Advertising on the portal

Biopsy of the nasal mucosa. Biopsy from the nasal cavity

Schneiderian papillomas are benign epithelial tumors that most often occur in adults and are associated with human papillomavirus (HPV). Most often localized on one side, but in in rare cases may affect multiple anatomical areas. Three variants of Schneiderian papillomas have been described.

Exophytic papillomas in the vast majority of cases, they are localized on the nasal septum, in the form of leaf-shaped papillary islands with a central fibrovascular core and a thickened, non-keratinizing flat epithelium. Inverted papillomas are the most frequent form. They amaze lateral wall The nasal cavities and paranasal sinuses (most often the maxillary) are characterized by endophytic growth, similar to the growth of non-keratinizing squamous epithelium.

Oncocytic papillomas(cylindrocellular) are less common than all other forms; localization is usually similar to that of inverted papillomas. They consist of stratified columnar epithelial cells with granular eosinophilic cytoplasm. These tumors often recur due to incomplete primary removal. Inverted and oncocytic papillomas degenerate into squamous cell carcinoma in about 11% of cases. Exophytic papillomas rarely become malignant.

Microscopic examination of the tissues of inverted papilloma reveals the presence of multiple areas of stratified squamous epithelium,
growing inside its own lamina; the integumentary epithelium is thinned, but its structure is not disturbed.

According to WHO classification 2005, there are several forms of nasopharyngeal cancer:
(1) (with typical characteristics of keratinizing squamous cell carcinoma);
(2) non-keratinizing cancer, which can be differentiated (intercellular bridges and clear cell boundaries are preserved) and undifferentiated (which are characterized by syncytial growth and the absence of clear boundaries between cells);
(3) basaloid squamous cell carcinoma (similar to tumors affecting the larynx). The mainstay of treatment is radiation therapy.

Squamous cell carcinoma of the nasal cavity and paranasal sinuses is a rare tumor, found mainly in adults, that affects maxillary sinus(60%), nasal cavity (12%), ethmoidal labyrinth (10-15%), nasal vestibule (4%), frontal and sphenoid sinuses (1% each). Metastasizes rarely, but is characterized by locally destructive growth.


a - Nonkeratinizing columnar cell carcinoma is characterized by the presence of strands of immature atypical epithelial cells (they lack keratin).
Note the invasion of the mucous gland.
b - Undifferentiated cancer of the nasal cavity is an extremely aggressive malignancy with a locally disseminated pathological process,
which in most cases is not related to Epstein-Barr virus.
It is characterized by the presence of small groups, trabeculae or sheets of undifferentiated epithelial cells with a high ratio of nucleus to cytoplasm,
frequent mitoses and the presence of extensive areas of necrosis.
Even with aggressive treatment the prognosis is unfavorable.

Most cases diseases represented by simple squamous cell carcinoma with clear cell boundaries, intact intercellular contacts, deposition of keratin in the intra- and extracellular space. Squamous cell carcinoma can be well differentiated (characterized by the formation of “epithelial pearls”), poorly differentiated (characterized by the absence of keratin), or moderately differentiated (containing some keratin).

In rare cases squamous cell carcinoma may be non-keratinizing (cylindrical cell, transitional cell). Verrucous carcinoma, basaloid squamous cell carcinoma, papillary squamous cell carcinoma, spindle cell carcinoma, and glandular squamous cell carcinoma are extremely rare.

Lymphoepithelial cancer is a rare undifferentiated form of cancer with pronounced lymphoplasmacytic infiltration. Can affect the nasal cavity and paranasal sinuses. Morphologically similar to lymphoepithelial cancer of the nasopharynx; often associated with Epstein-Barr virus. Reacts well to radiation therapy. Undifferentiated cancer of the oral cavity and paranasal sinuses is a highly malignant neoplasm that is not usually associated with Epstein-Barr virus.


For adenocarcinoma intestinal type affecting the paranasal sinuses,
characterized by the presence of malignant invasive epithelium with densely grouped glands of irregular shape,
consisting of columnar epithelial cells and rare goblet cells with hyperchromatic nuclei.
The inset shows the result of an immunohistochemical study for the expression of the CDX-2 marker.
Intestinal-type adenocarcinoma can affect the ethmoidal labyrinth (40%), nasal cavity (27%), and maxillary sinuses (20%).
Some of these cells histologically resemble normal intestinal structures (Paneth cells, enterochromaffin cells, villi, muscularis mucosa).

