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Sinonasal Tract: Nonneoplastic

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Textbook of Head and Neck Pathology

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Abstract

If it appears strange that that one etiologic agent gives rise to such a diversity of disease, then consider the three major components of any infectious process: (1) the inherent virulence of the agent, (2) the infectious dose, and (3) the patient status. Allergic fungal sinusitis represents the most common form of sinonasal fungal disease. Invasive fungal sinusitis {acute, (<4 weeks) and chronic (>12 weeks)} represents the most serious sinonasal fungal disease, which develops in the setting of neutropenia, or neutrophil dysfunction. Other more rare and exotic sinonasal infectious conditions, or infectious mimickers are also discussed in this chapter.

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Authors and Affiliations

  1. Erie County Medical Center, State University of New York at Buffalo, Buffalo, NY, USA

    Margaret S. Brandwein

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Appendices

Self Study

  1. 1.

    Which statement is true?

    1. (a)

      Rhinophyma is caused by von Frisch bacilli.

    2. (b)

      Myospherulosis is caused by mycoplasma.

    3. (c)

      Chronic invasive fungal sinusitis is the only condition in which fungal sexual reproduction occurs.

    4. (d)

      Invasive fungal hyphae are observable on hematoxylin and eosin stained slides.

  2. 2.

    Which statement/statements is/are true?

    1. (a)

      Allergic mucin is composed of degranulated eosinophils, Charcot Leydin crystals, and fungal hyphal fragments.

    2. (b)

      Antrochoanal polyps arise at the posterior choanae, and prolapse anteriorly through the nares, and are histologically characterized by a “strange emptiness” and bizarre fibroblasts.

    3. (c)

      Iron-like signaling is characteristic of a fungal ball.

    4. (d)

      a, b, c

    5. (e)

      a and c

Answers

  1. 1.

    Which statement is true?

    1. (a)

      Rhinophyma is characterized by pronounced sebaceous hyperplasia, cystically dilated ducts filled with keratin and sebum, vasodilatation in the upper and middle dermis, and perivascular/perifollicular inflammation (Fig. 2.21 self study).

      Fig. 2.21
      figure 21

      Self study

      Full size image
    2. (b)

      Myospherulosis is a non-infectious inflammatory reaction to agents such as exogenous lipids (e.g., petroleum, lanolin), vitamin E, or traumatized adipose tissue, resulting in the histological hallmark of pseudofungal “spherules”.

    3. (c)

      Sexual reproduction can be seen in a fungus ball, in the form of fruiting heads.

    4. (d)

      Invasive fungal hyphae are observable on hematoxylin and eosin stained slides – CORRECT. After systemic therapy, silver stains are necessary to observe hyphae.

  2. 2.

    Which statement/statements is/are true?

    1. (a)

      Fungal hyphal fragments are not necessarily present in allergic mucin.

    2. (b)

      Antrochoanal polyps arise in the maxilla and can protrude through the posterior choanae.

    3. (c)

      Iron-like signaling is characteristic of a fungal ball. CORRECT. Iron-like radiographic signaling reflects the iron, manganese, and calcium content of fungal hyphae.

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Brandwein, M.S. (2016). Sinonasal Tract: Nonneoplastic. In: Textbook of Head and Neck Pathology. Springer, Cham. https://doi.org/10.1007/978-3-319-33323-6_2

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