Fungal sinusitis: histologic spectrum and correlation with culture

Pathology of Fungal Rhinosinusitis: A Review

“…A second form of non-invasive FRS is the fungal ball, an extramucosal, entangled mass of fungi usually associated with minimal mucosal inflammation [1][2][3][4][5][6][7]. The most recent FRS guidelines consider fungal ball to be the most appropriate term for this entity as opposed to previously used terms, such as ''mycetoma'' (a term used to describe a chronic, soft tissue granulomatous fungal infection) and ''aspergilloma'' (fungal organisms other than Aspergillus sp.…”

“…Fungal cultures are often negative; however the most commonly isolated pathogen is Aspergillus sp. [3][4][5][6][8][9][10][11][12]. Treatment consists of surgical removal of the fungal material without the need for antifungal therapy.…”

“…Allergic FRS occurs in immunocompetent, atopic patients who present with symptoms of chronic rhinosinusitis (CRS) not responsive to standard conservative medical therapy. Allergic FRS is seen more commonly in warm humid climates such as in the southern and southeastern United States, India, and the Middle East, although a high incidence has also been reported in large urban areas in the Midwest and northeastern United States [3][4][5][6][10][11][12]. Grossly, the sinus contents from allergic FRS patients are described as inspissated, clay-like, mucin which is green, brown, or grayish in color.…”

“…or Aspergillus sp. depending on geography [3,4,6,[10][11][12]. In India as well as Saudi Arabia, Aspergillus flavus appears to be the most common fungal organism cultured in allergic FRS; however, in the US, particularly in the South and Southeast, the majority of allergic FRS cases (70-90 %) are associated with dematiaceous fungi [10][11][12][13][14][15][16]30].…”

“…FRS can be acute (aggressive; symptoms \30 days), subacute (symptoms 30-90 days), and chronic (indolent; symptoms [90 days) [1][2][3][4][5][6][7]. FRS is most commonly classified as noninvasive or invasive based on whether fungi have invaded into tissue.…”