Nasal cavity, paranasal sinuses, nasopharynx
Bacterial / fungal / viral
Fungal ball


Topic Completed: 1 February 2016

Revised: 30 May 2019

Copyright: 2003-2019, PathologyOutlines.com, Inc.

PubMed Search: Fungal ball nasal

Jihong Sun, M.D.
Margaret S. Brandwein-Weber, M.D.
Page views in 2018: 3,453
Page views in 2019 to date: 2,478
Cite this page: Sun J, Brandwein-Weber MS. Fungal ball. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/nasalfungalball.html. Accessed July 19th, 2019.
Definition / general
  • Noninvasive accumulation of fungal hyphae that branch at 45 degrees
  • Aspergillus causes fungus balls in nasal antrum of immunocompetent patients with minimal inflammatory response, microabscesses or multinucleated giant cells
  • Also causes invasive aspergillosis, regardless of immune status, with extension into retroorbital region, cranium or parapharyngeal space; often fatal
  • Also causes allergic fungal sinusitis
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
  • 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
  • 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
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

Microscopic (histologic) 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
Microscopic (histologic) images

Contributed by 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
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