Further observations on the primary paranasal aspergillus granuloma in the Sudan: A morphological study of 46 cases

Béla VeressDepartment of Pathology, Faculty of Medicine, University of Khartoum, Democratic Republic of the Sudan

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Osman A. MalikDepartment of Pathology, Faculty of Medicine, University of Khartoum, Democratic Republic of the Sudan

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Ahmed A. El TayebDepartment of Pathology, Faculty of Medicine, University of Khartoum, Democratic Republic of the Sudan

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Sayed El DaoudDepartment of Pathology, Faculty of Medicine, University of Khartoum, Democratic Republic of the Sudan

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El S. MahgoubDepartment of Pathology, Faculty of Medicine, University of Khartoum, Democratic Republic of the Sudan

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Ahmed M. El HassanDepartment of Pathology, Faculty of Medicine, University of Khartoum, Democratic Republic of the Sudan

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The morphological changes in 46 cases of primary paranasal aspergillus granuloma seen in the Sudan are described. Histologically, three groups can be differentiated: 1) a proliferative type, characterized by the presence of pseudotubercles in a fibrous tissue stroma; 2) an exudative-necrotizing type, consisting of large foci of edematous necrosis; and 3) a mixed group, where proliferation and necrosis exist side by side. Fungal hyphae are seen both within the giant cells and lying free in the stroma. Three factors seem to play a part in the pathogenesis of this disease: a) the climatic conditions, inducing recurrent inflammation of the nasal sinuses; b) the ability of the fungus and its toxic metabolites to cause damage; and c) an immunological process produced by the fungal antigens. The latter is supported by the finding of fibrinoid necrosis of collagen, vascular alterations, and formation of pseudotubercles.

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