Correlation of Histopathological Findings with Fungal Detection in Nasal Polyps
DOI:
https://doi.org/10.51985/Keywords:
Nasal Polyps; Chronic Rhinosinusitis; Fungi; Histopathology; Eosinophilic Mucin; Allergic Fungal RhinosinusitisAbstract
Objective: To determine the association between structured histopathological findings and fungal detection in nasal polyps. Study design and setting: Analytical cross-sectional study conducted in the Department of Pathology, Allama Iqbal Medical College/Jinnah Hospital, Lahore.
Methodology: A total of 230 adults undergoing endoscopic sinus surgery were evaluated. Polyp tissue and sinus mucin were examined using hematoxylin and eosin, periodic acid-Schiff, and Grocott methenamine silver stains, direct microscopy, fungal culture, and broad-range fungal PCR. Histopathological findings were compared between fungus-positive and fungusnegative cases, and multivariable logistic regression was used to identify independently associated features.
Results: Fungi were detected in 72/230 patients (31.3%): PCR was positive in 61, culture in 49, and histochemical stains in 43. Compared with fungus-negative cases, fungus-positive cases more often showed marked tissue eosinophilia (65.3% vs 29.7%), allergic/eosinophilic mucin (54.2% vs 11.4%), Charcot-Leyden crystals (36.1% vs 6.3%), and severe epithelial damage (38.9% vs 17.1%) (all p<0.001). In multivariable analysis, allergic/eosinophilic mucin (adjusted OR [aOR] 5.84), Charcot-Leyden crystals (aOR 3.42), marked tissue eosinophilia (aOR 2.76), CT hyperattenuation (aOR 2.31), and previous sinus surgery (aOR 1.96) were independently associated with fungal detection, while neutrophil-predominant inflammation was inversely associated (aOR 0.42).
Conclusion: Fungal detection was strongly associated with eosinophil-predominant inflammation, allergic/eosinophilic mucin, Charcot-Leyden crystals, and CT hyperattenuation. However, fungal material was not detected in all eosinophilic polyps, supporting a combined histopathological and mycological approach rather than reliance on a single diagnostic modality
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References
1. Mansour M, Hernandez-Prera JC. Histopathology of chronic
rhinosinusitis and sinonasal inflammatory polyps. Head Neck
Pathol. 2025;19(1):35. https://doi.org/10.1007/s12105-025-
01760-8
2. Ceballos Cantu JC, Alobid I, Mullol J. Current evaluation
and management of patients with chronic rhinosinusitis and
nasal polyps. Expert Rev Clin Immunol. 2022;18(12):1253-
1263. https://doi.org/10.1080/1744666X.2022.2128767
3. Challapalli SD, McKee S, Luong AU. The role of fungus in
the pathogenesis of chronic rhinosinusitis. Curr Opin
Otolaryngol Head Neck Surg. 2022;30(1):58-62. https://doi.org
/10.1097/MOO.0000000000000775
4. Lee JT, Simpson CA, Yang HH, Suh JD, Wang MB, Lagishetty
V, et al. Fungal and bacterial microbiome in sinus mucosa of
patients with and without chronic rhinosinusitis. Laryngoscope.
2024;134(3):1054-1062. https://doi.org/10.1002/lary.30941
5. Uzunoðlu E, Kalkancý A, Kýlýç E, Kýzýl Y, Aydil U, Diker
KS, et al. Bacterial and fungal communities in chronic
rhinosinusitis with nasal polyps. PLoS One. 2024;19(5):
e0304634. https://doi.org/10.1371/ journal.pone. 0304634
6. Simpson T, Talati V, Baird AM, Gattuso P, Allen-Proctor MK,
Papagiannopoulos P, et al. Histopathology of allergic fungal
rhinosinusitis versus chronic rhinosinusitis with nasal polyps.
Laryngoscope. 2024;134(6):2617-2621. https://doi.org/10.
