Lung - nontumor - Aspergillus

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Lung-nontumor

Infections

Aspergillus

Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 23 December 2011, last major update August 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Hyphate fungus (mold) that presents as secondary colonization of lung abscess, aspergilloma (fungus ball, Indian J Pathol Microbiol 2008;51:342), allergic bronchopulmonary aspergillosis, bronchocentric granulomatosis or invasive aspergillosis in immunocompromised (Clin Microbiol Rev 2009;22:447)

Clinical features
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● Aspergillus infection is associated with solid organ or bone marrow transplants and antileukemic chemotherapy; relatively uncommon in AIDS patients
● Allergic bronchopulmonary aspergillosis: bronchocentric granulomas in asthmatics that contain numerous eosinophils and non-invasive aspergillus organisms or other fungi (Clin Dev Immunol 2011;2011:843763); patients have elevated IgE directed against aspergillus antigens, also thick mucus plugs; impacted mucus may form cast of airways (plastic bronchitis); over time, bronchi become dilated, causing bronchiectasis; patients develop intractable bronchospasm; rarely other fungi cause similar disease
● Bronchocentric granulomatosis: cell mediated reaction to aspergillus in airway; circumferential granulomatous inflammation surrounding small airways with mucus and cellular debris and loss of lining epithelium within airway (Radiographics 2007;27:617); may be isolated or part of allergic bronchopulmonary aspergillosis; rarely due to other fungi
● References: J Bras Pneumol 2009;35:1238

Diagrams
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Invasive aspergillosis by Aspergillus fumigatus

Gross description
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● Invasive disease usually shows targetoid lesions with peripheral consolidation and central thrombosed vessels due to angioinvasive fungi; variable bronchopneumonia or lobar pneumonia

Gross images
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Abscess

Aspergilloma

Micro description
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● Dichotomous (into two nearly equal branches, or 45 degrees) branching, hyphae with frequent septation, diameter ranges from 2.5 to 4.5 um
● May see aspergillus fruiting body (other fungi may mimic aspergillus, in general, should not definitively diagnose aspergillosis in tissue without the presence of a fruiting body), and often invades vessels

Micro images
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Fungus ball


Hyphae


Bronchocentric granulomatosis in asthma patient

conidiophore of Aspergillus flavus


Phialoconidia of Aspergillus fumigatus

Conidial head of Aspergillus niger

PAS stain


PAS stains-contributed by Professor Venna Maheshwar, Drs. Kiran Alam and Anshu Jain, J. N. Medical College, India


PAS stains-contributed by Dr. Claudia Mendez, Bogota, Columbia

Aspergilloma: Left-GMS, middle-H&E, right-PAS; contributed by Dr. Claudia Mendez, Bogota, Columbia

GMS stain

Virtual slides
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Aspergilloma (fungal ball)

Cytology images
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Invasive aspergillus tracheobronchitis: abundant necrotic material with multiple mycelia, consisting of septate hyphae branching at 45 degrees

Allergic bronchopulmonary aspergillosis with coexistant aspergilloma

End of Lung-nontumor > Infections > Aspergillus

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