Intestinal type adenocarcinoma affects the ethmoid labyrinth (40%), nasal cavity (27%), maxillary sinus (20%).

For poorly differentiated adenocarcinoma non-intestinal origin is characterized by a glandular or papillary structure with a single layer of cuboidal epithelium; characterized by local invasion.

Papillary adenocarcinoma of the nasopharynx may have a similar morphological structure to papillary cancer thyroid gland, from which it is distinguished by a negative immunohistochemical reaction to thyroglobulin and thyroid transcription factor (TTF-1). Small cell neuroendocrine cancer is a highly differentiated malignant tumor, growing from the upper or posterior sections nasal cavity and spreading into the paranasal sinuses and/or nasopharynx.

Small or medium cell size forms clusters; They are characterized by a high nucleus-cytoplasm ratio, nuclear hyperchromatosis, nuclear fusion, and high mitotic activity. Immunohistochemically, the tumor is characterized by an increase in the level of neuroendocrine markers (synaptophysin, chromogranin, neuro-specific enolase) and cytokeratin. Extremely rare carcinoids of the nose and paranasal sinuses have also been described.


Olfactory neuroblastoma (eisthesioneuroblastoma) is a malignant neuroectodermal tumor
originating from the olfactory layer of the upper parts of the nasal cavity with spread into the cranial cavity and/or paranasal sinuses.
Typically, tumor cells are grouped in the submucosal layer in the form of lobes or nodes that are separated by vascularized fibrous stroma.
The cells are characterized by a small amount of cytoplasm and the presence of inclusions of nuclear chromatin (“salt and pepper”).
Sometimes rosettes (pseudorosettes of Homer Wright or true Flexner-Wintersteiner rosettes), zones of necrosis, are formed.
Tumors are classified depending on differentiation, presence of nuclear pleomorphism and necrosis, mitotic rate (patients with Hyam stage I-II have best forecast than Hyam III-IV).
Neuroendocrine markers are positive, cytokeratin is negative. At the periphery of tumor nodes, specific supporting cells expressing S-100 are identified.
Ectopic pituitary adenoma consists of polygonal, cytologically normal epithelial cells with clear boundaries; the degree of cytoplasmic staining may vary.
Ectopic pituitary adenomas originate from embryonic remnants of the adenohypophysis in the nasopharynx or sphenoid sinus.
Polygonal epithelial cells express cytokeratin, neuroendocrine markers and specific pituitary hormones.

Olfactory neuroblastoma (esthesioneuroblastoma) is a malignant neuroectodermal tumor arising from the olfactory epithelium of the upper nasal cavity, which often extends into the cranial cavity and/or paranasal sinuses. Ectopic pituitary adenomas can arise at the site of the embryonic remnant of the adenohypophysis (in the nasopharynx or sphenoid sinus). They may contain polygonal epithelial cells containing cytokeratins, neuroendocrine markers and specific pituitary hormones.

Malignant melanoma mucous membranes is rare tumor paranasal sinuses and nasal cavity, which sometimes occurs in elderly patients. Like melanoma of any other localization, it easily mimics and can be represented by the most different cells(epithelioid, fusiform, plasmacytoid, rod-shaped and/or multinucleated. Specific immunohistochemical markers (S-100, HMB-45, melan-A, microphthalmia-associated transcription factor) help in diagnosis.

To other rare neuroectodermal tumors include Ewing's sarcoma, primitive neuroectodermal tumors and paragangliomas. Hemangioma is a benign vascular tumor that can be localized on the nasal septum, turbinates and paranasal sinuses; it consists of proliferating capillaries with inclusions of fibrous stroma.


Angiofibroma of the nasopharynx is characterized by irregularly shaped vascular spaces with thick walls,
the stroma is collagenized, with spindle-shaped and stellate fibroblasts.
Angiofibroma of the nasopharynx occurs exclusively in young males and originates from the posterolateral wall of the nasal cavity or nasopharynx,
characterized by the presence of areas of proliferation of vascular tissue.
The vessels are thin, branching, lined with endothelium, muscle layer not always present. The probability of relapse reaches 20%.

