UTILITY OF FROZEN SECTIONS BIOPSY FOR THE DIAGNOSIS AND TREATMENT OF MUCORMYCOSIS. CASE REPORT AND REVIEW OF THE LITERATURE
DOI:
https://doi.org/10.29176/2590843X.1555Keywords:
Frozen section biopsy, Fungal histochemistry stains, Intraoperatory evaluation, Invasive fungal infections, Sinonasal mucormycosisAbstract
Background: Mucormycosis refers to fungal infections of the Mucoraceae family, of the order Mucorales. There are 3 important genera responsible for human infections: Rhizopus, Mucor and Absidia. Mucormycosis May be, rhinocerebral, sinonasal, pulmonary, gastrointestinal, cutaneous and disseminated have been described. Usually affects immunocompromised patient or with some degree of immune system compromise.
Case report: 24-year-old female patient with approximately one month of evolution of left otalgia who received different antibiotic management without improvement of the condition. She refers that she had a procedure on the upper left dental face and arch with subsequent change in skin color, paleness and necrosis. A diagnosis of soft tissue sepsis and diabetes mellitus de novo is made. It is evaluated by the dermatology service who take biopsy for frozen sections, in which hyaline filaments in the form of ribbons, hyphae with irregular walls and variable diameter, some irregularly branched, at angles greater than 45° and few septa are recognized, which stand out with the periodic acid Schiff (PAS) staining in the subsequent paraffin sections. The objective of this article is to describe the usefulness of frozen biopsy in the early diagnosis of mucormycosis.
Conclusions: The use of frozen section biopsy in the context of mucormycosis has proven to be a valuable tool for intraoperative evaluation of skin and soft tissues with great impacts in the evaluation of treatment and survival, so it must be controlled in conjunction with clinical characteristics at the time of decision making.
Author Biographies
Samuel David Morales-Naranjo
Médico Patólogo, Hospital de San José/Instituto Nacional De Cancerología, instructor programa de patología Fundación universitaria de ciencias de la Salud (Fucs)/Hospital De San José, Sociedad de Cirugía de Bogotá.
Juan Eduardo Rocha-Aguirre
Médico Patólogo y Epidemiólogo, Fundación universitaria de ciencias de la Salud (Fucs), Fellow Dermatopatología Universidad CES, Medellín Colombia
Rocío Paola Prieto-Pérez
Médico especialista en Sistemas de garantía de calidad y auditoria de servicios de salud, Residente de tercer año del programa de patología Fundación universitaria de ciencias de la Salud (Fucs)/Hospital De San José, Sociedad de Cirugía de Bogotá.
References
2. Botero JC, Moreno LF, Caparroso LC. Mucormicosis rinocerebral en paciente con cefalea y diabetes mellitus. Infectio. 2008;12(1):298-303.
3. Tapia O, Chahín C, Concha C. Mucormicosis cutánea primaria: a propósito de dos casos. Revisión de la literatura. Revista Chil Infectol. 2011;28(3):269-73. doi: 10.4067/S0716-10182011000300012
4. Vergara DIN, Barragán G, Bonifaz A, Núñez C. Mucormicosis pulmonar en un paciente con trasplante renal y hemoptisis incoercible. Rev Iberoamericana Micol. 2017;34(4):233-6.
5. Pak J, Tucc V, Vincent A, Sandin R, Greene J. Mucormycosis in immunochallenged patients. J Emerg Trauma Shock. 2008;1(2):106-13. doi: 10.4103/0974-2700.42203
6. Sarvestani S, Pishdad G, Bolandparvaz S. Epidemiology and Clinical Characteristics of Mucormycosis in Patients with Leukemia; A 21-year Experience from Southern Iran. Bull Emerg Trauma. 2014;2(1):38-43.
7. Noorifard M, Sekhavati E, Khoo H, Hazraty I, Tabrizi R. Epidemiology and clinical manifestation of fungal infection related to Mucormycosis in hematologic malignancies. J Med Life. 2015;8(Spec Iss 2):32-37.
