Fine‐needle aspiration biopsy as an initial diagnostic modality in a clinically unsuspected case of invasive maxillary fungal sinusitis: A case report

Abstract

Cases of invasive fungal lesions involving the paranasal sinuses are generally diagnosed either on histologic examination or on fungal culture. Here, we report a case of invasive fungal sinusitis diagnosed primarily by a fine-needle aspiration biopsy (FNAB).Our patient was a 36-year-old male who presented with a history of slowly progressive, painless swelling over the left cheek. The only positive clinical finding was a bony hard swelling in the left maxillary region, which was clinically interpreted as "fibrous dysplasia." A computed tomographic (CT) examination of the paranasal sinuses showed a soft tissue attenuation lesion involving the bilateral maxillae, with the destruction of multiple bones and involvement of multiple sinuses and the bilateral orbits. FNAB of the maxillary swelling showed several giant cells, many of them exhibiting ingested organisms with a morphologic resemblance to the Aspergillus species of fungi. Strikingly, no significant inflammatory cells were seen on cytologic smears. Unfortunately, owing to a lack of initial clinical suspicion, as well as the patient's loss to further follow-up, a culture/histopathologic examination could not be carried out.This case is presented chiefly to highlight the clinical utility of a simple FNAB procedure, as an initial diagnostic modality in cases of fungal sinusitis, which can masquerade clinically as a neoplastic lesion. In addition, if radiologic findings are also available at the time of cytologic examination, a pretherapeutic comment on the invasive nature of the lesion can also be made.

Concurrence of polyostotic fibrous dysplasia and spinal aspergillus in non-immunocompromised adult patient:case report

“…Vinas et al (15) detected underlying diseases including hematological malignancy, chronic granulamatosis, organ transplantation, corticosteroid use, surgical intervention history, tuberculosis in most of the patients in their study, while no immunosuppressants were reported in three patients as in our case. Fibrous dysplasia and Aspergillus infections may interfere in the clinical diagnosis (16), however in our case there was a coexistence of Aspergillus infection and fibrous dysplasia. In Aspergillus infections, spinal involvement is seldom and radiological findings remind tuberculosis (2).…”

Fine Needle Aspiration Cytology: A Useful Technique for Diagnosis of Invasive Fungal Rhinosinusitis

“…In the current series, the patients presented with mass lesions involving nose and paranasal sinuses with and without proptosis, nasal discharge and obstruction, mimicking malignancy. This has been the experience with other centres as well [1][2][3][4][5][6][7][8]. Patients may also complain of facial and dental pain, headache and decreased vision.…”

“…It can also be used for diagnosis of fungal etiology in rhino-sinusoidal inflammation. In literature there are only few case reports which describe diagnosis of rhinosinusoidal mycoses on cytology [3][4][5]. We present a series of nine such cases diagnosed on FNA.…”

Invasive cavernous sinus aspergillosis: an orbitocranial approach for diagnosis and management

“…However, utility of this approach has been limited to cases with significant sinus involvement. 16 Given the atypical presentation of our case with respect to limited sinus involvement, a surgical approach was indicated. We performed a lateral orbitotomy extending intracranially to the middle cranial fossa to directly biopsy the region without a craniotomy, minimizing surgical morbidity.…”