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Presented by Dr. Pedram Argani and prepared by Dr. Harsimar Kaur
This is a 67 year old male with sinusitis.
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1. Question
This is a 67 year old male with sinusitis.
Correct
Answer: B
Histologic Description: This specimen consists of respiratory mucosa which demonstrates chronic inflammation and only scattered eosinophils. Also in the specimen are large arrogates of fungal hyphae, forming cohesive clusters. There is no evidence of tissue invasion and no significant tissue eosinophilia. These findings are typical of a mycetoma (fungus ball).
Differential Diagnosis: Allergic fungal sinusitis represents a prominent eosinophil rich inflammatory reaction to rare scattered hyphae within the nasal mucus. It is typically seen in atopic patients and here the fungus acts as an allergen. Invasive fungal sinusitis occurs in severely compromised neutropenic patients (typically patients with cancer who are undergoing chemotherapy), and usually involves vascular invasion without a prominent inflammatory response. One sees these fungi in dead tissue associated with vascular invasion. Chronic indolent fungal sinusitis is seen in mildly immunocompromised patients such as diabetics, and is characterized by minimal tissue invasion that is commonly associated with granulomatous reaction.
Sinus mycetoma (fungus ball) is often associated with abnormal sinus anatomy secondary to prior episodes of sinusitis, and represents colonization of these cavities by fungus. Here the fungus is a saprophyte. Treatment is typically debridement and aeration.
Incorrect
Answer: B
Histologic Description: This specimen consists of respiratory mucosa which demonstrates chronic inflammation and only scattered eosinophils. Also in the specimen are large arrogates of fungal hyphae, forming cohesive clusters. There is no evidence of tissue invasion and no significant tissue eosinophilia. These findings are typical of a mycetoma (fungus ball).
Differential Diagnosis: Allergic fungal sinusitis represents a prominent eosinophil rich inflammatory reaction to rare scattered hyphae within the nasal mucus. It is typically seen in atopic patients and here the fungus acts as an allergen. Invasive fungal sinusitis occurs in severely compromised neutropenic patients (typically patients with cancer who are undergoing chemotherapy), and usually involves vascular invasion without a prominent inflammatory response. One sees these fungi in dead tissue associated with vascular invasion. Chronic indolent fungal sinusitis is seen in mildly immunocompromised patients such as diabetics, and is characterized by minimal tissue invasion that is commonly associated with granulomatous reaction.
Sinus mycetoma (fungus ball) is often associated with abnormal sinus anatomy secondary to prior episodes of sinusitis, and represents colonization of these cavities by fungus. Here the fungus is a saprophyte. Treatment is typically debridement and aeration.