Angiofibroma of the nasopharynx It occurs exclusively in young males and is localized on the posterolateral wall of the nasal cavity or in the nasopharynx. The risk of local relapse is quite high.


Glomangiopericytoma (hemangiopericytoma of the paranasal sinuses) affects the paranasal sinuses,
characterized by a perivascular myxoid phenotype, the presence of round nuclei and irregularly shaped vessels.
It is a subepithelial non-encapsulated tumor consisting of cells tightly fused to each other with solid,
fascicular or convoluted growth pattern, collagen fibers and frequent branching vessels.
Positive for muscle actin, vimentin, factor XIIIa; negative HaCD34, Bcl-2, CD99 (which distinguishes it from soft tissue hemangiopericytoma).

Glomangiopericytoma(hemangiopericytoma of the nasal cavity and paranasal sinuses) is a subepithelial non-encapsulated tumor consisting of cells closely adjacent to each other, growing in a solid, umbilical, curled, tortuous type; characterized by a low collagen content and the presence of branching (“coral”) vessels.

Solitary fibrous tumors in the nasal cavity rare, they are composed of intertwined fibroblasts and a dense vascular network. The cells are positive for CD34 and Bcl-2 but do not express smooth muscle actin. Germ cell tumors of the nasal cavity are rare. Mature teratomas may include mature skin, skin appendages, neuroglial tissue, smooth muscle, bones, salivary glands, respiratory and gastrointestinal epithelium. Elements of ectoderm, endoderm and mesoderm can occur in any proportion.

Nasopharyngeal biopsy is the removal of a small piece of tissue for subsequent examination under a microscope. Biopsy material can be taken from any area of ​​the skin and mucous membranes, incl. and from the mucous membrane of the nasopharynx. This diagnostic intervention performed in our clinic under the control of an optical endoscope.

Indications for nasopharyngeal biopsy under endoscopic control

We resort to endoscopic biopsy of the nasopharynx to diagnose tumor processes, and, above all, nasopharyngeal cancer. Cancerous tumors grow from the skin and mucous membranes. Unfortunately, the nasopharyngeal mucosa is no exception in this regard.

About probable availability tumor process in the nasopharynx the following signs indicate:

  • mucous membranes and mucopurulent discharge from the external nasal openings on the affected side, not associated with a cold or runny nose
  • here is bloody discharge or nosebleeds
  • difficulty in nasal breathing due to mechanical obstruction, swelling of the mucous membrane, and displacement of the nasal septum
  • nasal voice
  • headaches
  • pain, numbness in certain areas of the face, paralysis of facial muscles.

In some cases, especially in advanced stages, visual and auditory disturbances are possible in the form of a feeling of ear congestion, ringing in the ears, double vision, decreased visual acuity and hearing. However, at first all these symptoms may not be present, and the tumor manifests itself only as an enlargement of the cervical lymph nodes.

In this regard, the unreasonably increased and painful lymph nodes- a cause for concern. The first thing you need to think about is their metastatic lesion. However, all the symptoms listed above, incl. and lymph node involvement is not strictly specific for cancer. Perhaps these symptoms are related to benign tumors nasopharynx: fibromas, chondromas, polyps.

The presence of a large tumor formation in the nasopharynx is confirmed by non-invasive tests (not related to penetration into internal environments, and with tissue damage) research methods. These are x-rays, computed tomography and magnetic resonance imaging. Based on the data obtained, we can judge the type of tumor, but only indirectly. Final diagnosis placed only after a biopsy.

Nasopharyngeal biopsy technique

The anatomical features of the initial part of the pharynx, the nasopharynx, are that it is difficult to reach visual inspection and interventions. The pharynx can only be partially examined retrogradely, through oral cavity from the oropharynx using a special mirror.

Endoscopy allows not only to examine the nasopharynx, but also to certain types interventions, incl. and biopsy. A nasopharyngoscope is a type of endoscope for examining the pharyngeal sections. This optical instrument with a flexible probe, equipped with a light source and a video camera.

