变应性真菌性鼻窦炎临床病理分析

Clinicopathological evaluation of 36 cases of allergic fungal sinusitis

目的探讨变应性真菌性鼻窦炎（AFS）的临床病理特征，提高对AFS的认识和病理诊断水平。方法回顾并分析首都医科大学附属北京同仁医院2002—2006年36例AFS的临床病理和影像学资料，应用阿尔辛蓝一过碘酸雪夫（AB—PAS）、环六亚甲基四胺银（GMS）特殊染色及黏蛋白5B（MUC5B）免疫组织化学（sP法）染色标记真菌，同时选取AFS新鲜活检组织10例进行透射电镜观察。结果36例AFS中，男21例，女15例，发病年龄11～53岁。多具有变应性疾病病史。CT平扫示受累的鼻窦充满软组织影，伴斑片状高密度影，窦壁骨质可出现压力性骨破坏。实验室检查：一种或多种真菌抗原皮试阳性（31／36）；血清学检查总IgE和（或）真菌特异性IgE增高（20／36）；外周血嗜酸性粒细胞数增多（23／36）。真菌培养10例阳性。组织病理学：大体典型病变为黏稠的“油灰样”分泌物，镜下为特征性的“嗜酸性黏蛋白”，AB-PAS及GMS染色、MUC5B免疫组织化学染色真菌均着色。透射电镜可见嗜酸性粒细胞脱颗粒现象。结论“嗜酸性黏蛋白”是AFS最具特征性的病理学表现，建议采用AB—PAS、GMS特殊染色及MUC5B免疫组织化学染色等多种方法联合标记真菌；需对临床症状、影像学特点、实验室检查及病理学表现等多个方面进行综合判断以得出正确诊断。

Objective To characterize clinicopathological features of allergic fungal sinusitis （AFS）. Methods Thirty-six cases of AFS were retrieved from the department archival files of Beijing Tongren Hospital from 2002 to 2006. AB-PAS, GMS and MUC5B stain were performed using paraffinembedded tissues of the cases. Ten cases with available fresh diagnostic tissue were investigated by electron microscopy. Results Patients included 21 males and 15 females. The age of patients ranged from 11 to 53 years. Atopy was very common in these patients. On plain CT scans, the affected nasal sinuses were filled with soft tissue shadow with patchy hyperdensity. The bony sinus wall showed areas of pressure erosion. Skin antigen tests showed fungal positivity in 31 of 36 cases. Serum levels of the total IgE and/or the specific fungal IgE were elevated in 20 cases. The eosinophil quantity was elevated in 23 cases. Fungal culture was positive in 10 cases. Gross examination showed thick putty secretions within the lesions. Light microscopy showed typical “eosinophilic mucin”. Fungal elements were seen with AB-PAS, GMS and MUC5B stains. Electron microscopy demonstrated degranulation by the eosinophils. Conclusions “Eosinophilic muein” is the typical histopathological feature of AFS. AB-PAS, GMS and MUC5B staining methods can used to detect fungal species in mucin. Accurate diagnosis of AFS requires correlations among clinical findings, radiologic examinations, laboratory tests and histopathologic features. However, the ultimate diagnosis requires a histopathologic confirmation.