Destructive noninvasive paranasal sinus aspergillosis: component of a spectrum of disease.

A chronic, destructive form of paranasal sinus aspergillosis may exist without evidence of tissue fungal invasion. In this state, the pathogen results in progressive, chronic inflammation intermediate between previously described saprophytic and invasive states. We report three such cases. This variety of aspergillosis and an analysis of the clinical and histopathologic findings of previously reported cases support the concept that infection with the organism may produce a spectrum of pathologic changes and is akin to the range of aspergillosis disease states described affecting the lung. We classify paranasal and nasal aspergillosis as (1) noninvasive, either an aspergilloma or allergic type, (2) destructive, noninvasive, and (3) invasive, either slowly progressive or fulminant. Any form may progress to, or be associated with, more aggressive disease.