Chronic Invasive Fungal Sinusitis Mimicking Malignancy Post-Radiotherapy: A Case Report.

Autor: Lim AWY; Department of Otorhinolaryngology and Head and Neck Surgery, Changi General Hospital, Singapore, 2 Simei Street 3, Singapore, 529889 Singapore., Lee TS; Department of Otorhinolaryngology and Head and Neck Surgery, Changi General Hospital, Singapore, 2 Simei Street 3, Singapore, 529889 Singapore., Wee JJ; Department of Otorhinolaryngology and Head and Neck Surgery, Changi General Hospital, Singapore, 2 Simei Street 3, Singapore, 529889 Singapore., Pang CYM; Department of Otorhinolaryngology and Head and Neck Surgery, Changi General Hospital, Singapore, 2 Simei Street 3, Singapore, 529889 Singapore.
Jazyk: angličtina
Zdroj: Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India [Indian J Otolaryngol Head Neck Surg] 2024 Oct; Vol. 76 (5), pp. 4086-4090. Date of Electronic Publication: 2024 Jun 14.
DOI: 10.1007/s12070-024-04787-5
Abstrakt: 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 Aspergillus 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.
Competing Interests: Conflict of InterestThe authors declare that they have no competing interests.
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Databáze: MEDLINE
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