Crist Henry, Hennessy Max, Hodos Jacob, McGinn Johnathan, White Bartholomew, Payne Sakeena, Warrick Joshua I
Department of Pathology, College of Medicine, The Pennsylvania State University, 500 University Drive, Hershey, PA, 17033-0850, USA.
Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
Head Neck Pathol. 2019 Sep;13(3):318-326. doi: 10.1007/s12105-018-0965-8. Epub 2018 Sep 12.
Acute invasive fungal rhinosinusitis (AIFRS) is a fulminant infection in immunocompromised patients requiring rapid diagnosis (DX), frequently made on frozen section (FS) of sinonasal biopsies, followed by prompt surgical debridement. However, FS interpretation is often difficult and DX sometimes not possible. In this study we sought to characterize reasons for misinterpretation and methods to improve diagnostic accuracy. The FS slides from 271 biopsies of suspected AIFRS in a 16-year period were reviewed and the morphologic features evaluated for their utility in DX. Recurring specific patterns of necrosis were identified, which to our knowledge have not been described in the literature. Although they provide strong evidence for AIFRS, identifying fungus consistently in necrotic tissue is essential for DX. Clues to identifying fungus and pitfalls in misidentification were identified, but even with expert knowledge of these, a gap in accurate DX remained. The key to FS DX of AIFRS is to improve fungus identification in necrotic tissues. Methods had been sought in the past to stain fungus at FS without consistent success. The Periodic Acid Schiff's Reaction for Fungi was modified by our histopathology department for use on frozen tissue (PASF-fs) resulting in effective staining of the fungus. It stained fungus on all 62 positive slides when applied retrospectively over hematoxylin and eosin (H&E) stained FSs and used prospectively at FS for DX. Although knowledge of histologic morphology on FS is important, the crucial value of this study is the novel use of PASF-fs to identify fungus in the DX of AIFRS.
急性侵袭性真菌性鼻-鼻窦炎（AIFRS）是免疫功能低下患者的一种暴发性感染，需要快速诊断（DX），通常通过鼻窦活检的冰冻切片（FS）进行诊断，随后进行及时的手术清创。然而，FS的解读往往很困难，有时无法进行诊断。在本研究中，我们试图明确解读错误的原因以及提高诊断准确性的方法。回顾了16年间271例疑似AIFRS活检的FS切片，并评估了其形态学特征在诊断中的效用。确定了反复出现的特定坏死模式，据我们所知，这些模式在文献中尚未有描述。虽然它们为AIFRS提供了有力证据，但在坏死组织中持续识别真菌对于诊断至关重要。确定了识别真菌的线索和错误识别的陷阱，但即使有这些专业知识，准确诊断仍存在差距。AIFRS的FS诊断关键在于提高坏死组织中真菌的识别率。过去一直在寻找在FS上对真菌进行染色的方法，但没有一直成功。我们的组织病理学部门对真菌的过碘酸希夫反应进行了改良，用于冰冻组织（PASF-fs），从而有效地对真菌进行了染色。当回顾性应用于苏木精和伊红（H&E）染色的FS时，它对所有62张阳性切片上的真菌都进行了染色，并前瞻性地用于FS诊断。虽然了解FS上的组织形态学很重要，但本研究至关重要的价值在于PASF-fs在AIFRS诊断中识别真菌的新应用。
