title: [Allergic fungal sinusitis, fungus ball and invasive sinonasal mycosis - three fungal-related diseases].
abstract: BACKGROUND
  Three different fungal-related clinical pictures have to be differentiated in the paranasal sinuses: allergic fungal sinusitis, fungus ball and invasive sinonasal mycosis.
  
  
  OBJECTIVE
  A morphological reevaluation of fungal-related diseases of the paranasal sinuses as well as a retrospective analysis of their clinical parameters was performed.
  
  
  METHODS
  86 patients with patho-histological proven fungal-related disease of the nasal sinuses were enclosed in this study. Reevaluation and correlation of clinical and histological parameters were conducted on routine material (HE, PAS and Grocott) according to the modern morphological definitions.
  
  
  RESULTS
  Invasive sinonasal mycosis was seen in 22 cases, eleven male and eleven female, mean age 57 years (22 to 84 years). It was significantly related (nine out of 22 patients, 41%) to immunocompromising conditions: three patients had diabetes mellitus type II, five had have a radiation therapy due to carcinoma and one patient suffered from bacterial endocarditis. A fungus ball was diagnosed in 60 patients, 26 male, 34 female, mean age 54 years (22-88 years). An immunocompromising condition was seen in nine out of 60 patients (15%). Causes for immune impairment were diabetes mellitus (two patients), radiation therapy due to carcinoma (four patients), myocarditis (one patient) and chronic hepatitis (two patients). Allergic fungal sinusitis was recorded in four patients, three male, one female, mean age 43 years (17-63 years). No immunosuppression was diagnosed.
  
  
  CONCLUSIONS
  Despite the fact that allergic fungal sinusitis is the most common fungal disease of the paranasal sinuses, it is not well known among physicians and pathologists and therefore underrepresented within the diagnoses of paranasal infections. The term "aspergilloma" is imprecise and does not represent a clear diagnosis. A further differentiation in "fungus ball" (without invasion) and "invasive sinonasal mycosis" is required. The three groups of fungal-related sinusitis occur at different ages. Allergic fungal sinusitis is common among young adults. An immunocompromising condition is a prerequisite for an invasive sinonasal mycosis.
authors.affiliation: Klinikum der Universität Regensburg, Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany. oliver.driemel@klinik.uni-regensburg.de
authors.forename: Oliver
authors.initials: O
authors.lastname: Driemel
authors.forename: Christina
authors.initials: C
authors.lastname: Wagner
authors.forename: Susann
authors.initials: S
authors.lastname: Hurrass
authors.forename: Urs
authors.initials: U
authors.lastname: Müller-Richter
authors.forename: Thomas
authors.initials: T
authors.lastname: Kühnel
authors.forename: Torsten Eugen
authors.initials: TE
authors.lastname: Reichert
authors.forename: Hartwig
authors.initials: H
authors.lastname: Kosmehl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery; D009181:Mycoses / Q000473:pathology* / Q000601:surgery; D009894:Opportunistic Infections / Q000473:pathology / Q000601:surgery; D010256:Paranasal Sinuses / Q000473:pathology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012852:Sinusitis / Q000473:pathology* / Q000601:surgery