8. Skiada A, Groll A, Zimmerli S, Dupont B, Lagrou K, Lass-Florl C, et al. Zygomycosis inEurope: análisis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between2005 and 2007. Clin Microbiol Infect. 2011;17(12):1859-67. doi: 10.1111/j.1469-0691.2010.03456.x
9. Deja M, Weber-Carstens S, Lehmann TN, Adler A, Ruhnke M, Tintelnot K. Gastrointestinal zygomycosis caused by Mucor indicus in a patient with acute traumaticbrain injury. Med Mycol. 2006;44(7):683-7. doi: 10.1080/13693780600803888
10. Pozo JC, Ponte A, Pozo C, Robles JC, Linares MJ. Mucormicosis diseminadas en pacientes sin inmunodeficiencias: una enfermedad que también existe. Rev Iberoamericana Micol. 2015;32(2):63-70. doi: 10.1016/j.riam.2014.01.006
11. Kradin RL. Diagnostic pathology of infectious disease. Filadelfia: Saunders; 2018.
12. Zahoor BA, Piercey J, Wall D, Tetsworth K. A surgical approach in the management of mucormycosis in a trauma patient. Annals R Coll Surg Engl. 2016;98(8):e173-7. doi: 10.1308/rcsann.2016.0221
13. Singh V, BansalC, Kaintura M. Sinonasal Mucormycosis: A to Z. Indian J Otolaryngol Head Neck Surg. 2019;71(Suppl 3):1962-71. doi: 10.1007/s12070-018-1384-6
14. 14. Espellberg B, Walsh TJ, Kontoyiannis DP, Edwards Jr J, Ibrahim AS. Recent advances in the management of mucormycosis: from bench to bedside. Clin Infect Dis. 2009;48(12):1743-51. doi: 10.1086/599105
15. Hofman V, Castillo L, Bétis F, Guevara N, GariToussaint M, Hofman P. Usefulness of frozen section in rhinocerebral mucormycosis diagnosis and management. Pathology. 2003;35(3):212-6. doi: 10.1080/0031302031000123173
16. Delgado JA. Realidad en biopsias por congelación. Universitas Médica. 2007;48(1):37-45.
17. Hennessy M, McGinn J, White B, Payne S, Warrick J, Crist H. Frozen section as a rapid and accurate method for diagnosing acute invasive fungal rhinosinusitis. Otolaryngol Head Neck Surg. 2018;159(3):576-80. doi: 10.1177/0194599818770615
18. Zimmermann N, Hagen M, Schrager J, HebbelerClarck R, Masineni S. Utility of frozen section analysis for fungal organisms in soft tissue wound debridement margin determination. Diagn Pathol. 2015;10(1):188. doi: 10.1186/s13000-015-0423-9
19. Milner DA. Diagnostic Pathology: Infectious Diseases. 2.a edición. Filadelfia: Elsevier Health Sciences; 2019.
20. Son HJ, Song JS, Choi S, Jung J, Jae M, Chong Y, et al. A comparison of histomorphologic diagnosis with culture- and immunohistochemistry-based diagnosis of invasive aspergillosis and mucormycosis. Infect Dis (Lond). 2020;52(4):279-83. doi: 10.1080/23744235.2020.1716063
21. Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. 2000;13(2):236-301. doi: 10.1128/cmr.13.2.236-301.2000
22. Guarner J, Brandt M. Histopathologic diagnosis of fungal infections in the 21st century. 2011;24(2):247-80. doi: 10.1128/CMR.00053-10
23. Hofman V, Dhouibi A, Butori C, Padovani B, Gari-Toussaint M, Garcia D, et al. Usefulness of molecular biology performed with formaldehyde-fixed paraffin embedded tissue for the diagnosis of combined pulmonary invasive mucormycosis and aspergillosis in an immunocompromised patient. Diagn Pathol. 2010;5(1):1. doi: 10.1186/1746-1596-5-1
24. Sharifipour F, Rezaeetalab F, Naghibi M. Pulmonary fungal infections in kidney transplant recipients: an 8-year study. Transplant Proc. 2009;41(5):1654-6. doi: 10.1016/j.transproceed.2009.02.072
25. Larkin PM, Lawson K, Contreras D, Le C, Trejo M, Realegeno S, et al. Amplicon-Based NextGeneration Sequencing for Detection of Fungi in Formalin-Fixed, Paraffin-Embedded Tissues: Correlation with Histopathology and Clinical Applications. J Mol Diagn. 2020;22(10):1287-93. doi: 10.1016/j.jmoldx.2020.06.017
How to Cite
Downloads
Downloads
Published
How to Cite
Issue
Section
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
