Allergic Fungal Sinusitis: Expanding the Clinicopathologic Spectrum
Allergic Fungal Sinusitis: Expanding the Clinicopathologic Spectrum
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过敏性真菌性鼻窦炎：扩大临床病理谱
DOI：
10.1016/j.otohns.2003.09.004
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
S. Dahiya
中科院分区：
文献类型：
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作者：
A. Thakar;C. Sarkar;M. Dhiwakar;S. Bahadur;S. Dahiya
目的：我们试图确定是否发生组织学组织侵袭变应性真菌性鼻窦炎（AFS），如果是这样的话，以确定临床指标为same.Study设计和设置：我们进行了一个回顾性的病例记录审查的所有28个AFS的情况下，确定了组织学超过32个月的时间在三级保健转诊中心。所有的组织学标本进行了重新评估的侵袭性病理学特征，并与临床，放射学，或实验室参数与这种invasion.Results：除了普遍发现的特征性过敏性粘蛋白与真菌成分的鼻窦腔内容物的组织病理学检查，6例（21%）有额外的证据表明粘膜浸润肉芽肿性炎症和分支隔膜真菌菌丝在粘膜下组织。这种共存的侵犯与晚期疾病相关，如临床评估中眼眶受累的发生率较高（P= 0.024）和计算机断层扫描评估中窦外扩散（眶内或颅内扩散）（P= 0.003）。单一的死亡，发生在后续的患者共存invasion.CONCLUSION：先进的AFS可能是复杂的组织invasion.SIGNIFICANCE的组织学证据：非侵入性和侵袭性形式的真菌性鼻窦炎不一定是离散的，可能共存于同一个病人。眼眶受累的临床特征或窦外播散的CT表现应引起临床医师警惕。
OBJECTIVE:We sought to determine whether histologic tissue invasion occurs in allergic fungal sinusitis (AFS) and, if so, to identify clinical indicators for the same.STUDY DESIGN AND SETTING:We conducted a retrospective case record review of all 28 AFS cases identified by histology over a 32-month period at a tertiary care referral center. All histologic specimens were reevaluated for features of invasive pathology, and case records were correlated for clinical, radiologic, or laboratory parameters associated with such invasion.RESULTS:In addition to the universal finding of the characteristic allergic mucin with fungal elements on histopathologic examination of the sinus luminal contents, 6 cases (21%) had additional evidence of mucosal invasion as indicated by granulomatous inflammation and branching septate fungal hyphae in the submucosal tissues. Such coexistent invasion was associated with advanced disease as indicated by a higher incidence of orbital involvement on clinical evaluation (P= 0.024), and extra-sinus spread (intraorbital or intracranial spread) on the computed tomography evaluation (P= 0.003). The single death that occurred on follow-up was in a patient with coexistent invasion.CONCLUSION:Advanced AFS may be complicated by histologic evidence of tissue invasion.SIGNIFICANCE:The noninvasive and invasive forms of fungal sinusitis are not necessarily discrete and may coexist in the same patient. Clinical features of orbital involvement or computed tomography manifestations of extrasinus spread should alert the clinician to the possibility of invasion.