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Histopathology of aspergilloma, H&E staining

An aspergilloma, also known as a mycetoma or fungus ball, is a clump of fungus which exists in a body cavity such as the lung. It is associated with the Aspergillus species,^[1] but Zygomycota and Fusarium may also form similar structures.^{[citation needed]}

Etiology

The most common place affected by aspergillomas is the lung. Aspergillus fumigatus, the most common species, is typically inhaled as small (2 to 3 micrometer) spores which do not affect people without underlying lung or immune system disease. However, people who have pre-existing lung problems, especially the cavities typically caused by tuberculosis, are at risk for developing aspergillomae. The fungus settles in a cavity and is able to grow free from interference because the immune system is unable to penetrate into the cavity. As the fungus multiplies, it forms a ball, which incorporates dead tissue from the surrounding lung, mucus, and other debris.^[2]

Clinical syndrome

Typically, individuals who are affected by aspergillomata do not have symptoms related to the infection. People often co-exist for decades with aspergillomata prior to incidental diagnosis, typically by X-ray or computed tomography. However, a small percentage of aspergillomata invade into the wall of the cavity and can result in bleeding. Thus, the most common symptom of associated with aspergillomata is coughing up blood (hemoptysis). Although this can occasionally be life-threatening, the amount of blood produced is usually inconsequential.

Aspergillomata can form in other body cavities. They can form abscesses in the brain, usually in people who are immunocompromised. They can also form within the different sinuses in the face, within the kidneys and urinary system, the ear canal, and on the heart valves.

Treatment

Most cases of aspergilloma do not require treatment. Treatment of diseases which increase the risk of aspergilloma, such as tuberculosis, may help prevent their formation. In cases complicated by severe hemoptysis, surgery may be required to remove the aspergilloma and stop the bleeding. There has been interest in treatment with antifungal medications, such as itraconazole, but as of 2005, none has been shown to eradicate aspergillomae.

While fungus can grow within a pre-existing lung cavity as a rounded mass of hyphae, there is another, probably more common cause of "fungus ball." Although fungi, especially Aspergillus, fail to grow in healthy humans, significant growth may occur during periods of diminished resistance including very low white blood cell counts. Within the lungs of immunocompromised individuals the fungal hyphae spread out as a spherical growth. With restoration of normal defense mechanisms, white blood cells are attracted to the edge of the spherical fungal growth where they lyse, releasing tissue-digesting enzymes as a normal function. A sphere of infected lung is thus cleaved from the adjacent lung. This sphere flops around in the resulting cavity and is recognized on x-ray as a fungus ball but is really a "lung ball". This process is benficial as a potentially serious invasive fungal infection is converted into surface colonization. Although the fungus is inactivated in the process, surgeons may choose to operate to reduce the possibility of bleeding. Microscopic examination of surgically removed recently-formed fungus balls clearly show a sphere of dead lung containing fungal hyphae. Microscopic examination of older lesions reveal mummified tissue which may reveal faint residual lung or hyphal structures.^[3]

References

^ "aspergilloma" at Dorland's Medical Dictionary
^ Soubani AO, Chandrasekar PH (June 2002). "The clinical spectrum of pulmonary aspergillosis". Chest 121 (6): 1988–99. doi:10.1378/chest.121.6.1988. PMID 12065367.
^ Przyjemski, CJ; Mattii, R (1980). "The Formation of Pulmonary Mycetomata". Cancer 46: 1701–1704.

External links

Aspergillus organization: diagnosis, treatment, cases, images, educational video

UpToDate Contents

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1. 慢性肺アスペルギルス症の治療 treatment of chronic pulmonary aspergillosis
2. 慢性肺アスペルギルス症の臨床症状および診断 clinical manifestations and diagnosis of chronic pulmonary aspergillosis
3. HIV感染患者における肺アスペルギルス症および侵襲性疾患の疫学および臨床症状 epidemiology and clinical manifestations of pulmonary aspergillosis and invasive disease in hiv infected patients
4. Clinical manifestations and diagnosis of allergic bronchopulmonary aspergillosis
5. 成人における喀血の病因および評価 etiology and evaluation of hemoptysis in adults

English Journal

Pulmonary infections imitating lung cancer: clinical presentation and therapeutical approach.

