Usefulness of frozen section in rhinocerebral mucormycosis diagnosis and management.
OBJECTIVE
Rhinocerebral mucormycosis (RCM) is a well-described fulminant fungal infection that presents acutely in patients with ketoacidosis and immunosuppression. Very early diagnosis, established with the demonstration of characterised hyphae in tissues, greatly improves the prognosis of RCM. In this regard, the specificity and the sensitivity of frozen section for the diagnosis and the surgical debridement of RCM were evaluated in this study.


RESULTS
Frozen section was performed for the diagnosis (six of seven cases) and surgical treatment (three of seven cases) of RCM. In all cases, diagnosis was made by frozen section and confirmed by histological examination. Frozen section allowed radical surgical excision of infected tissue. In all cases, invasive, broad-based non-septated hyphae with branching at right angles were well demonstrated on toluidine blue staining. Cultures were positive for Rhizopus oryzae in three of seven cases. Outcome was favourable for five of seven patients and two patients died after the diagnosis.


CONCLUSIONS
Frozen section is a specific and sensitive method to make both a quick initial diagnosis of RCM and to successfully eradicate the tissue infected by organisms belonging to the order Mucorales.
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D003646:Debridement; D005260:Female; D005629:Frozen Sections; D016591:Histocytological Preparation Techniques; D006801:Humans; D008081:Liposomes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009090:Mucorales / Q000302:isolation & purification* / Q000502:physiology; D009091:Mucormycosis / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D012680:Sensitivity and Specificity; D012852:Sinusitis / Q000209:etiology / Q000473:pathology* / Q000628:therapy
D008081:Liposomes; D000666:Amphotericin B