J Korean Assoc Oral Maxillofac Surg.  2010 Apr;36(2):125-127. 10.5125/jkaoms.2010.36.2.125.

Squamous cell carcinoma occurring with aspergillosis in the maxillary sinus: a case report and histological study

• Byun JH
• Lee JH
• Rho GJ
• Park BW

• KMID: 2189989
• DOI: http://doi.org/10.5125/jkaoms.2010.36.2.125

Abstract

The coexistence of aspergillosis and squamous cell carcinoma (SCC) in the maxillary sinus was very rare. To our knowledge, this is the second report of coexistent SCC and aspergillosis in the maxillary sinus. A 58-year-old man underwent surgery for unilateral maxillary sinus infection with oroantral fistula. In the surgical specimen, SCC and aspergillosis were co-detected with routine and immunohistochemical stainings. Moreover, human papillomavirus 18 (HPV-18) was detected by polymerase chain reaction in the sinus specimen. The patient was re-operated with subtotal maxillectomy and has been followed up for two years without any evidence of recurrence or metastasis. Although it is not understood how aspergillosis could induce carcinoma formation, the chronic inflammation caused by prolonged fungal infection might be carcinogenic. Moreover, HPV-16 and -18 were another causative pathogens of SCC in the head and neck region. We recommend careful examination, including preoperative cytology, in patients with maxillary sinus fungal infections because of the potential for cancer development.

Keyword

Aspergillosis; Squamous cell carcinoma; Maxillary sinus

MeSH Terms

Aspergillosis
Carcinoma, Squamous Cell
Head
Human papillomavirus 16
Human papillomavirus 18
Humans
Inflammation
Maxillary Sinus
Middle Aged
Neck
Neoplasm Metastasis
Oroantral Fistula
Polymerase Chain Reaction
Recurrence

Figure

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  Fig. 1. Preoperative computed tomography (CT) and postoperative sinus mucosa. A. Preoperative CT showing calcified masses in the soft tissue density lesion of the left maxillary sinus. (arrows) B. Abundant, grey, caseous material and affected mucosa were removed from the left maxillary sinus.

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  Fig. 2. Histopathologic examinations of the affected maxillary sinus mucosa. A. Microphotograph after hematoxylin and eosin staining. The coexistence of moderately differentiated squamous cell carcinoma (SCC) and aspergillosis (ASP) was confirmed in the surgical specimen. (x12 magnification) B. Microphotograph after immunohistochemical staining with aspergillus antibody. Strong positive expression was detected in the partial portion of the SCC (square portion), as well as in the aspergillosis component. (x12) C, D. Under higher magnification of the SCC component, some aspergillus looked like a mixed form within the carcinoma tissues. (C: x100, D: x200) E. Epithelial koilocytosis was observed on the epithelial surface of the SCC.(arrows) (x200) F. Under high magnification of the immunostained aspergillosis component, aggregation of septated fungal hyphae with acute-angle branches was observed in the aspergillosis-affect region. (x400)

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  Fig. 3. Polymerase chain reaction revealed human papillomavirus-18 DNA in the maxillary sinus lesion. (M: 100bp marker, N: negative control, Pt: patient's sample, P: positive control)

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