Invasive Fungal Sinusitis
Bruce M. Wenig, MD
Key Facts
Terminology
Acute, fulminant fungal infestation of sinonasal tract resulting in tissue destruction within days
Clinical Issues
Typically occurs in immunocompromised patients
Requires surgical debridement and antifungal chemotherapy (e.g., voriconazole, amphotericin B)
Mortality rates high
Microscopic Pathology
Tissue necrosis is evident, but inflammatory response often is very limited
Fungal forms identified throughout resected tissue, which may include angioinvasion
Ancillary Tests
Histochemical stains (GMS, PAS) positive
 Resection material from invasive fungal sinusitis shows necrosis  and infarction  with effacement of the normal mucosal architecture, although residual mucoserous glands are present  . |
 The identification of fungi is facilitated by histochemical staining. Aspergillus species are characterized by septated hyphae  and acute angle branching  . |
TERMINOLOGY
Synonyms
Acute fulminant Aspergillus sinusitis
Definitions
Acute, fulminant fungal infestation of sinonasal tract often resulting in destruction of involved sinus(es) within days
ETIOLOGY/PATHOGENESIS
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