The device we have in service is connected to a computer. The image of the mucosal area is captured by a video camera and sent through optical fibers to the device and then to the computer. Here the received information is digitized and converted into a multiply enlarged image on the monitor.

Thanks to this, the doctor can easily detect the tumor and determine its location. The nasopharyngoscope is equipped with a special channel for devices with which biopsy material is taken.

The procedure for taking biopsy material is carried out by an otolaryngologist in the endoscopy room of our center. The probe is inserted into the oropharynx through the external nasal opening of the corresponding side, and then through the lower nasal passage, choana (internal nasal opening) into the nasopharynx.

The nasal cavity is first irrigated with sprays of vasoconstrictor and local anesthetic substances to eliminate pain and prevent swelling of the nasal mucosa. To enhance pain relief, the doctor treats the endoscope probe with local anesthetic gel. The end of the probe is rounded so as not to injure the mucous membranes.

During the study, the doctor takes biopsy material and assesses the condition of the mucous membrane of the orifices opening into the oropharynx auditory tubes with tubal tonsils, pharyngeal tonsils. The whole procedure takes about 20 minutes. The conclusion will be available in approximately 7 days. During the first days after the study, short-term painful sensations, nasal congestion.

Contraindications to endoscopic biopsy of the nasopharynx

In many ways they are similar to those for biopsies of other areas:

  • colds of the upper respiratory tract
  • any other acute infections
  • decompensation, exacerbation of existing chronic diseases
  • slowing down blood clotting
  • mental disorders
  • allergies to the drugs used.

“You need to get a biopsy” - many have heard this phrase from their attending physician. But why is it needed, what does this procedure provide and how is it carried out?

Concept

Biopsy is diagnostic test, which involves taking biomaterial from a suspicious area of ​​the body, for example, a lump, a tumor formation, a long-term non-healing wound, etc.

This technique is considered the most effective and reliable among all those used in the diagnosis of oncological pathologies.

Photo of breast biopsy

  • Thanks to microscopic examination of the biopsy specimen, tissue cytology can be accurately determined, which gives full information about the disease, its degree, etc.
  • The use of a biopsy makes it possible to identify pathological process at its earliest stage, which helps to avoid many complications.
  • Besides, this diagnosis allows you to determine the volume upcoming operation in cancer patients.

The main task of a biopsy is to determine the nature and nature of pathological tissue. For detailed diagnostics, biopsy examination is supplemented with water x-ray techniques, immunological analysis, endoscopy, etc.

Species

Biomaterial can be collected in different ways.

  1. – a technique for obtaining a biopsy using a special thick needle (trephine).
  2. Excision biopsy is a type of diagnosis in which an entire organ or tumor is removed during the process surgical intervention. It is considered a large-scale type of biopsy.
  3. puncture– This biopsy technique involves obtaining the necessary samples by puncture with a thin needle.
  4. Incisional. Removal affects only a certain part of the organ or tumor and is carried out during a full-fledged surgical operation.
  5. Stereotactic– a minimally invasive diagnostic method, the essence of which is to build a specialized access scheme to a specific suspicious area. Access coordinates are calculated based on a preliminary scan.
  6. Brush biopsy– a variant of the diagnostic procedure using a catheter, inside of which a string with a brush is built to collect biopsy material. This method is also called brush method.
  7. Fine needle aspiration biopsy– a minimally invasive method in which material is collected using a special syringe that sucks out biomaterial from tissues. The method is applicable only for cytological analysis, since it is determined only cellular composition biopsy.
  8. Loop biopsy – a biopsy sample is taken by excision of pathological tissue. The required biomaterial is cut off with a special loop (electric or thermal).
  9. Transthoracic biopsy – invasive diagnostic method, used to obtain biomaterial from the lungs. He is carried through chest open or puncture method. Manipulations are carried out under the supervision of a video thoracoscope or computed tomograph.
  10. Liquid biopsy is latest technology detection of tumor markers in liquid biopsy, blood, lymph, etc.
  11. Radio wave. The procedure is carried out using specialized equipment– Surgitron apparatus. The technique is gentle and does not cause complications.
  12. Open– this type of biopsy is performed using open access to the tissues of which a sample needs to be obtained.
  13. Preskalennaya biopsy is a retroclavicular examination in which a biopsy sample is taken from the supraclavicular lymph nodes and lipid tissues at the angle of the jugular and subclavian veins. The technique is used to identify pulmonary pathologies.

