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Evidence for a 'preinvasive' variant of fungal sinusitis: Tissue invasion without angioinvasion
Hassan Paknezhad1, Nicole A Borchard1, Greg W Charville1
1Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, USA.
Abstract:
Clinical experience has suggested the existence of an intermediate form of fungal sinusitis between the categories of non-invasive fungal sinusitis (non-IFS) and invasive fungal sinusitis (IFS). This fungal sinusitis variant demonstrates unhealthy mucosa by endoscopy with fungal invasion, but lacks angioinvasion microscopically, representing what clinically behaves as a 'pre-invasive' subtype of fungal sinusitis. Unlike non-IFS disease, patients with pre-invasive fungal sinusitis were still felt to require anti-fungal medications due to histologic presence of invasive fungus. While sharing some clinical features of IFS, these 'intermediate' patients were successfully spared extended and repeated surgical debridements given the microscopic findings, and have been successfully treated with shorter courses of antifungal therapy. These select patients have had favorable outcomes when managed in a judicious and semi-aggressive manner, in an undefined zone between the treatments for routine fungal ball and aggressive IFS.
Insights
A new intermediate form of fungal sinusitis, termed pre-invasive fungal sinusitis, has been identified. This condition requires antifungal treatment but may avoid extensive surgery, offering a less invasive approach for specific patients.
Area of Science:
- Otolaryngology
- Mycology
- Pathology
Background:
- Clinical observations suggest a fungal sinusitis subtype between non-invasive (non-IFS) and invasive (IFS) forms.
- This intermediate type exhibits mucosal disease and fungal invasion without microscopic angioinvasion.
Purpose of the Study:
- To define and characterize this 'pre-invasive' fungal sinusitis.
- To establish appropriate management strategies differentiating it from non-IFS and IFS.
Main Methods:
- Clinical case review and endoscopic evaluation.
- Histopathological analysis to assess for angioinvasion.
- Comparison of treatment outcomes based on disease classification.
Main Results:
- Identified a 'pre-invasive' fungal sinusitis variant with unhealthy mucosa and fungal invasion, but no angioinvasion.
- Patients with this variant required antifungal medication but benefited from avoiding extensive surgery.
- Shorter antifungal courses and judicious management led to favorable outcomes.
Conclusions:
- Pre-invasive fungal sinusitis represents a distinct clinical entity.
- This subtype can be managed effectively with a tailored approach, balancing antifungal therapy and surgical intervention.
- Recognizing this intermediate form optimizes patient care and outcomes.
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