This case report describes an 87-year-old woman presenting with nasal obstruction, facial pressure, and recurrent epistaxis. Computed tomography revealed a destructive-appearing sinonasal mass with calcifications and extensive osseous remodeling, initially raising suspicion of malignancy. Histopathologic examination demonstrated a sinonasal fungus ball with positive GMS staining, while a separate tissue biopsy showed chronic inflammation without identified malignancy. Notably, bacterial culture revealed heavy growth of Eikenella corrodens, despite negative fungal smear and culture. This case highlights the diagnostic challenges of destructive-appearing sinonasal lesions and the importance of correlating imaging, histopathology, and microbiologic findings. Although bacterial and fungal findings coexisted, the role of E. corrodens in the osseous changes remains uncertain.
Table of Contents
1. Introduction
2. Case Presentation
3. Radiologic Evaluation
4. Endoscopic Biopsy and Debridement
5. Histopathology and Microbiology
6. Discussion
6.1. Fungus Ball and the Differential Diagnosis of a Destructive Sinonasal Lesion
6.2. Calcification and Radiologic Appearance
6.3. GMS-Positive Fungus Ball With Negative Fungal Culture
6.4. Significance of Eikenella corrodens
6.5. Clinical Significance of the Combined Findings
6.6. Implications for Diagnosis and Management
7. Limitations
8. Conclusion
9. References
10. Figure Legends
Research Objectives and Core Themes
This case report details the clinical, radiologic, histopathologic, and microbiological findings of an elderly female patient presenting with a sinonasal fungus ball exhibiting destructive osseous changes and heavy growth of Eikenella corrodens, aiming to address the diagnostic challenges in distinguishing noninvasive fungal rhinosinusitis from aggressive sinonasal malignancies.
- Clinical presentation of a destructive-appearing sinonasal lesion mimicking malignancy
- Radiological evaluation and osseous remodeling associated with sinonasal fungus balls
- Histopathological confirmation using Grocott methenamine silver (GMS) staining
- Microbiological correlation and the significance of heavy Eikenella corrodens growth alongside negative fungal cultures
- Multidisciplinary diagnostic approaches and practical lessons for rhinology management
Excerpt from the Book
3. Radiologic Evaluation
Computed tomography of the paranasal sinuses performed on November 13, 2023, demonstrated a posterior nasal cavity soft-tissue mass measuring approximately 2.1 × 2.8 × 2.1 cm. The lesion contained speckled internal calcifications and was associated with substantial osseous remodeling and destructive changes. Additional findings included mild left maxillary mucosal thickening, bilateral sphenoid mucosal thickening with air-fluid levels, and moderate bilateral ethmoid mucosal thickening. Subsequent review emphasized the predominantly midline location, superior septal destruction, and marked sphenoid-region bone remodeling.
Given the combination of a soft-tissue mass, calcific foci, and destructive osseous changes, the original radiologic interpretation raised concern for an underlying sinonasal carcinoma.
Summary of Chapters
1. Introduction: Introduces fungal rhinosinusitis, categorizes fungus balls within noninvasive spectrums, and discusses the diagnostic challenges posed by bone erosion and misleading microbiological studies.
2. Case Presentation: Details the clinical evaluation of an 87-year-old woman presenting with chronic nasal obstruction, facial pressure, epistaxis, and a friable sinonasal lesion.
3. Radiologic Evaluation: Examines the computed tomography findings of a posterior nasal soft-tissue mass with internal calcifications and significant destructive osseous changes.
4. Endoscopic Biopsy and Debridement: Documents the office endoscopic exploration, macroscopic appearance of yellow-brown material, and the absence of tissue invasion upon pathology.
5. Histopathology and Microbiology: Analyzes the decisive diagnostic evidence from GMS staining confirming a fungus ball alongside aerobic bacterial culture results demonstrating heavy growth of Eikenella corrodens.
6. Discussion: Evaluates the differential diagnosis, radiological appearance, culture discordance, significance of Eikenella corrodens, and management implications of combined findings.
7. Limitations: Acknowledges study constraints including single-patient observation, inability to establish direct causation, and lack of long-term follow-up.
8. Conclusion: Summarizes how sinonasal fungus balls can mimic aggressive neoplasms and emphasizes the necessity of clinicoradiologic, histopathologic, and microbiologic correlation.
9. References: Provides comprehensive academic and clinical citations supporting the diagnostic framework.
10. Figure Legends: Compiles detailed descriptions for all endoscopic, radiologic, and pathological figures presented in the report.
Keywords
fungus ball, fungal rhinosinusitis, Eikenella corrodens, sinonasal mass, bone erosion, sinonasal malignancy, computed tomography, case report, histopathology, GMS staining, nasal obstruction, otolaryngology
Frequently Asked Questions
What is the primary focus of this publication?
The publication is a case report focusing on an elderly female patient presenting with a sinonasal fungus ball that exhibited extensive bone erosion and mimicked an aggressive sinonasal malignancy, complicated by the heavy growth of Eikenella corrodens.
What are the central thematic areas covered in the text?
The central themes include noninvasive fungal rhinosinusitis, radiological interpretation of sinonasal masses, histopathological verification via GMS staining, microbiological analysis, and the diagnostic challenges of managing overlapping clinical presentations.
What is the primary objective or clinical question addressed in the case report?
The primary clinical goal is to highlight how noninvasive sinonasal fungus balls can radiologically simulate malignant neoplasms through destructive osseous changes and to evaluate the clinical significance of coexisting bacterial isolates like Eikenella corrodens.
Which scientific and medical methods were utilized in the evaluation?
The evaluation utilized rigid nasal endoscopy, multiplanar computed tomography (CT) imaging, surgical biopsy and debridement, histopathological examination with Grocott methenamine silver (GMS) special staining, and aerobic bacterial and fungal cultures.
What aspects are addressed in the main body of the work?
The main body covers the patient's clinical presentation, radiologic findings, endoscopic excision results, histopathological and microbiological discrepancies, and an extensive discussion on diagnostic pitfalls and management implications.
Which keywords characterize the scope of this medical case report?
Key terms include fungus ball, fungal rhinosinusitis, Eikenella corrodens, sinonasal mass, bone erosion, sinonasal malignancy, computed tomography, and case report.
How old was the patient, and what were her primary symptoms upon presentation?
The patient was an 87-year-old woman who presented with approximately three months of persistent nasal obstruction, left-predominant facial pressure, recurrent epistaxis, and a history of anosmia.
What specific diagnostic discrepancy arose between pathology and microbiology?
While histopathology confirmed a fungus ball with positive GMS fungal staining and separate tissue showed chronic inflammation without malignancy, fungal smears and cultures remained completely negative, whereas aerobic bacterial cultures showed heavy growth of Eikenella corrodens.
Did the presence of Eikenella corrodens prove that the bacteria caused the bone destruction?
No, the available evidence established coexistence rather than causation, meaning the data did not prove that Eikenella corrodens was responsible for the radiographic osseous destruction.
What are the primary clinical lessons derived from this case report?
The report highlights three practical lessons: radiographic destruction does not necessarily imply malignancy, negative fungal cultures do not exclude a histologically proven fungus ball, and heavy bacterial growth does not automatically establish the cause of osseous destruction.
- Arbeit zitieren
- Pablo Arango (Autor:in), Manuel Medina Suárez (Autor:in), Manuel Javier Medina Rodríguez (Autor:in), 2026, Sinonasal Fungus Ball With Heavy Growth of Eikenella corrodens Mimicking a Destructive Sinonasal Malignancy, München, GRIN Verlag, https://www.hausarbeiten.de/document/1778612