Why is a biopsy done?

A biopsy is indicated in cases where, after other diagnostic procedures, the results obtained are not sufficient to make an accurate diagnosis.

Typically, a biopsy is prescribed upon detection to determine the nature and type of tissue of the formation.

This diagnostic procedure Today it is successfully used to diagnose many pathological conditions, and even non-oncological ones, since in addition to malignancy, the method allows you to determine the degree of spread and severity, stage of development, etc.

The main indication is to study the nature of the tumor, however, a biopsy is often prescribed to monitor the ongoing oncology treatment.

Today, a biopsy can be obtained from almost any area of ​​the body, and the biopsy procedure can perform not only a diagnostic, but also a therapeutic mission, when the pathological focus is removed in the process of obtaining biomaterial.

Contraindications

Despite all the usefulness and highly informative nature of the technique, biopsy has its contraindications:

  • The presence of blood pathologies and problems associated with blood clotting;
  • Intolerance to certain drugs;
  • Chronic myocardial failure;
  • If alternative non-invasive options are available diagnostic options, having similar information content;
  • If the patient refuses to undergo such a procedure in writing.

Material research methods

The resulting biomaterial or biopsy specimen is subjected to further examination using microscopic technologies. Usually biological tissues sent for cytological or histological diagnosis.

Histological

Sending a biopsy sample for histology involves microscopic examination tissue sections, which are placed in a specialized solution, then in paraffin, after which staining and sectioning are carried out.

Staining is necessary so that cells and their areas are better distinguished during microscopic examination, on the basis of which the doctor draws up a conclusion. The patient receives results in 4-14 days.

Sometimes histological examination needs to be done urgently. Then the biomaterial is taken during the operation, the biopsy sample is frozen, and then sections are made and stained according to a similar scheme. The duration of such analysis is no more than 40 minutes.

Doctors have a fairly short period of time to determine the type of tumor, decide on the volume and methods surgical treatment. Therefore, in such situations, urgent histology is practiced.

Cytological

If histology was based on the study of tissue sections, it involves a detailed study cellular structures. Similar technique used if it is not possible to obtain a piece of fabric.

Such diagnostics are carried out mainly to determine the nature of a particular formation - benign, malignant, inflammatory, reactive, precancerous, etc.

The resulting biopsy is used to make a smear on glass, and then conduct a microscopic examination.

Although cytological diagnosis is considered simpler and faster, histology is still more reliable and accurate.

Preparation

Before the biopsy, the patient must undergo laboratory test blood and urine for the presence various kinds infections and inflammatory processes. In addition, magnetic resonance, ultrasound, and x-ray diagnostics are performed.

The doctor studies the picture of the disease and finds out whether the patient is taking medications.

It is very important to tell your doctor about the presence of pathologies of the blood clotting system and allergies to medicines. If the procedure is planned to be carried out under anesthesia, then you should not eat or drink liquid 8 hours before taking the biopsy sample.

How is a biopsy done in certain organs and tissues?

The collection of biomaterial is carried out using general or local anesthesia Therefore, the procedure is usually not accompanied by painful sensations.

The patient is placed on a couch or operating table in the right specialist position After which they begin the process of obtaining a biopsy sample. The total duration of the process is often several minutes, and with invasive methods it can reach half an hour.

In gynecology

The indication for biopsy in gynecological practice is the diagnosis of pathologies of the vagina, ovaries, and external organs of the reproductive system.

Similar diagnostic technique is decisive in the detection of precancerous, background and malignant formations.

In gynecology they use:

  • Incisional biopsy - when tissue is excised with a scalpel;
  • Targeted biopsy - when all manipulations are controlled by extended hysteroscopy or colposcopy;
  • Aspiration – when the biomaterial is obtained by aspiration;
  • Laparoscopic biopsy - this method usually takes a biopsy sample from the ovaries.

