title: Fine-needle aspiration biopsy as an initial diagnostic modality in a clinically unsuspected case of invasive maxillary fungal sinusitis: A case report.
abstract: Cases of invasive fungal lesions involving the paranasal sinuses are generally diagnosed either on histologic examination or on fungal culture. Here, we report a case of invasive fungal sinusitis diagnosed primarily by a fine-needle aspiration biopsy (FNAB).Our patient was a 36-year-old male who presented with a history of slowly progressive, painless swelling over the left cheek. The only positive clinical finding was a bony hard swelling in the left maxillary region, which was clinically interpreted as "fibrous dysplasia." A computed tomographic (CT) examination of the paranasal sinuses showed a soft tissue attenuation lesion involving the bilateral maxillae, with the destruction of multiple bones and involvement of multiple sinuses and the bilateral orbits. FNAB of the maxillary swelling showed several giant cells, many of them exhibiting ingested organisms with a morphologic resemblance to the Aspergillus species of fungi. Strikingly, no significant inflammatory cells were seen on cytologic smears. Unfortunately, owing to a lack of initial clinical suspicion, as well as the patient's loss to further follow-up, a culture/histopathologic examination could not be carried out.This case is presented chiefly to highlight the clinical utility of a simple FNAB procedure, as an initial diagnostic modality in cases of fungal sinusitis, which can masquerade clinically as a neoplastic lesion. In addition, if radiologic findings are also available at the time of cytologic examination, a pretherapeutic comment on the invasive nature of the lesion can also be made.
authors.affiliation: Department of Pathology, Division of Cytology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
authors.forename: Neha
authors.initials: N
authors.lastname: Singh
authors.forename: Neelaiah
authors.initials: N
authors.lastname: Siddaraju
authors.forename: Surendra
authors.initials: S
authors.lastname: Kumar
authors.forename: Femela
authors.initials: F
authors.lastname: Muniraj
authors.forename: Satvinder
authors.initials: S
authors.lastname: Bakshi
authors.forename: Suryanarayanan
authors.initials: S
authors.lastname: Gopalakrishnan
mesh_terms: D000328:Adult; D044963:Biopsy, Fine-Needle; D015726:Giant Cells / Q000473:pathology; D006801:Humans; D008297:Male; D008437:Maxilla / Q000473:pathology*; D015523:Maxillary Sinusitis / Q000175:diagnosis* / Q000382:microbiology* / Q000473:pathology; D013194:Staining and Labeling