Nasal cavity, paranasal sinuses, nasopharynx
Inflammatory / infectious lesions
Sinusitis

Author: Nat Pernick, M.D. (see Authors page)

Revised: 18 May 2018, last major update November 2004

Copyright: (c) 2004-2018, PathologyOutlines.com, Inc.

PubMed Search: Sinusitis[TI] nasal cavity[mh]

Cite this page: Pernick, N. Sinusitis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/nasalsinusitis.html. Accessed September 21st, 2018.
Acute
Definition / general
  • Often preceded by acute or chronic rhinitis
  • Usually self limited or well controlled with supportive treatment
Acute invasive fungal (fulminant invasive fungal)
Definition / general
  • Often seen in immunocompromised or diabetic patients, often ocular involvement or intracranial extension, associated with progressive disease and death

Treatment
  • Vigorous systemic antifungal therapy

Microscopic (histologic) description
  • Vascular invasion by fungi is present and may cause thrombi
  • Neutrophils, eosinophils, tissue necrosis and hemorrhage
Chronic sinusitis
Definition / general
  • Mixed bacterial flora, develops after acute sinusitis
  • May produce osteomyelitis of orbit or thrombophlebitis of dural venous sinus
  • Most commonly in maxillary sinus, and preceded by periapical infection from floor of sinus
  • May need biopsy for accurate diagnosis
  • Noninvasive fungal disease is often Aspergillus

Treatment
  • Surgery to control disease may be necessary

Gross description
  • Edematous mucosa which blocks drainage and may cause empyema of sinus

Microscopic (histologic) description
  • Glandular hyperplasia, squamous metaplasia, basement membrane thickening, inflammatory cells including eosinophils, edema
  • Bone may show thickening and remodeling with osteoblastic rimming and fibrosis of bone marrow spaces
  • Presence of allergic mucin (lamellated collection of inspissated inflammatory debris) suggests fungal organisms
Chronic noninvasive fungal
Definition / general
  • Also called indolent fungal sinusitis
  • Associated with diabetes, immunocompromise or endemic areas (Sudan, Saudi Arabia)

Microscopic (histologic) description
  • Fungi with surrounding foreign body inflammatory response or granulomas and tissue invasion
  • No vascular invasion by definition