Seo Min Young, Seok Hyeri, Lee Seung Hoon, Choi Ji Eun, Hong Sang Duk, Chung Seung-Kyu, Peck Kyong Ran, Kim Hyo Yeol
Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan 15355, Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
J Clin Med. 2020 Feb 24;9(2):600. doi: 10.3390/jcm9020600.
Fungal rhinosinusitis (FRS) with mucosal invasion is not classified by the current criteria, and clinical reports on the topic are limited. The aim of this study was to present our 25-year experience on fungal balls with mucosal invasion that do not appear in the FRS classification.
Of 1318 patients who underwent endoscopic surgery with paranasal FRS between November 1994 and July 2019, 372 underwent mucosal biopsies. Medical chart and pathology review were performed on 13 patients diagnosed as having fungal balls with mucosal invasion without accompanying tissue invasion.
Histopathologic findings identified all fungi as belonging to the species. In 13 patients, 7 fungal balls were located in the maxillary sinus, 3 in the sphenoid sinus, and 3 in both the maxillary and ethmoid sinuses. The median age at diagnosis was 67 years (interquartile range (IQR): 62-72), and the sex ratio was 1:2 (4 men and 9 women). Five patients had comorbidities-three with diabetes mellitus and two with hematologic malignancy-all of whom received postoperative antifungal therapy. The median duration of antifungal treatment was 13 weeks (IQR: 8-17). No recurrences occurred during the median follow-up period of 30 months (IQR: 22-43).
Patients who have been clinically diagnosed with a fungal ball and showed mucosal invasion but no vascular invasion, based on pathologic findings after surgery, may need a new FRS classification category, such as microinvasive FRS, and adjuvant antifungal treatment may be needed for immunocompromised patients with microinvasive FRS.
Fungal rhinosinusitis with mucosal invasion is different from fungal ball and invasive fungal rhinosinusitis and may be classified in a separate category as microinvasive FRS.
目前的标准未对伴有黏膜侵犯的真菌性鼻-鼻窦炎（FRS）进行分类，关于该主题的临床报告有限。本研究的目的是介绍我们在25年中对FRS分类中未出现的伴有黏膜侵犯的真菌球的经验。
在1994年11月至2019年7月期间接受鼻旁窦FRS内镜手术的1318例患者中，372例接受了黏膜活检。对13例被诊断为伴有黏膜侵犯但无组织侵犯的真菌球患者进行了病历和病理复查。
组织病理学检查结果显示所有真菌均属于该物种。13例患者中，7个真菌球位于上颌窦，3个位于蝶窦，3个位于上颌窦和筛窦。诊断时的中位年龄为67岁（四分位间距（IQR）：62 - 72岁），性别比为1:2（4名男性和9名女性）。5例患者有合并症，3例患有糖尿病，2例患有血液系统恶性肿瘤，所有患者均接受了术后抗真菌治疗。抗真菌治疗的中位持续时间为13周（IQR：8 - 17周）。在中位随访期30个月（IQR：22 - 43个月）内未发生复发。
根据手术后的病理结果，临床上被诊断为真菌球且显示有黏膜侵犯但无血管侵犯的患者，可能需要一个新的FRS分类类别，如微侵袭性FRS，对于微侵袭性FRS的免疫功能低下患者可能需要辅助抗真菌治疗。
伴有黏膜侵犯的真菌性鼻-鼻窦炎不同于真菌球和侵袭性真菌性鼻-鼻窦炎，可能应单独分类为微侵袭性FRS。
