Fungal Rhinosinusitis: A Retrospective Microbiologic and Pathologic Review of 400 Patients at a Single University Medical Center

Table 1

Classification of fungal rhinosinusitis.

	Histopathologic Criteria
Non-invasive FRS
Fungus ball (FB)	An entangled mass on fungi with Minimal surrounding inflammatory reaction or surrounding fibrinous necrotic exudate containing fungal forms; no tissue invasion or granulomatous reaction is present
Allergic fungal rhinosinusitis (AFRS)	The presence of eosinophilic mucin (mucinous material admixed with eosinophils, acute inflammatory cells, eosinophilic debris, and Charcot-Leyden crystals; sparse fungi or positive fungal cultures; no tissue invasion present)
Mixed FB/AFRS	The presence of features of both AFRS and FB
Invasive FRS
Acute (AIFRS)	Invasion of fungal forms into submucosal with frequent angioinvasion and necrosis in a patient with symptoms of less than one-month duration
Chronic (CIFRS)	Invasion of fungal forms into submucosal often with surrounding chronic inflammation and fibrosis in patient with long-standing symptoms (>3-month duration)
Chronic granulomatous (CGFRS)	Invasion of fungal forms into submucosal often with surrounding chronic inflammation, fibrosis, and granuloma production in patient with long-standing symptoms (>3-month duration)
Mixed Non-invasive/invasive FRS	A mixture of either of the invasive and non-invasive categories