Mycotic infections of the nasal cavity and paranasal sinuses represent a wide spectrum of disorders that vary in clinical presentation, histopathologic appearances, and biological significance. The second most common form is a fungal ball.
The objective of the research was to describe the cases of paranasal sinus fungal ball found in the files of patients with chronic rhinosinusitis.
Materials and Methods. There were demonstrated clinical and histopathological data of two patients.
Results. A 42-year-old woman and a 40-year-old man with chronic hypertrophic sinusitis had a large amount of friable cheesy mass in the maxillary sinus. The female patient previously underwent upper dental arch sanation. Histology revealed dense laminated masses of matted fungal hyphae that were separate from the mucosa. Sinonasal mucosa showed mild chronic inflammation (male) and severe non-specific chronic active inflammation (female). No evidence of fungal invasion in the mucosa was found.
Conclusions. Fungal ball represents a non-invasive form of mycotic rhinosinusitis with favourable prognosis. Biopsy examination plays an important role in the diagnostic process. Although the diagnosis can also be achieved by polymerase chain reaction assays, biopsy is the only way to explore the status of an inflammatory damage to adjacent tissue and, thus, to rule out potential invasive mycotic sinus disease with much worse clinical outcome.
Deutsch, Whittaker, Prasad. Invasive and Non-Invasive Fungal Rhinosinusitis—A Review and Update of the Evidence. Medicina [Internet]. 2019 Jun 28;55(7):319. Available from: https://doi.org/10.3390/medicina55070319
Chakrabarti A, Das A, Panda NK. Controversies surrounding the categorization of fungal sinusitis. Medical Mycology [Internet]. 2009 Jan;47(s1):S299–S308. Available from: https://doi.org/10.1080/13693780802213357
Chakrabarti A, Denning DW, Ferguson BJ, Ponikau J, Buzina W, Kita H, et al. Fungal rhinosinusitis. The Laryngoscope [Internet]. 2009 Jun 18;119(9):1809–1818. Available from: https://doi.org/10.1002/lary.20520
Montone KT. Pathology of Fungal Rhinosinusitis: A Review. Head and Neck Pathology [Internet]. 2016 Feb 1;10(1):40–46. Available from: https://doi.org/10.1007/s12105-016-0690-0
Lu Y-T, Wang S-H, Liou M-L, Shen T-A, Lu Y-C, Hsin C-H, et al. Microbiota Dysbiosis in Fungal Rhinosinusitis. Journal of Clinical Medicine [Internet]. 2019 Nov 14;8(11):1973. Available from: https://doi.org/10.3390/jcm8111973
Wang L-L, Chen F-J, Yang L-S, Li J-E. Analysis of pathogenetic process of fungal rhinosinusitis: Report of two cases. World Journal of Clinical Cases [Internet]. 2020 Jan 26;8(2):451–463. Available from: https://doi.org/10.12998/wjcc.v8.i2.451
Seo MY, Seok H, Lee SH, Choi JE, Hong SD, Chung S-K, et al. Microinvasive Fungal Rhinosinusitis: Proposal of a New Subtype in the Classification. Journal of Clinical Medicine [Internet]. 2020 Feb 24;9(2):600. Available from: https://doi.org/10.3390/jcm9020600
Montone KT, Livolsi VA, Feldman MD, Palmer J, Chiu AG, Lanza DC, et al. Fungal Rhinosinusitis: A Retrospective Microbiologic and Pathologic Review of 400 Patients at a Single University Medical Center. International Journal of Otolaryngology [Internet]. 2012;2012:1–9. Available from: https://doi.org/10.1155/2012/684835
Kim DW, Kim YM, Min J-Y, Kim J-W, Kim J-K, Mo J-H, et al. Clinicopathologic characteristics of paranasal sinus fungus ball: retrospective, multicenter study in Korea. European Archives of Oto-Rhino-Laryngology [Internet]. 2019 Nov 28;277(3):761–765. Available from: https://doi.org/10.1007/s00405-019-05738-5
Shcherbakov D, Klimova N, Malysheva T, Shcherbakova A. Large Fungal Ball of the Paranasal Sinuses and Nasal Cavity: Two Case Reports. International Journal of Biomedicine [Internet]. 2019 Dec 15;9(4):376–378. Available from: https://doi.org/10.21103/Article9(4)_CR1
Liu X, Liu C, Wei H, He S, Dong S, Zhou B, et al. A retrospective analysis of 1,717 paranasal sinus fungus ball cases from 2008 to 2017. The Laryngoscope [Internet]. 2019 Aug 29;130(1):75–79. Available from: https://doi.org/10.1002/lary.27869
Dufour X, Kauffmann-Lacroix C, Ferrie JC, Goujon JM, Rodier MH, Klossek JM. Paranasal sinus fungus ball: epidemiology, clinical features and diagnosis. A retrospective analysis of 173 cases from a single medical center in France, 1989–2002. Medical Mycology [Internet]. 2006 Jan;44(1):61–67. Available from: https://doi.org/10.1080/13693780500235728
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