Nasal cavity
Inflammatory / infectious lesions
Fungal ball

Author: Jihong Sun, M.D. (see Authors page)
Editor: Margie Brandwein-Gensler, M.D.

Revised: 14 April 2016, last major update February 2016

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Fungal ball [title] nasal
Definition / General
  • Noninvasive accumulation of fungal hyphae
Essential Features
  • Dense fungal growth with no tissue invasion
  • Fruiting heads (sexual reproduction) may be seen
Terminology
  • Fungal ball, mycetoma, chronic noninvasive fungal sinusitis
Sites
  • The maxilla is most commonly affected
Pathophysiology / Etiology
  • A fumigatus and A flavus are the most common isolates
  • Usually immunocompetent patients, often prior history of sinus disease, trauma or foreign body
Clinical Features
  • Nasal congestion / obstruction
  • Sinus pain
Radiology Description
  • An expansile massive process with bony remodeling
  • MR / CT signaling reflects the iron, manganese and calcium content of fungal hyphae ("iron-like signalling")
Radiology Images
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CT of face

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MR of face

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Likely calcific in nature

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Normal pneumatization

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Opacification

Case Reports
Treatment
  • Conservative curettage, irrigation with saline or iodine solution, surgery
Clinical Images
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Fungal ball in maxillary sinus

Gross Description
  • May present as a large, expansile mass, without involvement of the underlying mucous membrane
  • Grumous, friable, gray-brown-black mass, often with clotted blood
Gross Images
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Maxillary sinusotomy

Micro Description
  • Tightly packed laminated hyphae with inflammatory exudates and cell debris
  • Pigmented hyphae may be dematiaceous group of fungi
  • Presence of characteristic fruiting heads is diagnostic for Aspergillus sp
  • Black conidia specifically indicate Aspergillus niger
  • Fungal invasion of tissue is usually not seen, although it has been reported
  • No / minimal host response in mucosa
Micro Images
Images hosted on PathOut server, courtesy of Dr. Margie Brandwein-Gensler, M.D.:
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Large fungus ball

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Fungal hyphae,
fungal sexual reproduction (fruiting heads)



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Aspergilloma

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Hyphae of mycetes

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Foot

Differential Diagnosis