scholarly journals Microinvasive Fungal Rhinosinusitis: Proposal of a New Subtype in the Classification

2020 ◽  
Vol 9 (2) ◽  
pp. 600
Author(s):  
Min Young Seo ◽  
Hyeri Seok ◽  
Seung Hoon Lee ◽  
Ji Eun Choi ◽  
Sang Duk Hong ◽  
...  
Keyword(s):  
Hematologic Malignancy ◽  
Antifungal Treatment ◽  
Fungal Ball ◽  
Fungal Rhinosinusitis ◽  
Key Points ◽  
Ethmoid Sinuses ◽  
Histopathologic Findings ◽  
Classification Category ◽  
Invasive Fungal Rhinosinusitis

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.

scholarly journals Invasive fungal rhinosinusitis associated with COVID-19: An observational study

2021 ◽  
Vol 7 (4) ◽  
pp. 237-241
Author(s):  
Bhagyashri Jadhav ◽  
Neeta Patwardhan
Keyword(s):  
Observational Study ◽  
Viral Infections ◽  
Respiratory Infections ◽  
Fungal Infections ◽  
Fungal Rhinosinusitis ◽  
Acute Invasive Fungal Rhinosinusitis ◽  
History Of ◽  
Lost To Follow Up ◽  
Invasive Fungal Rhinosinusitis

Respiratory Viral infections predispose patients to various coinfections and this may lead to enhanced disease severity and mortality. Despite the proven importance of co-infections, these are understudied during the large outbreaks of respiratory infections. Occurrence of invasive fungal respiratory superinfections in patients with COVID-19 has gained increasing attention recently. This study aims to assess Clinical & Microbiological profile of patients with invasive sinusitis in setting of COVID-19 disease at our institute Study Design: A retrospective observational study. Study included patients diagnosed with acute invasive fungal rhinosinusitis (AIFR) suffering from or having a history of coronavirus disease infection over the period of three months.(April 21 – June 21). The patients’ presentation details, imaging findings, co-morbidities, management details, and follow-up information were obtained, recorded and analysed. A total of 32 patients with AIFR with a mean age of 54.46±13.13 years old were included. Most common associated disease was diabetes mellitus (62.5%). Mycological analysis revealed most common fungi isolated from these patients were Mucor species.(56.25%) followed by Aspergillus species(15.62%) while coinfection with both of these species was seen in 5 patients.(15.62%) Candida species was isolated from samples of 4 patients (12.5%). Radiological studies of nose and paranasal sinuses showed that ethmoid (62.5%) and maxillary (46.87%) sinuses being the most commonly affected sinuses followed by Frontal (31.25%) and sphenoid (21.87%) sinuses. Peri-orbital invasion was seen in 5 (15.62%) cases whereas intracranial involvement was seen in 1 patient.(3.12%) In 8 (25%) patients only medical line of treatment was sufficient whereas 20 (62.5%) patients required surgical debridement during the treatment. 4 patients were lost to follow up. Overall survival was 90.62% (29/32) at the conclusion of the study. We are still learning the new and long-term complications of COVID- 19.The puzzle still remains unsolved about the cause and increased prevalence of invasive fungal infections in post-covid-19 population. High clinical suspicion and early and accurate diagnosis of AIFR in COVID-19 patients are essential for better prognosis.

scholarly journals Bioabsorbable Steroid-Releasing Sinus Implants in the Frontal and Maxillary Sinuses: 2-Year Follow-Up

2015 ◽  
Vol 6 (2) ◽  
pp. ar.2015.6.0117 ◽  
Author(s):  
Keith E. Matheny
Keyword(s):  
Topical Therapy ◽  
Signs And Symptoms ◽  
Sinus Surgery ◽  
Fungal Rhinosinusitis ◽  
Allergic Fungal Rhinosinusitis ◽  
Inflammatory Bowel ◽  
The Right ◽  
Ethmoid Sinuses ◽  
Maxillary Sinuses

