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Year : 2022  |  Volume : 65  |  Issue : 4  |  Page : 944-945
Endobronchial aspergilloma: Benign appearance of potentially fatal consequences


Rabin Medical Center, Pulmonary Institute, Petah Tikva; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

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Date of Submission30-Jan-2021
Date of Decision13-Oct-2021
Date of Acceptance21-Apr-2022
Date of Web Publication12-May-2022
 

How to cite this article:
Izhakian S, Kramer MR. Endobronchial aspergilloma: Benign appearance of potentially fatal consequences. Indian J Pathol Microbiol 2022;65:944-5

How to cite this URL:
Izhakian S, Kramer MR. Endobronchial aspergilloma: Benign appearance of potentially fatal consequences. Indian J Pathol Microbiol [serial online] 2022 [cited 2022 Nov 30];65:944-5. Available from: https://www.ijpmonline.org/text.asp?2022/65/4/944/345152




Endobronchial aspergilloma is a rare disease entity of pulmonary aspergillosis.[1],[2],[3],[4] It is characterized by growth of the Aspergillus species into the bronchial lumen. The clinical presentation ranges from asymptomatic patients who are diagnosed during surveillance bronchoscopies,[1] to patients having cough, dyspnea on exertion, lobar atelectasis, and hemoptysis, which can be fatal.[2] This pathogen mainly affects immunocompromised patients; however, immunocompetent patients are also known to be affected.[4] A nidus or structural lung changes are usually required to induce airflow stasis to colonize the bronchial lumen. The nidus for endobronchial growth can be cancer, a foreign body,[4] post-lung transplantation bronchial anastomosis sutures, and even bronchial stump post-lung resection. We report a case of endobronchial aspergillosis whose growth was on the endobronchial stent.

A 62-year-old man presented to a scheduled routine bronchoscopic follow-up of an endobronchial stent. His medical history was positive for chronic obstructive pulmonary disease due to smoking, status post left upper lobe lobectomy due to squamous cell carcinoma and irradiation to the mediastinum. Subsequently, he had left lower lobe bronchial stenosis that necessitated balloon dilation and metallic endobronchial stent placement. Before the procedure, he reported of having hemoptysis for the past 2 weeks. During the procedure, we found an in-growth of a yellow endobronchial mass on the endobronchial stent [Figure 1]a. Routine hematoxylin and eosin staining of mass sections was performed, which revealed a branching septate Aspergillus, branching at very acute angles of 45 degrees [Figure 1]b. Bronchoalveolar fungal culture was positive for Aspergillus fumigatus.
Figure 1: (a) Fiberoptic bronchoscopy revealed a yellow mass on a metallic endobronchial stent in the left lower bronchus. (b) Gram-staining of endobronchial mass samples revealed branching and closely packed septate hyphae (H and E stain, 10×)

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In conclusion, endobronchial aspergilloma is usually incidentally detected in patients with underlying lung disease and also in immunocompromised patients. It appears as a necrotic mass that causes bronchial obstruction on bronchoscopy and can be confirmed by biopsy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ma JE, Yun EY, Kim YE, Lee GD, Cho YJ, Jeong YY, et al. Endobronchial aspergilloma: Report of 10 cases and literature review. Yonsei Med J 2011;52:787-92.  Back to cited text no. 1
    
2.
Yoshizaki A, Yamamoto M, Hirabayashi A, Ono Y, Hatakeyama Y, Nakata K, et al. Fatal hemoptysis due to endobronchial aspergilloma in the hyperinflated native lung after single-lung transplantation for lymphangioleiomyomatosis: A case report. Kobe J Med Sci 2020;65: E114-7.  Back to cited text no. 2
    
3.
Jung SW, Kim MW, Cho SK, Kim HU, Lee DC, Yoon BK, et al. A case of endobronchial aspergilloma associated with foreign body in immunocompetent patient without underlying lung disease. Tuberc Respir Dis 2013;74:231-4.  Back to cited text no. 3
    
4.
Nilsson JR, Restrepo CS, Jagirdar J. Two cases of endobronchial carcinoid masked by superimposed aspergillosis: A review of the literature of primary lung cancers associated with Aspergillus. Ann Diagn Pathol 2013;17:131-6.  Back to cited text no. 4
    

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Correspondence Address:
Shimon Izhakian
The Pulmonary Institute, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petach Tikva – 49100
Israel
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpm.ijpm_116_21

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