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Microinvasive Fungal Rhinosinusitis: Proposal of a New Subtype in the Classification
Min Young Seo1,2, Hyeri Seok3,4, Seung Hoon Lee1
1Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan 15355, Korea.
Background:
Fungal rhinosinusitis (FRS) with mucosal invasion is not classified by the current criteria, and clinical reports on the topic are limited. The aim of this study was to present our 25-year experience on fungal balls with mucosal invasion that do not appear in the FRS classification.
Methods:
Of 1318 patients who underwent endoscopic surgery with paranasal FRS between November 1994 and July 2019, 372 underwent mucosal biopsies. Medical chart and pathology review were performed on 13 patients diagnosed as having fungal balls with mucosal invasion without accompanying tissue invasion.
Results:
Histopathologic findings identified all fungi as belonging to the Aspergillus species. In 13 patients, 7 fungal balls were located in the maxillary sinus, 3 in the sphenoid sinus, and 3 in both the maxillary and ethmoid sinuses. The median age at diagnosis was 67 years (interquartile range (IQR): 62-72), and the sex ratio was 1:2 (4 men and 9 women). Five patients had comorbidities-three with diabetes mellitus and two with hematologic malignancy-all of whom received postoperative antifungal therapy. The median duration of antifungal treatment was 13 weeks (IQR: 8-17). No recurrences occurred during the median follow-up period of 30 months (IQR: 22-43).
Conclusions:
Patients who have been clinically diagnosed with a fungal ball and showed mucosal invasion but no vascular invasion, based on pathologic findings after surgery, may need a new FRS classification category, such as microinvasive FRS, and adjuvant antifungal treatment may be needed for immunocompromised patients with microinvasive FRS.
Key Points:
Fungal rhinosinusitis with mucosal invasion is different from fungal ball and invasive fungal rhinosinusitis and may be classified in a separate category as microinvasive FRS.
Insights
Fungal rhinosinusitis with mucosal invasion, distinct from fungal balls, may require a new classification as microinvasive FRS. This condition, identified in 13 patients, showed no recurrences after treatment.
Area of Science:
- Otolaryngology
- Mycology
- Pathology
Background:
- Current fungal rhinosinusitis (FRS) criteria do not classify mucosal invasion.
- Clinical data on FRS with mucosal invasion are limited.
- This study presents a 25-year experience with fungal balls exhibiting mucosal invasion, not fitting existing FRS classifications.
Purpose of the Study:
- To describe the clinical and pathological characteristics of fungal balls with mucosal invasion.
- To evaluate the outcomes of surgical and antifungal treatment for this condition.
- To propose a potential new classification for microinvasive FRS.
Main Methods:
- Retrospective review of 1318 patients with FRS undergoing endoscopic surgery.
- Analysis of medical charts and pathology reports for 13 patients with fungal balls and mucosal invasion without tissue invasion.
- Histopathologic identification of fungal species and assessment of invasion patterns.
Main Results:
- All identified fungi were *Aspergillus* species.
- Fungal balls were primarily located in the maxillary and sphenoid sinuses.
- Median age at diagnosis was 67 years; 9 women and 4 men. Five patients had comorbidities and received antifungal therapy.
- No recurrences were observed during a median follow-up of 30 months.
Conclusions:
- Fungal rhinosinusitis with mucosal invasion represents a distinct entity from fungal balls and invasive FRS.
- A new classification, 'microinvasive FRS', is proposed for fungal balls with mucosal invasion but no vascular invasion.
- Adjuvant antifungal treatment may benefit immunocompromised patients with microinvasive FRS.
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