ONLINE ONLY: Aspergilloma in combination with adenocarcinoma of the lung

• Published in: Canadian Journal of Surgery 2008-02, Vol.51 (1), p.E3
• Main Authors: Saleh, Waleed, Ostry, Avi, Henteleff, Harry
• Format: Article
• Language: English
• Subjects: Lungs; Medical diagnosis; Medical treatment; Respiratory diseases
• ISSN: 0008-428X; 1488-2310

Four distinctive patterns of Aspergillusrelated lung diseases are recognized, as follows: saprophytic colonization, pulmonary aspergilloma, hypersensitivityinduced aspergillosis and invasive pulmonary aspergillosis.2 When a preexisting cavity becomes colonized by a fungus, typically Aspergillus, a mycetoma (fungus ball or aspergilloma) forms, usually in the upper lung fields. It consists of branched, septated hyphae and blood cells.3 It is typically caused by Aspergillus fumigatus, although other species may be associated with its formation. The diagnosis is usually established radiologically by demonstrating the characteristic appearance of the fungus ball. Conditions associated with aspergilloma formation include tuberculosis, sarcoidosis, histoplasmosis, lung abscess, bronchiectasis, bullae, pulmonary infarcts, cystic fibrosis, HIV infection and cavitated squamous cell lung cancer.1 From 1959 to 1992, the most common preexisting condition was tuberculosis. Since then, the prevalence of pulmonary aspergilloma has declined.3 In one study, the prevalence of Aspergillus growth in patients with bronchogenic carcinoma was reported as being 14.2%,4 but only a few cases of combined aspergilloma and lung cancer have been reported in the literature.5 Most cases lacked one or both of the features of postinflammatory intracavitary aspergilloma: a loose fungus ball and antifungal serum antibodies. In some cases, the presence of lung cancer with aspergilloma was difficult to detect radiologically. 5