1002/lary.31225
7. Kokoszka M, Stryjewska-Makuch G, Kantczak A, Górny D,
Glück J. Allergic fungal rhinosinusitis in Europe: literature
review and own experience. ORL J Otorhinolaryngol Relat
Spec. 2023;85(9):856-865. https://doi.org/10.1159/000531017
8. Ashraf MJ, Kord M, Morovati H, Ansari S, Shekarkhar G,
Badali H, et al. Evaluating a semi-nested PCR to support
histopathology reports of fungal rhinosinusitis in formalinfixed paraffin-embedded tissue samples. J Clin Lab Anal.
2022;36(2):e24209. https://doi.org/10.1002/jcla.24209
9. Dubois A, Simon F, Alanio A, Guillonnet A, Kaci R, Herman
P, et al. Allergic fungal rhinosinusitis and eosinophilic mucin
chronic rhinosinusitis: differential diagnostic criteria. A twocenter comparative study following STROBE methodology.
Eur Ann Otorhinolaryngol Head Neck Dis. 2023;140(6):267-
270. https://doi.org/10.1016/j.anorl.2023.10.007
10. Iordache A, Balica NC, Horhat ID, Morar R, Tischer AA,
Milcu AI, et al. Allergic rhinitis associated with nasal polyps
and rhinosinusitis: histopathological and immunohistochemical
study. Rom J Morphol Embryol. 2022;63(2):413-419.
https://doi.org/10.47162/RJME.63.2.12
11. Brescia G, Alessandrini L, Frasconi S, Contro G, Frigo AC,
Marioni G. Structured histopathology and laboratory evidence
in nasal polyposis with different pathogenesis. Am J
Otolaryngol. 2023;44(1):103649. https://doi.org/10.1016/
j.amjoto.2022.103649
12. Awan NU, Cheema KM, Naumeri F, Qamar S. Allergic fungal
rhino-sinusitis frequency in chronic rhino-sinusitis patients
and accuracy of fungal culture in its diagnosis. Pak J Med
Sci. 2020;36(3):555-558. doi:10.12669/pjms.36.3.1661.
13. Dhanani R, Ghaloo SK, Salam B, Pasha HA, Yousuf FH,
Ikram M. Prevalence of allergic fungal sinusitis among patients
with nasal polyposis. J Pak Med Assoc. 2021;71(6):1605-
1607. doi:10.47391/JPMA.050
14. Sajjad SMQ, Suhail Z, Ahmed R. Prevalence of fungal infection
in nasal polyposis: a cross-sectional study conducted at a
tertiary care hospital in Karachi. J Pak Med Assoc.
2020;70(1):48-52. doi:10.5455/JPMA.296507.
15. Soundarya R, Deepa HC, Prakash PY, Geetha V. Fungal
rhinosinusitis: an integrated diagnostic approach. Ann Diagn
Pathol. 2025;75:152415. https://doi.org/10.1016/j. anndiagpath.
2024.152415
16. Kurokawa M, Kurokawa R, Baba A, Kim J, Tournade C,
McHugh J, et al. Deadly fungi: invasive fungal rhinosinusitis
in the head and neck. Radiographics. 2022;42(7):2075-2094.
https://doi.org/10.1148/rg.220059
17. Almutairi D. Imaging features of invasive fungal rhinosinusitis:
a systematic review. Can Assoc Radiol J. 2024. https://doi.
org/10.1177/08465371241227424
18. Zhu KZ, He C, Li Z, Wang PJ, Wen SX, Wen KX, et al.
Development and multicenter validation of a novel radiomicsbased model for identifying eosinophilic chronic rhinosinusitis
with nasal polyps. Rhinology. 2023;61(2):132-143. https://doi.
org/10.4193/Rhin22.361
19. Jiang RS, Liang KL. Comparison of bacteriology between
eosinophilic and noneosinophilic chronic rhinosinusitis with
nasal polyps. Otolaryngol Head Neck Surg. 2023;168(6):1545-
1550. https://doi.org/10.1002/ohn.237
20. Huang CC, Chang PH, Huang YL, Lee TJ, Huang CC, Wu
PW. Clinical characteristics of eosinophilic chronic
rhinosinusitis with nasal polyps in adolescents. J Asthma
Allergy. 2023;16:1197-1206. https://doi.org/10.2147/ JAA.
S437876
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