Director, Pediatric Otolaryngology--Head and Neck Surgery Vanderbilt University Medical Center Nashville, Tennessee
Objective(s): Unchecked eosinophilic inflammation leads to epithelial dysfunction and fibrosis in eosinophilic esophagitis(EoE). Poor epithelial barrier function, elevated eosinophil density and elevated eosinophil chemoattractants have been demonstrated on immunohistochemical (IHC) staining of esophageal biopsies in patients with EoE. The objective of this study is to determine the extent to which eosinophilic laryngitis (elevated laryngeal eosinophils) resembles EoE based on IHC and epithelial histology.
Methods:Forty-nine patients, aged 0-18 years, with aerodigestive disease underwent routine arytenoid biopsy as clinical specimens (formalin-fixed, paraffin-embedded (FFPE)). A population of patients with elevated laryngeal eosinophils, elevated laryngeal mast cells and neither were subjected to systematic histopathological analysis as well as IHC staining for filaggrin, eotaxin-3, mast cell tryptase and eosinophil cytoplasmic granules (Luna). Review of EMR assessed concomitant esophageal biopsy evidence for EoE.
Results: Luna staining identified eosinophils/um2 (mean=9.5, median=2.1, range=(0-156), compared to mean=0.5, median=0, range=(0-15) identified by histopathology (H&E) per high-powered field. Samples with high eotaxin 3 staining density correlated with high areal MCT expression (Pearson’s rho=0.80, p=0.000) and areal Luna staining (Pearson’s rho=0.80, p=0.000), whereas filaggrin-positive cell staining demonstrated Pearson’s rho=0.10, p=0.661. Four patients (8.2%) had EoE on biopsy.
Conclusions: Patients with higher staining density for eotaxin 3 tended to have higher staining density for eosinophils and for mast cell-expressed tryptase. These correlations suggest laryngeal eosinophils may be part of an inflammatory milieu amplified by eotaxin3 and related to mast cell activity—resembling EoE. However, there was no demonstrable relationship between eotaxin3 and filaggrin-positive staining.