Clinicopathologic study of malignant tumors in head and neck region complicated by fungal infection

Abstract

To study the clinicopathologic features of malignant tumors in head and neck region complicated by fungal infection. Twenty-one cases of malignant tumors occurring in head and neck region complicated by fungal infection were retrieved from the archival file. The light microscopic findings were reviewed. Histochemical (for PAS and GMS) and immunohistochemical (for MUC5B) studies were carried out. Fungal culture results were available in 13 of the 21 cases. The age of the patients ranged from 12 to 72 years (median = 48 years). The male-to-female ratio was 17:4. Eight cases (38.1%) were complicated by invasive fungal sinusitis, with orbital involvement in 6 cases and brain involvement in 1 case. The primary tumors in such cases included leukemia (n = 7) and nasopharyngeal carcinoma (n = 1). The fungi belonged to Zygomycete in 5 cases and Aspergillus in 3 cases. These patients had history of chemotherapy/radiotherapy or antibiotics usage. The remaining 13 cases of fungal infection often affected necrotic tumor tissue in nasal cavity, paranasal sinuses, pharynx, larynx and palate. The fungi involved were Aspergillus (n = 6) and Candida (n = 4). Seven of such patients had received radiotherapy. Fungal culture was positive in 9 cases. Fourteen patients had follow-up information available and six of them died of the disease. Malignant tumors occurring in head and neck region can be complicated by fungal infection. Invasive fungal sinusitis (due to Zygomycetes and Aspergillus) often occurs in patients with leukemia, tends to involve orbit and is associated with poor prognosis. On the other hand, Aspergillus and Candida are the commonest fungi found in the necrotic tumor tissue. Pathologic examination remains the hallmark in confirming the diagnosis and fungal typing.