Fine Needle Aspiration Cytology: A Useful Technique for Diagnosis of Invasive Fungal Rhinosinusitis

Abstract

Mycotic infections are on the rise globally. Patients with invasive fungal infection of the paranasal sinuses often present with destructive mass lesions and mimic malignancy clinically and radiologically. To assess the utility of Fine needle aspiration cytology for early diagnosis of invasive fungal rhinosinusitis. Fine needle aspiration cytology was performed from the maxillary/ethmoid sinus in patients with a destructive mass lesion in the maxilla. Differential diagnoses were malignancy and fungal rhinosinusitis. In eight cases fungi were detected on initial examination whereas in a single case that was initially reported as giant cell lesion, hyphae could be identified within giant cells, on review. Smears showed inflammatory cells with variable numbers of eosinophils with neutrophils and histiocytes. Foreign body giant cells were seen in all cases. The fungi conformed to morphology of aspergillus in seven cases (77.78 %); in two cases (22.22 %), typing could not be done. Periodic acid Schiff and Grocott stains highlighted the fungi in all the cases. Fine needle aspiration is a simple technique that can be useful for diagnosis of fungal rhinosinusitis and to exclude malignancy. Search for fungus may be more aggressive in smears with many foreign body giant cells and inflammatory cells and in cases with a high clinical suspicion. Differentiation between aspergillus and mucor can be made with help of special stains. Aspergillus is the commonest agent isolated. Preoperative cytological diagnosis obviates the need for biopsy, saves time and helps to plan proper treatment.

Role of fine‐needle aspiration cytology in early diagnosis of fungal infections

“…The yield and efficacy of FNA cytology in the identification of pathogens has been demonstrated in several publications 1‐3,9‐14 . Presumptive diagnosis based on morphology of fungal yeasts can be provided in the majority of the cases involving the four most common of these fungi: Histoplasma , Cryptococcus , Blastomyces , and Coccidioides , usually found in immunocompromised patients 11‐12 .…”

“…The yield and efficacy of FNA cytology in the identification of pathogens has been demonstrated in several publications. [1][2][3][9][10][11][12][13][14] Presumptive diagnosis based on morphology of fungal yeasts can be provided in the majority of the cases involving the four most common of these fungi: Histoplasma, Cryptococcus, Blastomyces, and Coccidioides, usually found in immunocompromised patients. [11][12] Characteristic cytologic features, along with appropriate combination of stains (Table 3), allow an accurate distinction among these fungi, especially when the observer is experienced.…”

First report of invasive Aspergillus rhinosinusitis in a critically ill COVID‐19 patient affected by acute myeloid leukemia, northeastern Iran

“…Although opportunistic hyaline fungi such as Aspergillus , Penicillium , and Rhizomucor are commonly reported causes of fungal rhinosinusitis, some coenocytic fungi such as Bipolaris , Curvularia , Alternaria , and Neoscytalidium are also have been observed with increasing frequency 7,8,13,14 . Generally, fungal rhinosinusitis is seen in warm and dry climatic conditions, and it is particularly common in young men from rural areas 7,8,15 . In the current case, also this patient had rural communities.…”

Slowly progressive invasive rhino‐orbito‐cerebral aspergillosis: case report and literature review

“…There are several reports of fungal rhinosinusitis and lesions associated with A. flavus in Iran and in the rural population in India . It is commonly seen in warm and dry climatic conditions, and it is particularly common in young men from rural background . The Aspergillus genre is becoming an increasingly recognized pathogen in the nasal tract .…”