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Sinus Contents

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IntroductionEdit

Sinus contents are generated by a "FESS" (functional endoscopic sinus surgery). In most cases, these are done for chronic sinusitis. The tissue usually consists of sinonasal mucosa, but you may potentially find numerous eosinophils, allergic mucin, pieces of a sinonasal polyp, or even a tumor.

Fresh HandlingEdit

Dunk in formalin.

Grossing InEdit

  • Give the aggregate measurement of the sinus contents.
  • Describe of the tissue (mucoid/soft tissue fragments/polypoid fragments/bony fragments/hemorrhagic/color/texture/etc.).

Submit all tissue.

  • Short term decalcification may be necessary if bony fragments are present.
  • Any unusual lesions or larger polypoid fragments should be described and submitted separately.
  • If an ethmoid resection is present, describe the size, mucosal appearance and presence of ossification/bone. Serially section to look for gross lesions. Take a representative block which may encompass several cross sections, sampling any specific lesions if present—may require decaling as above.

Review and SignoutEdit

In some cases, allergic mucin (suggestive of Aspergillus) can be seen. In these cases, there are numerous eosinophils and copious mucin. A Grocott/GMS stain can be helpful, and if you are certain that you see the allergic mucin, most attendings will not mind if you preorder this.

1. Sinonasal contents, left, endoscopic sinus surgery:

2. Sinonasal contents, right, endoscopic sinus surgery:

3. Sinonasal contents, bilateral trap, endoscopic sinus surgery:

Benign sinonasal mucosa with (mild, moderate, severe) chronic inflammation.
Benign sinonasal mucosa with (mild, moderate, severe) chronic inflammation, see note.
NOTE: The chronic inflammation is comprised of predominantly lymphocytes and plasma cells with few eosinophils. No fungal organisms or Charcot-leyden crystals are identified.
Benign sinonasal mucosa with (mild, moderate, severe) chronic inflammation with abundant eosinophils and allergic-type mucin, see note.
NOTE: The inflammatory infiltrate contains abundant eosinophils, and allergic-type mucin is present. A Grocott stain was performed which (reveals fungal hyphae or is negative for fungal organisms). Charcot-Leyden crystals are not identified.

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