Schweigert M, Dubecz A, Beron M, Ofner D, Stein HJ.SourceDepartment of General and Thoracic Surgery, Klinikum Nürnberg Nord, Nürnberg, Germany, michael.schweigert@klinikum-nuernberg.de.
Irish journal of medical science.Ir J Med Sci.2013 Mar;182(1):73-80. doi: 10.1007/s11845-012-0831-8. Epub 2012 May 17.
BACKGROUND: Pulmonary infections occasionally present with infectious pseudotumour of the lung not easily distinguishable from true pulmonary neoplasm. In such cases, radiographic findings and clinical manifestation are highly suggestive of lung cancer. These inflammatory lung lesions cause signific
PMID 22592566

Two cases of endobronchial carcinoid masked by superimposed aspergillosis: a review of the literature of primary lung cancers associated with Aspergillus.

Nilsson JR, Restrepo CS, Jagirdar J.SourceDepartment of Pathology and Cytology, Karolinska University Hospital, Karolinska vagen, 17176 Solna, Sweden. Electronic address: nilssonrobert77@hotmail.com.
Annals of diagnostic pathology.Ann Diagn Pathol.2013 Feb;17(1):131-6. doi: 10.1016/j.anndiagpath.2011.06.005. Epub 2011 Nov 10.
We describe 2 cases of endobronchial pulmonary carcinoid tumor with superimposed Aspergillus colonization. The Aspergillus hyphae were associated with fibrin, ulcer debris, and granulomatous inflammation in part masking the carcinoid tumor. Presence of necrotic debris made diagnosis on biopsy diffic
PMID 22079170

Cranial aspergilloma masquerading as meningioma.

Verma R, Singh P, Kumar A, Paliwal VK.SourceDepartment of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
BMJ case reports.BMJ Case Rep.2013 Jan 9;2013. pii: bcr2012008118. doi: 10.1136/bcr-2012-008118.
Cranial aspergillosis may present as meningitis, cerebral abscess, cerebral infarcts/haemorrhages or extra-axial mass. Extra-axial cranial aspergilloma may mimic meningioma owing to mass-like characteristics and intense contrast enhancement on MRI there by delaying the diagnosis and further worsenin
PMID 23307467

Japanese Journal

Diagnostic significance of Aspergillus species isolated from respiratory samples in an adult pneumology ward.

Tashiro Takayoshi,Izumikawa Koichi,Tashiro Masato,Takazono Takahiro,Morinaga Yoshitomo,Yamamoto Kazuko,Imamura Yoshifumi,Miyazaki Taiga,Seki Masafumi,Kakeya Hiroshi,Yamamoto Yoshihiro,Yanagihara Katsunori,Yasuoka Akira,Kohno Shigeru
Medical Mycology : official publication of the International Society for Human and Animal Mycology 49(6), 581-587, 2011-08
… and displayed no clinical symptoms of aspergillosis, while 77 (55%) had a form of pulmonary aspergillosis, characterized as either chronic necrotizing pulmonary aspergillosis (CNPA) (48%), aspergilloma (29%), IPA (13%), or allergic bronchopulmonary aspergillosis (ABPA) (10%). … fumigatus was most commonly isolated in patients with IPA, aspergilloma, and CNPA, whereas A. …
NAID 120003751853

高用量リポソーマルアムホテリシンB投与で著効を示したボリコナゾール無効の侵襲性肺アスペルギルス症の1例

畑地治,駒田文彦,小林裕康,田口修
日本呼吸器学会雑誌 = The journal of the Japanese Respiratory Society 49(7), 496-500, 2011-07-10
NAID 10029372342

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