Differential Diagnosis of Necrotizing Sinonasal Lesions

Abstract

Context A number of entities may result in necrosis in the sinonasal tract and lead to significant morbidity and mortality. These include infections, necrotizing vasculitis, neoplastic processes, and drug dependency. This review will concentrate on the differential diagnosis of sinonasal necrotizing lesions. Objective To review the differential diagnoses of necrotizing destructive lesions of the sinonasal tract. Data Sources The current literature was reviewed to provide updated information regarding the differential diagnosis of sinonasal necrotizing lesions, including infectious disease processes; antineutrophilic cytoplasmic antibody–associated vasculitides; neoplastic processes, particularly natural killer/T-cell lymphomas; and drug abuse. Conclusions The differential diagnosis of necrotizing sinonasal lesions is broad, with often overlapping diagnostic features that lead to diagnostic challenges. Ancillary tests such as special stains and immunohistochemical studies can offer significant assistance.

Pathology of Fungal Rhinosinusitis: A Review

“…This entity occurs in the background of acquired immunodeficiency syndrome, solid organ transplantation, diabetes, and in patients undergoing treatment with corticosteroids. A. fumigatus is the most common fungus isolated in these patients [1,2,44]. In contrast to granulomatous fungal sinusitis, fungal organisms are more numerous, there is a sparse inflammatory infiltrate, and occasionally angioinvasion (Fig.…”

“…The infection is characterized the presence of submucosal granulomatous inflammation, rare fungal hyphae, and extensive fibrosis [10][11][12]44] (Fig. 5).…”

Intranasal tissue necrosis associated with opioid abuse: Case report and systematic review

“…Following exclusion of IFRS by tissue biopsy, alternative hypotheses of intranasal tissue necrosis may be considered, including bacterial, autoimmune, neoplastic, and iatrogenic causes . Further examination of collected tissues using special pathologic staining techniques may help in limiting this broad differential, with antineutrophil cytoplasmic antibody stains evaluating for autoimmune causes such as granulomatosis with polyangiitis, hematoxylin and eosin stains for neoplastic change or granuloma formation, and polarization by light microscopy to evaluate for evidence of tablet inhalation .…”

“…5,8 Following exclusion of IFRS by tissue biopsy, alternative hypotheses of intranasal tissue necrosis may be considered, including bacterial, autoimmune, neoplastic, and iatrogenic causes. 18 Further examination of collected tissues using special pathologic staining techniques may help in limiting this broad differential, with antineutrophil cytoplasmic antibody stains evaluating for autoimmune causes such as granulomatosis with polyangiitis, hematoxylin and eosin stains for neoplastic change or granuloma formation, and polarization by light microscopy to evaluate for evidence of tablet inhalation. 19 In addition, evaluation with a toxicology screen, chest X-ray, complete blood count with differential, angiotensinconverting enzyme level, antinuclear antibody, rheumatoid factor, erythrocyte sedimentation rate, Anti-Sj€ ogren'ssyndrome-related antigens A (SSA/Ro) and B (SSB/La), and human immunodeficiency virus (HIV) -1/HIV-2 immunoassay may be considered.…”

Chronic Myelomonocytic Leukemia Mimicking Invasive Fungal Rhinosinusitis

“…Vasculitic etiologies include granulomatosis with polyangiitis (GPA) and eosinophilic GPA. 5,6 Infectious mimics of AIFR include bacterial and parasitic disease. 5,6 Neoplastic mimics can be divided into primary cancers, such as sinonasal carcinoma; metastatic cancer, such as breast cancer; and hematologic cancers, such as lymphoma and leukemia.…”