PMC5971388_01
Cytologic sample obtained via fine-needle aspiration of the ulcerative nasal lesion containing septated fungal elements (~3 microm), moderately basophilic to green, of varying length with occasional acute angular branching found within macrophages (black arrows) and free in the background. Some fungal elements demonstrate ballooning of internal and/or terminal segments (white arrow). Wright-Giemsa stain at x 100 objective
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Hyphae (~3 microm diameter) had roughly parallel walls, frequent ballooning of internal and/or terminal segments and less frequent acute angular branching (Figure 1).
(a,b) CT images of dorsal plane, post-contrast (window level [WL] 350, window width [WW] 2700) and (c,d) transverse plane post-contrast (WL 350, WW 1500). (a) Multiplanar reformat (MPR) of available post-contrast data; (b-d) MPRs of the volume data. (a,c) Contrast-enhancing swelling is shown on the dorsum of the nose (white arrows). (b,d) Six month postoperative images revealing resolution of the previous swelling
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Soft tissue-attenuating, non-contrast-enhancing material was present in the right nasal cavity with accompanying multifocal turbinate lysis (Figure 2). The previously identified soft-tissue-attenuating material in the left nasal cavity and focal mass on the nasal planum were absent (see Figure 2).
Histopathology of nasal biopsy. Large numbers of tan-to-brown hyphae (~2-6 microm) septate, parallel to non-parallel walls with occasional acute angle branching (black arrow), pseudohyphae and yeast-like structures (white arrow) scattered throughout the tissue, composed of moderate fibrovascular stroma. Hematoxylin and eosin stained section at x 580 magnification. The black bar measures 15.5 microm
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Within the intraluminal exudate, there were small numbers of 6-9 microm diameter GMS-positive piriform yeasts, or pseudohyphal structures, exhibiting broad-based budding (Figure 3).