Fig. 2.3. a Sinonasal aspergilloma: densely packed branching hyphae of aspergillus forming a fungal ball. (Gomori's methenamine silver). b Sinonasal allergic mucinosis: dense aggregates of eosinophilic leukocytes distributed between pools of mucin. At the centre, one Charcot-Leyden crystal. c Allergic fungal sinusitis: scarce fungal hyphae found after diligent search in a lake of mucin (Gomori's methenamine silver)
PAS or Gomori methanamine silver the fungi appear as dichotomously branching septate hyphae 6-8 p,m wide. Aspergillosis may occur as a non-invasive disease in which a mass of fungal hyphae (fungal ball) is present in a sinus (Fig. 2.3a). Invasive aspergillosis is seen more often in immunocompromised patients, associated with destructive inflammation of the sinonasal tissues . The disease may also occur as an allergic mucinous sinusitis in which the sinuses contain masses of inspissated mucus with abundant eosinophils, Char-cot-Leyden crystals (Fig. 2.3b), necrotic cell debris and scarce fungal hyphae (Fig. 2.3c) [137, 172]. The sinus mucosa shows inflammatory changes without fungal invasion.
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