Clinicopathologic and Immunohistochemical Characteristics of Fungal Sinusitis

Background and Purpose: Fungal sinusitis (FS) is a common disease in Taiwan. Histologically, there are 4 types of FS, i.e., acute invasive, chronic invasive, fungal ball and allergic FS. Among the various fungal pathogens, ”Aspergillus” is the most important. This study analyzed results of antibody staining against ”Aspergillus” species on tissue sections of FS to identify fungal elements and evaluated the role of ”Aspergillus” in different types of FS. Methods: We retrospectively reviewed140 cases with a pathologic diagnosis of FS in our hospital from 1995 to 2003. The clinical information, hematoxylin and eosin staining, and Gomori methenamine silver staining results for each patient were analyzed. Patients were reclassified into 4 categories of FS according to histologic presentation. The causative fungi were divided into ”Aspergillus” and non-”Aspergillus” group according to the results of immunoreactivity against anti-”Aspergillus” antibody. Results: Fungal ball was diagnosed in 126 patients (90%), 66.6% of whom were females. Only 3 patients died of underlying disease not related to the fungal infection. Immunohistochemical staining demonstratd ”Aspergillus” infection in 108 out of 119 patients (90.7%). Thirteen patients were categorized as having acute invasive FS due to the presence of vascular and stromal invasion. All but 1 patient had underlying diseases associated with immunocompromised status and 1 lout of the 13 patients died of sepsis. Immunohistochemical study revealed 5 of these patients were infected with ”Aspergillus” species, and the other 8 were infected with non-”Aspergillus” fungi. Allergic FS was diagnosed in 1 patient based on the presence of allergic mucin containing numerous eosinophils and few fungal hyphae. The fungal elements were negative for anti-”Aspergillus” antibody. None of the patients had chronic invasive FS. Conclusion: Fungal ball and acute invasive FS were the 2 most common types of FS in this study from Taiwan. However, both allergic FS and chronic invasive FS are rare. Immunohistochemical staining was useful in identifying specific species of fungus in tissue sections. ”Aspergillus” accounted for 90.7% of fungal ball infections and 38.4% of acute invasive FS infections. It is important to differentiate among the categories of FS because the clinical course, etiology, treatment and prognosis are quite different.

並列關鍵字

Aspergillus ； Immunohistochemistry ； Mycoses ； Retrospective studies ； Sinusitis

國際替代計量

全文下載

主題瀏覽