Hostname: page-component-5db58dd55d-d6ndz Total loading time: 0 Render date: 2026-05-25T10:57:52.435Z Has data issue: false hasContentIssue false
  • English
  • Français

Isolated fungus ball mimicking mucocele or frontal sinus tumour: a diagnostic pitfall

Published online by Cambridge University Press:  23 December 2009

M Popko ,
M A Broglie  and
D Holzmann
M Popko*
Affiliation:
Department of Otolaryngology, Poznan University of Medical Science, Poland
M A Broglie
Affiliation:
Department of Otolaryngology Head and Neck Surgery, University Hospital of Zurich, Switzerland
D Holzmann
Affiliation:
Department of Otolaryngology Head and Neck Surgery, University Hospital of Zurich, Switzerland
*
Address for correspondence: Dr Mariola Popko, Department of Otolaryngology, Poznan University of Medical Science, Przybyszewskiego 49, 60-355 Poznan, Poland. Fax: +48 61 8691 690 E-mail: popkom@interia.pl
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To demonstrate the clinical, radiological and diagnostic pitfalls of managing an isolated frontal sinus fungus ball, and to compare with the literature.

Material and methods:

Retrospective analysis of two cases and literature review.

Results:

Isolated frontal sinus fungus ball is a rare cause of frontal sinus disease. We present two cases of isolated frontal sinus fungus ball which pre-operatively were suspected to be either a tumour or a mucocele. In both cases, cheesy, clay-like material was found intra-operatively within the frontal sinus, suggesting a fungus ball. Effective treatment included surgical debridement via an exclusively endoscopic or an external approach, variously. Final histopathological and mycological analysis revealed Aspergillus fumigatus. A literature review revealed 20 reported cases of isolated frontal sinus fungus ball, confirming the low prevalence of the disease.

Conclusions:

Frontal sinus fungus ball should be considered in the differential diagnosis of chronic, nonspecific forehead symptoms. To evaluate the underlying disease, computed tomography scans should first be performed, followed by magnetic resonance imaging if malignancy is suspected. It is essential to be aware of the possibility of an atypical fungus ball appearance on computed tomography and magnetic resonance imaging scans. If bony destruction and calcification coexist on radiological images, then endoscopic biopsy is an indispensable part of the diagnostic procedure, and should be performed to collect material for both histological and mycological analysis, and to aid surgical planning. In cases of sinus fungus ball, an endoscopic approach for biopsy may be curative.

Keywords

Frontal SinusAspergillus FumigatusDiagnosisImaging

Information

Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 10 , October 2010 , pp. 1111 - 1115
Copyright
Copyright © JLO (1984) Limited 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1deShazo, RD, O'Brien, M, Chapin, K, Soto-Aguilar, M, Swain, R, Lyons, M et al. Criteria for the diagnosis of sinus mycetoma. J Allergy Clin Immunol 1997;99:475–85CrossRefGoogle ScholarPubMed
2Dufour, X, Kauffmann-Lacroix, C, Ferrie, JC, Goujon, JM, Rodier, MH, Karkas, A et al. Paranasal sinus fungus ball and surgery: a review of 175 cases. Rhinology 2005;43:34–9Google ScholarPubMed
3Grosjean, P, Weber, R. Fungus ball of the paranasal sinuses: a review. Eur Arch Otorhinolaryngol 2007;264:461–70CrossRefGoogle Scholar
4Swoboda, H, Ullrich, R. Aspergilloma in the frontal sinus expanding into the orbit. J Clin Pathol 1992;45:629–30CrossRefGoogle ScholarPubMed
5Ferguson, BJ. Fungus ball of the paranasal sinuses. Otolaryngol Clin North Am 2000;33:389–98CrossRefGoogle Scholar
6Babinski, D, Narozny, W, Skorek, A, Rzepko, R, Stankiewicz, C. Noninvasive fungal sinusitis (fungus ball) – diagnostic difficulties [in Polish]. Otolaryngol Pol 2007;61:694–7Google ScholarPubMed
7Bhalla, D, Kumar, S, Pal, ND, Malhotra, V, Dhingra, PL. Aspergilloma of the frontal lobe. Acta Neurochir 1980;55:135–9CrossRefGoogle ScholarPubMed
8Chen, H, Chen, TM. Isolated frontal sinus aspergillosis. Otolaryngol Head Neck Surg 2000;122:460–1CrossRefGoogle ScholarPubMed
9Ferreiro, JA, Carlson, BA, Cody, DT. Paranasal sinus fungus balls. Head Neck 1997;19:481–63.0.CO;2-V>CrossRefGoogle ScholarPubMed
10Gupta, KR, Udhayakumar, S, Rao, PB, Madhaven, M, Das Gupta, LR. Aspergilloma of the frontal bone. J Laryngol Otol 1973;87:1007–11CrossRefGoogle ScholarPubMed
11Klossek, JM, Serrano, E, Péloquin, L, Percodani, J, Fontanel, JP, Pessey, JJ. Functional endoscopic sinus surgery and 109 mycetomas of the paranasal sinuses. Laryngoscope 1997;107:112–17CrossRefGoogle ScholarPubMed
12Kodama, S, Moriyama, M, Okamoto, T, Hirano, T, Suzuki, M. Isolated frontal sinus aspergillosis treated by endoscopic modified Lothrop procedure. Auris Nasus Larynx 2009;36:88–91CrossRefGoogle ScholarPubMed
13Kumar, BS, Patro, M, Mishra, D, Bal, A, Behera, B, Sahoo, S. Fine needle aspiration in aspergilloma of frontal sinus: a case report. Acta Cytol 2008;52:500–4Google Scholar
14Panda, NK, Reddy, CEE. Primary frontal sinus aspergillosis: an uncommon occurrence. Mycoses 2005;48:235–7CrossRefGoogle ScholarPubMed
15Sekula, J, Popielski, L, Betkowski, A. A case of aspergillosis involving the frontal sinus and orbit [in Polish]. Otolaryngol Pol 1981;35:365–9Google ScholarPubMed
16Stevens, MH. Aspergillosis of the frontal sinus. Arch Otolaryngol 1978;104:153–6CrossRefGoogle ScholarPubMed
17Warder, FR, Chikes, PG, Hudson, WR. Aspergillosis of the paranasal sinuses. Arch Otolaryngol 1975;101:683–5CrossRefGoogle ScholarPubMed
18Broglie, MA, Tinguely, M, Holzmann, D. How to diagnose sinus fungus balls in the paranasal sinus? An analysis of an institution's cases from 1999 – 2006. Rhinology 2009, in pressCrossRefGoogle Scholar
19Gerlinger, I, Gobel, G, Toth, E, Szanyi, I, Weninger, C. Primary carcinoma of the frontal sinus: a case report and review of literature. Eur Arch Otolaryngol 2008;265:593–7CrossRefGoogle ScholarPubMed
20Mourouzis, C, Evans, BT, Shenouda, E. Late presentation of mucocele of the frontal sinus: 50 years postinjury. J Oral Maxillofac Surg 2008;66:1510–13CrossRefGoogle ScholarPubMed
21Rao, MV, Sharma, D, Madan, A. Imaging of frontal sinus disease. Otolaryngol Clin North Am 2001;34:23–39CrossRefGoogle ScholarPubMed