Endometrial biopsy is performed using a pipette biopsy, which uses a special curette.

Intestines

A biopsy of the small and large intestines is performed in various ways:

  • puncture;
  • Petlev;
  • Trepanation - when a biopsy is taken using a sharp hollow tube;
  • Shchipkov;
  • Incisional;
  • Scarification - when the biopsy is scraped.

The specific choice of method is determined by the nature and location of the area being examined, but most often they resort to colonoscopy with biopsy.

Pancreas

Biopsy material from the pancreas is obtained in several ways: fine needle aspiration, laparoscopic, transduodental, intraoperative, etc.

Indications for pancreatic biopsy are the need to determine morphological changes pancreatic cells, if present, and to identify other pathological processes.

Muscles

If the doctor suspects that the patient has developed systemic connective tissue pathologies, which are usually accompanied muscle damage, then a biopsy examination of the muscle and muscle fascia will help determine the disease.

Besides, this procedure carried out if there is a suspicion of the development of periarteritis nodosa, dermatopolymyositis, eosinophilic ascites, etc. Similar diagnostics are used using needles or in the open way.

Heart

Biopsy diagnosis of the myocardium helps to detect and confirm pathologies such as myocarditis, cardiomyopathy, ventricular arrhythmia of unknown etiology, as well as to identify processes of transplanted organ rejection.

According to statistics, a right ventricular biopsy is performed more often, with access to the organ through jugular vein right, femoral or subclavian vein. All manipulations are controlled by fluoroscopy and ECG.

A catheter (bioptome) is inserted into the vein, which is adjusted to required area, where you need to get a sample. On the bioptome, special tweezers open and bite off a small piece of tissue. To prevent thrombosis, a special medicine is pumped through the catheter during the procedure.

Bladder

Bladder biopsy in men and women is performed in two ways: cold and TUR biopsy.

The cold method involves transurethral cytoscopic penetration and biopsy sampling with special forceps. TUR biopsy involves removing the entire tumor down to healthy tissue. The purpose of such a biopsy is to remove all visible formations from the bladder walls and make an accurate diagnosis.

Blood

Biopsy examination bone marrow carried out in the case of malignant tumor pathologies of the blood such as.

Also, a biopsy examination of bone marrow tissue is indicated for iron deficiency, splenomegaly, thrombocytopenia and anemia.

The doctor takes away the needle a certain amount red bone marrow and a small bone tissue sample. Sometimes the study is limited to obtaining only a bone tissue sample. The procedure is performed by aspiration or trepanobiopsy.

Eyes

Examination of eye tissue is necessary if there is a tumor of malignant origin. Such tumors are often found in children.

A biopsy helps to obtain a complete picture of the pathology and determine the extent of the tumor process. In the process of diagnosing retinoblastoma, the technique is used aspiration biopsy using vacuum extraction.

Bone tissue

Biopsy bone tissue carried out to identify or infectious processes. Typically, such manipulations are performed percutaneously by puncture, with a thick or thin needle or surgically.

Oral cavity

A biopsy examination of the oral cavity involves obtaining a biopsy sample from the larynx, tonsils, salivary glands, throat and gums. Such diagnostics are prescribed when detecting pathological formations jaw bones or, to determine salivary glandular pathologies, etc.

The procedure is usually carried out facial surgeon. He uses a scalpel to remove part and the entire tumor. The whole procedure takes about a quarter of an hour. Pain is observed when an anesthetic is injected, but there is no pain when a biopsy is taken.

Analysis results

The results of biopsy diagnostics are considered normal if the patient does not have cellular changes in the tissues being examined.

Consequences

The most common consequence similar diagnostics are rapid bleeding and pain at the site of biopsy sampling.

About a third of patients experience moderate to mild pain after a biopsy.

Serious complications after a biopsy usually do not occur, although in rare cases, fatal consequences of the biopsy occur (1 in 10,000 cases).

Post-procedure care

With severe pain syndrome analgesics can be used. Caring for the puncture site or suture (depending on the type of procedure) may vary slightly, but you can remove the bandage only one day after the biopsy, at which time you can take a shower.