Sundaragiri Krishna Sireesha, Saxena Shikha, Sankhla Bharat, Bhargava Akshay, Sharma Geeta, Gaurav Isha
Department of Oral Pathology, RUHS College of Dental Sciences (Govt. Dental College), Jaipur, Rajasthan, India.
Department of Oral Pathology, Patna Dental College and Hospital, Patna, Bihar, India.
J Oral Maxillofac Pathol. 2023 Jan-Mar;27(1):109-114. doi: 10.4103/jomfp.jomfp_314_22. Epub 2023 Mar 21.
Mucormycosis is an acute and rapidly progressing opportunistic fungal infection. COVID-19-associated mucormycosis (CAM) had re-emerged as a complication of COVID-19 infection during the second wave of the pandemic in 2021. The rhinomaxillary form is a variant of the rhino-cerebral mucormycosis that presents a diagnostic challenge to the dentist and the oral and maxillofacial pathologist. Gross examination of pathological specimens is the most undermined step even though it plays a vital role in the final diagnosis. No studies have described this post-clinical step for the maxillofacial soft and hard tissue submitted for examination.
A prospective comparative study was carried out on 52 COVID-19-associated rhinomaxillary mucormycosis (CARM) cases to achieve complete, representative, and informative sampling of the submitted tissue and establish a three-level gross macroscopic examination protocol. Complete clinical and radiological histories were recorded after informed, written consent from every patient was received. Details of the number and type of samples received were recorded, grossing procedure was done as per the proposed three-level grossing protocol and were then compared to the presence of fungal hyphae in the soft tissue or decalcified hard tissue.
All 100% of the samples consisted of soft tissue (maxillary sinus lining), while 90.4% of the samples contained different hard tissue specimens. Seventy percent of the grossing workload was carried out by first-year oral pathology residents. Sixty-seven point three percent of the total soft tissue samples submitted showed no presence of fungal hyphae, while 69.2% of total decalcified sections of hard tissue were positive for fungal hyphae with a positive correlation. Out of the 29 cases grossed via the three-level grossing protocol, 89.6% of the cases were histopathologically positive for fungal hyphae. Thus a positive association ( < 0.05) between histopathological diagnosis and the proposed three-level grossing protocol was found.
It is imperative to recognise that no mucormycosis report is to be signed out without multi-site (three-level grossed) bone decalcified reports. There is an immediate need to realise how vital documentation, correct laboratory practices, and grossing are for accurate histopathological diagnosis.
毛霉病是一种急性且进展迅速的机会性真菌感染。2021年第二波疫情期间，新型冠状病毒肺炎相关毛霉病（CAM）作为新型冠状病毒肺炎感染的一种并发症再度出现。鼻上颌型是鼻脑型毛霉病的一种变体，给牙医以及口腔颌面病理学家带来了诊断挑战。病理标本的大体检查是最容易被忽视的步骤，尽管它在最终诊断中起着至关重要的作用。尚无研究描述提交检查的颌面软硬组织的这一临床后步骤。
对52例新型冠状病毒肺炎相关鼻上颌毛霉病（CARM）病例进行了一项前瞻性对比研究，以实现对提交组织的完整、有代表性且信息丰富的采样，并建立一个三级大体检查方案。在获得每位患者的知情书面同意后，记录完整的临床和放射学病史。记录收到的样本数量和类型的详细信息，按照提议的三级检查方案进行大体检查，然后将其与软组织或脱钙硬组织中真菌菌丝的存在情况进行比较。
所有样本（100%）均包含软组织（上颌窦内衬），而90.4%的样本包含不同的硬组织标本。70%的大体检查工作量由一年级口腔病理学住院医师完成。提交的软组织样本中，67.3%未发现真菌菌丝，而硬组织脱钙切片中69.2%真菌菌丝呈阳性，二者呈正相关。在通过三级检查方案进行大体检查的29例病例中，89.6%的病例组织病理学检查真菌菌丝呈阳性。因此，发现组织病理学诊断与提议的三级检查方案之间存在正相关（<0.05）。
必须认识到，没有多部位（三级大体检查）骨脱钙报告，就不能签署毛霉病报告。迫切需要认识到记录、正确的实验室操作和大体检查对于准确的组织病理学诊断是多么重要。