Background Mometasone furoate-releasing implants have been approved for use in the ethmoid sinuses following endoscopic sinus surgery (ESS) to reduce the need for medical and surgical intervention postoperatively. Outcomes have not yet been studied when these implants are utilized in other paranasal sinuses after ESS. Objective To present a case in which bioabsorbable steroid-eluting implants were used to maintain patency and to decrease inflammation in the frontal and maxillary sinuses after revision ESS. Methods 52-year-old male with lifelong allergic rhinitis, chronic allergic fungal rhinosinusitis, and inflammatory bowel disease had previously undergone four endoscopic sinus surgeries, subcutaneous injection immunotherapy, and topical therapy with budesonide and amphotericin sinus irrigations. In July, 2012, during revision left frontal sinusotomy and right maxillary antrostomy (the fifth ESS), two bioabsorbable steroid-releasing implants were placed in the left frontal recess and the right maxillary sinus respectively and followed clinically, endoscopically, and radiographically for two years. Results Two year followup demonstrated near complete clinical, endoscopic, and radiographic resolution of the patient's signs and symptoms of chronic rhinosinusitis. Conclusions The steroid-releasing implants during the critical phase of wound-healing appear to have allowed the patient, now over two years postoperatively, to achieve a healthier state and to allow more successful management than the preceding 15–20 years.

scholarly journals Surgical Management of Fungal Rhinosinusitis

2009 ◽  
Vol 1 (1) ◽  
pp. 69-75
Keyword(s):  
Surgical Management ◽  
Current Treatment ◽  
Sinus Surgery ◽  
Surgical Approaches ◽  
Treatment Protocols ◽  
Fungal Rhinosinusitis ◽  
Intracranial Involvement ◽  
Invasive Fungal Rhinosinusitis ◽  
Orbital Soft Tissue

Abstract Fungal rhinosinusitis is on the rise. Most current treatment protocols for fungal rhinosinusitis include surgery combined with medical therapy. Endoscopic sinus surgery has revolutionized the management of this disease limiting the use of the open surgical approaches to very extensive cases with orbital, soft tissue or intracranial involvement by invasive fungal rhinosinusitis. A regular and thorough follow-up is mandatory in all cases to check for recurrences. This article discusses the various forms of fungal rhinosinusitis and their surgical management.

scholarly journals Understanding acute invasive fungal rhinosinusitis for better treatment outcomes

2019 ◽  
Vol 5 (2) ◽  
pp. 383
Author(s):  
Monika Patel ◽  
Maitri Kaushik ◽  
Arun Dehadaray ◽  
Gargi Kar
Keyword(s):  
Early Diagnosis ◽  
Treatment Outcomes ◽  
Tertiary Care ◽  
Good Prognosis ◽  
Surgical Debridement ◽  
Antifungal Treatment ◽  
Cerebral Disease ◽  
Fungal Rhinosinusitis ◽  
Acute Invasive Fungal Rhinosinusitis ◽  
Invasive Fungal Rhinosinusitis

<p class="abstract"><strong>Background:</strong> Objectives of the study were to identify factors that affect patient survival, determine treatment outcomes in various clinical presentations, increase awareness amongst clinicians and provide more accurate treatment options to patients. Study design was a retrospective study. Study places were Tertiary care centre and a Medical College.</p><p class="abstract"><strong>Methods:</strong> A series of patients diagnosed and treated for acute invasive fungal rhinosinusitis over a period of 7 years.  </p><p class="abstract"><strong>Results:</strong> Twelve patients were reviewed out of which eleven were diabetic. Most common fungus encountered was mucor. Six cases presented as sinonasal disease, four as rhino-orbital disease and two as rhino-orbito-cerebral disease. All the patients underwent surgical debridement with systemic antifungal treatment. It was seen that diseases confined to sino nasal areas had good prognosis. Early diagnosis and prompt intervention is major factor for better prognosis.</p><p class="abstract"><strong>Conclusions:</strong> Immunocompromised patients in ICU with ocular symptoms should be meticulously screened for invasive fungal rhinosinusitis. Early diagnosis and prompt management with surgical debridement and systemic antifungal treatment is utmost important factor in good prognosis. Intensivists and also the physicians should be made cognizant as they play important role in patient management as well. Multidisciplinary approach is the need of hour.</p>

