真菌性鼻窦炎(FRS)是一种较为常见的鼻窦炎,但鼻旁窦疾病常被误诊。FRS分为侵入式和非侵入式。非侵入性形式包括真菌球和过敏性FRS,侵入性形式包括急性侵入性FRS,慢性侵入性FRS,和肉芽肿性FRS。侵袭性真菌感染与高发病率和死亡率相关。因此需要紧急医疗和手术干预。组织形态学可以帮助识别某些无法培养或在分泌物中很少可见的真菌生物。组织侵袭性和非侵袭性真菌感染的形态学诊断对于适当的治疗至关重要。我们分析了三级癌症医院病理科2017年至2019年的鼻窦炎病例,拉合尔,巴基斯坦。从患者记录中检索所有临床信息。石蜡包埋的组织块用苏木精和伊红(H&E)染色,格罗科特亚甲基胺银染(GMS),和高碘酸希夫染色(PAS)根据标准协议。两位对真菌状况视而不见的病理学家对它们进行了审查。对169例鼻-鼻窦炎病例进行回顾性分析。FRS占146(86.4%)。FRS患者的平均年龄为32.8±14岁。男女比例为1.4:1。上颌窦是39例(27%)FRS患者的主要受累部位。在117例FRS中鉴定出曲霉属(80.1%)。44/146例(30.14%)FRS病例中有培养报告。他们在22/44(50.0%)为阴性,在18/44例(40.9%)的FRS病例中分离出曲霉属。非侵入性FRS84例(57.5%),侵入性FRS59例(40.4%)。在侵入性FRS中,有56例(38.4%)慢性肉芽肿性FRS病例,包括混合模式。多数情况下,54(96.4%),慢性肉芽肿性FRS表现出独特的拥挤巨细胞模式,包括异物和Langhans型巨细胞。这些巨细胞紧密排列,形成被淋巴细胞和纤维化包围的不规则非干酪样肉芽肿。有趣的是,巨细胞随意分散,也没有形成肉芽肿。在所有56例慢性肉芽肿性FRS中鉴定出真菌。组织学上,GMS和PAS染色的优势菌为曲霉属48株(85.7%)。我们的研究观察到了一种独特的拥挤巨细胞模式,这是侵袭性真菌感染的标志。如果病理学家熟悉这种独特的模式,他们可以在组织学上做出快速准确的诊断。医生可以及时开始抗真菌治疗,以获得更好的预后。
Fungal rhinosinusitis (FRS) is a relatively common, but often misdiagnosed disease of paranasal sinuses. The FRS is classified into invasive and non-invasive forms. The non-invasive form includes fungal ball and allergic FRS, and invasive form includes acute invasive FRS, chronic invasive FRS, and
granulomatous FRS. Invasive fungal infections are associated with high morbidity and mortality, hence requiring urgent medical and surgical intervention. The histomorphology can help identify certain fungal organisms that cannot be cultured or are rarely visible in exudates. The morphologic diagnosis of tissue invasive and non-invasive fungal infection is essential for appropriate treatment. We analyzed cases of rhinosinusitis from 2017 to 2019 in Pathology Department at a tertiary care cancer hospital, Lahore, Pakistan. All clinical information was retrieved from patient records. Paraffin-embedded tissue blocks were stained with hematoxylin and eosin (H&E), special Grocott methenamine silver stain (GMS), and periodic acid Schiff stain (PAS) according to standard protocol. They were reviewed by two pathologists blinded by fungus status. A total of 169 cases of rhinosinusitis were reviewed. FRS comprised 146 (86.4%) of them. The mean age of patients with FRS was 32.8±14 years. The male:female ratio was 1.4:1. Maxillary sinus was the main site of involvement in 39 (27%) FRS cases. Aspergillus was identified in 117 (80.1%) cases of FRS. The culture reports were available in 44/146 (30.14%) FRS cases. They were negative in 22/44 (50.0%), and Aspergillus species were isolated in 18/44 (40.9%) cases of FRS. There were 84 (57.5%) cases of non-invasive FRS and 59 (40.4%) cases of invasive FRS. Among invasive FRS, there were 56 (38.4%) chronic
granulomatous FRS cases including mixed patterns. Majority cases, 54 (96.4%), of chronic
granulomatous FRS showed a unique crowded giant cell pattern comprising of foreign body and Langhans type giant cells. These giant cells were arranged closely forming irregular non-caseating granulomas surrounded by lymphocytes and fibrosis. Interestingly, the giant cells were scattered haphazardly without forming a granuloma as well. Fungal organisms were identified in all 56 cases of chronic
granulomatous FRS. Histologically, predominant organism was Aspergillus in 48 (85.7%) on GMS and PAS stain. Our study observed a unique crowded giant cell pattern, which is a hallmark of invasive fungal infection. If pathologists are familiar with this unique pattern, they can make a quick and accurate diagnosis on histology. The physician can start antifungal treatment timely for better prognosis.