Acute Invasive Fungal Rhinosinusitis

Frozen Section Histomorphology and Diagnosis with PAS Stain

Henry Crist, Max Hennessy, Jacob Hodos, Johnathan McGinn, Bartholomew White, Sakeena Payne, Joshua Warrick

Research output: Contribution to journalArticle

Abstract

Acute invasive fungal rhinosinusitis (AIFRS) is a fulminant infection in immunocompromised patients requiring rapid diagnosis (DX), frequently made on frozen section (FS) of sinonasal biopsies, followed by prompt surgical debridement. However, FS interpretation is often difficult and DX sometimes not possible. In this study we sought to characterize reasons for misinterpretation and methods to improve diagnostic accuracy. The FS slides from 271 biopsies of suspected AIFRS in a 16-year period were reviewed and the morphologic features evaluated for their utility in DX. Recurring specific patterns of necrosis were identified, which to our knowledge have not been described in the literature. Although they provide strong evidence for AIFRS, identifying fungus consistently in necrotic tissue is essential for DX. Clues to identifying fungus and pitfalls in misidentification were identified, but even with expert knowledge of these, a gap in accurate DX remained. The key to FS DX of AIFRS is to improve fungus identification in necrotic tissues. Methods had been sought in the past to stain fungus at FS without consistent success. The Periodic Acid Schiff’s Reaction for Fungi was modified by our histopathology department for use on frozen tissue (PASF-fs) resulting in effective staining of the fungus. It stained fungus on all 62 positive slides when applied retrospectively over hematoxylin and eosin (H&E) stained FSs and used prospectively at FS for DX. Although knowledge of histologic morphology on FS is important, the crucial value of this study is the novel use of PASF-fs to identify fungus in the DX of AIFRS.

Original languageEnglish (US)
Pages (from-to)318-326
Number of pages9
JournalHead and Neck Pathology
Volume13
Issue number3
DOIs
StatePublished - Sep 1 2019

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Frozen Sections
Fungi
Coloring Agents
Periodic Acid-Schiff Reaction
Biopsy
Immunocompromised Host
Debridement
Hematoxylin
Eosine Yellowish-(YS)
Necrosis
Staining and Labeling
Infection

All Science Journal Classification (ASJC) codes

  • Pathology and Forensic Medicine
  • Otorhinolaryngology
  • Oncology

Cite this

Crist, Henry ; Hennessy, Max ; Hodos, Jacob ; McGinn, Johnathan ; White, Bartholomew ; Payne, Sakeena ; Warrick, Joshua. / Acute Invasive Fungal Rhinosinusitis : Frozen Section Histomorphology and Diagnosis with PAS Stain. In: Head and Neck Pathology. 2019 ; Vol. 13, No. 3. pp. 318-326.
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Acute Invasive Fungal Rhinosinusitis : Frozen Section Histomorphology and Diagnosis with PAS Stain. / Crist, Henry; Hennessy, Max; Hodos, Jacob; McGinn, Johnathan; White, Bartholomew; Payne, Sakeena; Warrick, Joshua.

In: Head and Neck Pathology, Vol. 13, No. 3, 01.09.2019, p. 318-326.

Research output: Contribution to journalArticle

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