har-El G. Recurrence rates after
endoscopic sinus surgery for massive sinus
polyposis. Laryngoscope 2004, Vol. 114 (5):
811-3.
7. Kirtsreekul V. Nasal polyps: the relationship
to allergy, sinonasal infection and
histopathological type. J Med Assoc Thai,
2004, Vol. 87 (3): 277-82.
8. Mabry RL. King HC. Allergic Management
13. Hellquist HB, Nasal polyps update.
Histopathology, Allergy Asthma Proc. 1997.
Vol. 17 (5): 237-42.
14. Bucholtz GA, Ejercito VS, Burmester JK.
The Cystic Fibrosis Conductance Regulator
Gene Exon Sequence is Normal in Patient
With Edematous Eosinophilic Nasal Polyps.
American Journal of Rhinology. 1999. Vol.
13(4): 221-3.
15. Dowell M. Ahmess L.Nasal Polypectomy:
Should Antral Washout be a Routine? The
Journal Of Laryngology and Otology 1992,
Vol. 106: 695-6.
Schaefer Mosby Inc.London 1998: 51-4.
16. Kennedy DW, Bolger WE, Zinrelch SJ.
Polyps. In: Disease of the Sinuses Diagnosis
and Treatment. BC Decker, Inc. London
2001. 39-40.
9. Voegels RL, Santoro P, Butugan O. Nasal
17. Suheryanto R. Efektifitas Pengobatan Poilp
Polyposis and Allergy: Is There a Correlation
?. American Journal of Rhinology 2001.15
hidung
dengan
Menggunakan
Kortikosteroid. Kumpulan Naskah Ilmiah
(1): 9-13.
KONAS XII PERHATI,
Oktober 1999: 578-90
of Nasal Polyps. Rhynology and Sinuse
Diseases A problem-Oriented Approach.
10. Tripathi A, Conley DB, Grammer LC,
Ditto AM, Lowerry MM, Seiberling KA.
Immunoglobulin E to staphilococcal and
streptococcal toxins in patiens with chronic
sinusitis/ nasal polyposis. Laryngoscope
2004, Vol. 114 (10):1822-6.
11. Bert van der Baan. Epidemiology and
natural history, in: Nasal Polyposis an
st
inflamatory disease and its treatment, 1
ed, Munksgaard. Copenhagen. 1997: 1315.
Semarang,
18. Siregar.A. Hubungan total Ig E Dengan
Histopatologi Polip Hidung Di Bagian THT
FK. USU/RSUP H. Adam Malik Medan.
Tesis. 1995.
19. Paparella MM, Shumrick DA, Gluckman
JS. Nasal Polyposis The Aspirin Triad And
Non Allergic Rhinitis. In: Otolaryngology
rd
Head and Neck. Vol.III.3 Ed. WB Saunders
Company. USA 1892.
12. Mangunkusumo E. Hamadi F. Kurniawan.
20. Scavuzzo MC, Fattori B, Rocchi V, Carpi A,
Berni R. Inflammatory mediator and
Histopathologic Characteristics of Nasal
Polyps in Jakarta, Indonesia. The Medical
eosinophilia in atopic and non atopic patiens
with nasal polyposis. Biomed Pharmacother
Journal of Malaysia 2004, Vol. 99: 224.
2005, Vol. 59 (6): 323-9.
Majalah Kedokteran Nusantara Volume 41 y No. 1 y Maret 2008
Universitas Sumatera Utara 3