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Case Reports
. 2014 Mar;8(3):121-2.
doi: 10.7860/JCDR/2014/6671.4130. Epub 2014 Mar 15.

Nasal discharge cytology an important diagnostic method for allergic fungal sinusitis: report of three cases

Sharada Raju Rane  1 , Nalini Vinayak Kadgi  2 , Sonal Ashok Agrawal  3 , Anita Neelkanth Kavatkar  4
Affiliations
Case Reports

Nasal discharge cytology an important diagnostic method for allergic fungal sinusitis: report of three cases

Sharada Raju Rane et al. J Clin Diagn Res. 2014 Mar.

Abstract

Allergic fungal sinusitis (AFS) is a distinct clinicopathological entity. It occurs in immunocompetent individuals with history of atopy, increased IgE levels and peripheral eosinophilia and causes noninvasive pansinusitis. It is histologically characterised by the presence of 'allergic mucin' with clusters of eosinophils, charcot - Leyden crystals and scattered fungal hyphae. AFS is an immunological reaction to fungal deposits. As AFS is noninvasive, fungal hyphae can be demonstrated in nasal secretions on cytology. Etiological agent of AFS is Aspergillus or pigmented dematiaceous family. Special stains are helpful for identification. We came across three cases of age group ranging from 26 to 60-year of recurrent rhinitis with nasal discharge. The nasal secretions were collected by nasal swabs onto the glass slide and stained with Giemsa and silver stains. Smears revealed fungal hyphae amidst inflammatory cells with occasional Charcot-Leyden crystals. Nasal secretion cytology plays an important role in diagnosis and can be used for preoperative as well as intraoperative diagnosis of AFS and can be used as an additional diagnostic tool.

Keywords: Allergic mucin; Charcot – Leyden crystals; Fungal hyphae.

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Figures

[Table/Fig-1]:
[Table/Fig-1]:
CT scan of paranasal sinuses showing soft tissue mass involving left maxillary sinus, left nasal cavity with nasopharyngeal extension and bony destruction.
[Table/Fig-2]:
[Table/Fig-2]:
Inflammatory cell collections with stained fungal hyphae , MGG stain (400 X )
[Table/Fig-3]:
[Table/Fig-3]:
Thick masses of mixed inflammatory infiltrate with clusters of eosinophils with laminated histology. H and E stain ( 100 X )
[Table/Fig-4]:
[Table/Fig-4]:
Charcot – Leyden crystals against a background of allergic mucin with clumps of eosinophils. Eosinophilic masses with Charcot – Leyden crystals , H and E stain(400X)
[Table/Fig-5]:
[Table/Fig-5]:
Thin filamentous fungal hyphae showing branching, Silver Methanamine stain (400 X)
See this image and copyright information in PMC

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