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

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  • 1 Department of Pathology, Faculty of Medicine, University of Khartoum, Democratic Republic of the Sudan

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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