deShazo et al reported criteria for the diagnosis of sinus mycetoma (fungus ball). The authors the University of South Alabama in Mobile.
Criteria for the diagnosis of sinus mycetoma:
(1) Imaging studies show opacification of the sinus with or without flocculent calcifications.
(2) The sinus contains mucopurulent, cheesy or clay-like material.
(3) There is a dense conglomeration of fungal hyphae adjacent to but separate from the sinus mucosa.
(4) There is no histologic evidence of fungal invasion into the mucosa, adjacent blood vessels or underyling bone (invasion indicates invasive disease).
(5) There is a chronic inflammatory response in the adjacent mucosa without features of allergic fungal sinusitis and without a granulomatous response.
Differential diagnosis:
(1) invasive fungal disease (The fungus invades into sinus mucosa or underlying tissue.)
(2) allergic fungal sinusitis (Dominance of eosinophils, presence of allergic mucin)
(3) bacterial sinusitis
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