Expanding the Spectrum of Chronic Necrotizing (Semi-Invasive) Aspergillosis: A Series of 8 Cases Presenting as Radiologically Solid Lung Nodules Mimicking Malignancy


Josephine Kamtai Dermawan, Subha Ghosh, Sanjay Mukhopadhyay
Histopathology 2019 Nov 19


Aim: Clinicopathologic characterization of a subset of aspergillosis characterized by radiologically solid lung nodules.

Methods: We reviewed our archives for lung biopsies/resections with fungal hyphae on histology. Cases classifiable as a well-established form of aspergillosis were excluded. Unclassifiable cases with radiologically solid lung nodules and histologic evidence of fungal hyphae consistent with Aspergillus were analyzed in detail.

Results: Of 134 lung biopsies/resections with fungal hyphae, 8 presented as a solid lung nodule on imaging and could not be classified as a well-recognized form of aspergillosis. All patients were non/minimally immunocompromised adult smokers. Imaging showed solid, predominantly solitary, spiculated, subpleural, hypermetabolic upper lobe nodules in emphysematous lungs. Malignancy was suspected clinically in all cases. Histologically, the nodules were necrotizing granulomas containing fungal hyphae consistent with Aspergillus. On follow-up, none of the nodules recurred or progressed to invasive disease.

Conclusions: Aspergillosis can present as a radiologically solid, spiculated lung nodule suspicious for malignancy.

Keywords: Aspergillosis; Aspergillus; fungal hyphae; lung nodules; necrotizing granuloma.