A Unique Cytological Approach In Diagnosing A Case Of Invasive Aspergillosis Masquerading As Retro-Orbital Neoplasm
2311-2315
Correspondence
Dr Menka Khanna
Email: mona74_khanna@yahoo.co.in
Aspergillus is a fungal mould that is commonly present and may colonize the paranasal sinuses and lungs by virtue of large number of Aspergillus spores present in the inhaled air. Rare cases
of invasive aspergillosis have been reported in immunocompetent individuals, although they are usually seen in immunocopromised individuals or diabetics.
The following is the description of a simple technique in the present case report of a young immunocompetent agricultural worker who presented with invasive aspergillosis as exophthalmos; where the diagnosis was made by isolating the pathogenic organism by employing the remnant material in the needle hub as the incubating material.
A 24 year old male presented to the ophthalmology OPD with the complaint of gradual and painless swelling of the right eye with accompanying loss of vision. A radiological opinion of orbital neoplasm was made, with differential diagnosis of benign fibrous histiocytoma and ?? lymphoma. A fine needle aspiration (FNA) was done and the May Grunwald Giemsa (MGG) stained smears revealed numerous foreign body type of giant cells, few epitheloid cell collections and scattered filamentous structures. To delineate the nature of the filamentous structures, Periodic acid Schiff (PAS) staining of the remaining smears was done, which showed that these filamentous structures were fragments of septate fungal hyphae with acute angle branching. A cytological diagnosis of fungal granulomatous lesion was given.
It was suggested that an attempt would be made to retrieve the fungal organism by means of culture from the remnant material in the hub of the needle which was used in the procedure .Both the needles were sealed and were sent to the mycology section of the microbiology department. A microbiological diagnosis of Aspergillus flavus was given.
The presentation of localized invasive aspergillosis can mimic infectious diseases such as mucormycosis and also neoplastic, vascular and neuro-ophthalmic diseases.