Lim Aloysius W Y, Lee Tee Sin, Wee Jia Jia, Pang C Y Maria
Department of Otorhinolaryngology and Head and Neck Surgery, Changi General Hospital, Singapore, 2 Simei Street 3, Singapore, 529889 Singapore.
Indian J Otolaryngol Head Neck Surg. 2024 Oct;76(5):4086-4090. doi: 10.1007/s12070-024-04787-5. Epub 2024 Jun 14.
Invasive fungal sinusitis is a life-threatening form of fungal rhinosinusitis. Due to the aggressive clinical presentation and radiological appearance, there is diagnostic difficulty in differentiating invasive fungal sinusitis from a malignant process. This is even more challenging in oncological patients who have undergone previous head and neck radiotherapy, due to possibility of a recurrence of primary malignancy and radiation-induced neoplasms. We report a rare case of invasive fungal sinusitis mimicking a malignancy in a post-radiotherapy patient. Our patient was a 68-year-old male, 25-years post-radiotherapy for nasopharyngeal carcinoma. He presented with a 3-month history of purulent sputum and right facial paraesthesia. Magnetic resonance imaging showed an irregular destructive enhancing mass of the greater wing of right sphenoid and pterygoid bone with extensive extension into nearby structures. In view of extensive local and bony invasion, and a history of radiotherapy, initial suspicions were that of primary malignancy, specifically radiation-induced sarcoma, and recurrence of nasopharyngeal carcinoma. He underwent transpterygoid biopsy of the lesion, and histopathology demonstrated species, with no malignancy identified. Our report highlights the diagnostic difficulties in the post-radiotherapy cancer patient presenting with symptoms suggestive of aggressive sino-nasal disease. Invasive fungal sinusitis closely mimics the clinical and radiological findings of several neoplastic processes. We discuss the clinical and radiological characteristics of pathologies that may mimic invasive fungal sinusitis. Histological examination remains the gold standard for diagnosis, and early fungal staining is crucial. Furthermore, one should not presume the initial histopathological diagnosis to be confirmatory of isolated fungal disease. Repeat radiological investigations for disease resolution and histopathologic re-evaluation if required should be performed, keeping in mind possibility of coexisting malignancy.
侵袭性真菌性鼻窦炎是真菌性鼻-鼻窦炎的一种危及生命的形式。由于其侵袭性的临床表现和影像学表现，在将侵袭性真菌性鼻窦炎与恶性病变进行鉴别诊断时存在困难。对于既往接受过头颈部放疗的肿瘤患者，由于存在原发性恶性肿瘤复发和放射性肿瘤的可能性，这一鉴别诊断更具挑战性。我们报告了一例放疗后患者发生侵袭性真菌性鼻窦炎酷似恶性肿瘤的罕见病例。我们的患者是一名68岁男性，鼻咽癌放疗后25年。他有3个月的脓性痰和右侧面部感觉异常病史。磁共振成像显示右侧蝶骨大翼和翼骨有不规则的破坏性强化肿块，并广泛延伸至附近结构。鉴于广泛的局部和骨质侵犯以及放疗史，最初怀疑是原发性恶性肿瘤，特别是放射性肉瘤以及鼻咽癌复发。他接受了病变的经翼突活检，组织病理学显示为 种，未发现恶性肿瘤。我们的报告强调了放疗后癌症患者出现提示侵袭性鼻窦疾病症状时的诊断困难。侵袭性真菌性鼻窦炎与几种肿瘤性病变的临床和影像学表现极为相似。我们讨论了可能酷似侵袭性真菌性鼻窦炎的病变的临床和影像学特征。组织学检查仍然是诊断的金标准，早期真菌染色至关重要。此外，不应认为初始组织病理学诊断可确诊为单纯的真菌疾病。如有必要，应重复进行影像学检查以观察疾病消退情况并进行组织病理学重新评估，同时要考虑到并存恶性肿瘤的可能性。