Paranasal Sinus Mucocele Clinical, imagistic and biochemical aspects

2018 ◽  
Vol 69 (8) ◽  
Author(s):  
Doina Vesa ◽  
Cristian Martu ◽  
Razvan Leata ◽  
Ludmila Lozneanu ◽  
luminita Radulescu ◽  
...  
Keyword(s):  
Facial Asymmetry ◽  
Retrospective Case ◽  
Mri Scans ◽  
The One ◽  
Ethmoid Sinuses ◽  
Retrospective Case Study ◽  
Cellular Components ◽  
Ct And Mri

Paranasal mucoceles are a type of cysts that evolve slowly and are asymptomatic; this poses a difficulty in diagnosing the patient because the symptoms can go unnoticed. The mucocele evolves unpredictably. On the one hand, it can become infected turning into pyoceles and on the other hand, it can invade important regions such as the orbital, cranial or genian regions, creating facial asymmetry. This is a retrospective case study of 37 patients diagnosed with sinus mucoceles, followed up by clinical examination and paraclinical tests such as CT and MRI scans. The biochemical components of the liquid from within the mucocele were analyzed and the following criteria were recorded: NaCl-, Cl-, Na+ and cholesterine as well as cellular components such as mastocytes, macrophages, hematocytes and leucocytes. In all cases, the treatment option was surgery with favorable post-operative and follow-up evaluation. The mucoceles that appeared post-operatively (maxillary and ethmoid sinuses) evolved more rapidly than the mucoceles that were induced byan external injury. Longer follow-up of operated patients permitted a more timely diagnosis of recurrences.

scholarly journals The impact of COVID-19 outbreak on the incidence of acute invasive fungal rhinosinusitis

2021 ◽  
pp. 103080
Author(s):  
Wael F. Ismaiel ◽  
Mohamed H. Abdelazim ◽  
Ibrahim Eldsoky ◽  
Ahmed A. Ibrahim ◽  
Mahmoud E. Alsobky ◽  
...  
Keyword(s):  
Fungal Rhinosinusitis ◽  
Acute Invasive Fungal Rhinosinusitis ◽  
The Impact ◽  
Invasive Fungal Rhinosinusitis

Lactotransferrin-Related Breast Amyloidosis: Report of a First Case

2021 ◽  
pp. 106689692110160
Author(s):  
Mingfei Yan ◽  
Mark Rodgers ◽  
Aparna Harbhajanka ◽  
Hannah Gilmore
Keyword(s):  
Breast Lesion ◽  
Hematologic Malignancy ◽  
Genetic Disorders ◽  
Rare Condition ◽  
Myoepithelial Cells ◽  
Hematological Disorders ◽  
First Case ◽  
Benign Nature ◽  
Extensive Involvement

Breast amyloidosis is a rare condition which is mostly associated with hematological disorders or hereditary genetic disorders. Imaging findings of breast amyloidosis can mimic malignancy, which often leads to biopsy or excision of the lesion. Here, we presented a case of localized lactotransferrin-related breast amyloidosis in an elderly female patient. Histologic examination revealed extensive involvement of breast lobules by amorphous amyloid materials, with attenuation of lobular structures and prominent calcifications. Positive immunostains for myoepithelial cells helped to exclude the possibility of invasive carcinoma. The patient had no hematologic malignancy besides immunoglobulin G lambda monoclonal gammopathy of undetermined significance. Mass spectrometry of the breast amyloid identified lactotransferrin and no immunoglobulin or its light chain. On follow-up, the patient showed no recurrence of the breast lesion after local excision nor showed other systematic comorbidities, indicating the benign nature of the lesion. This first report of lactotransferrin-related amyloidosis may represent a special type of localized breast amyloidosis that has no correlation with systematic disorders.

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