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[Transformation of the fungus ball type pulmonary aspergillosis]
T Nomura1, H Sawazaki, S Saiki
1Department of Thoracic Surgery, International Medical Center of Japan, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
Abstract:
Though the concept of semi-invasive pulmonary aspergillosis was advocated in 1981 by Gefter et al., its histopathological appearance has not yet been reported in detail. Pathological studies on fungus ball type pulmonary aspergillosis (PA) were originally made mainly in regard to related bronchi. Chronic-progressive destructive changes cannot be completely explained from this viewpoint alone. Clinically, since bloody sputum and hemoptysis appeared frequently, further studies on the pulmonary vasculature were considered necessary. In the resected lungs of 3 cases of semi-invasive pulmonary aspergillosis, the pathological features of pulmonary vasculature were characterized by numerous fungal clots within pulmonary arteries and veins, marked destruction of pulmonary blood vessels and extensive intravascular fibrin deposition. Intravascular fibrin deposition causes stasis of blood flow, promotes intravascular proliferation of aspergilli and probably accelerates pulmonary destruction caused by blood stasis. Important pathological findings of fungus ball type pulmonary aspergillosis of the semi-invasive subtype with clinical aspects of chronic-progressive lung destruction caused by severe inflammation, were reported for both the vascular and the bronchial system.
Insights
This study details the histopathology of semi-invasive pulmonary aspergillosis, revealing vascular destruction and fungal clots. These findings explain chronic lung destruction in this fungal infection.
Area of Science:
- Pulmonology
- Pathology
- Mycology
Background:
- Semi-invasive pulmonary aspergillosis (PA) histopathology remains underexplored.
- Previous studies focused on bronchial aspects, not fully explaining chronic lung destruction.
- Clinical presentation includes hemoptysis, suggesting vascular involvement.
Observation:
- Examined resected lungs from 3 semi-invasive PA cases.
- Detailed pathological features of pulmonary vasculature.
- Observed fungal clots in pulmonary arteries and veins.
Findings:
- Marked destruction of pulmonary blood vessels.
- Extensive intravascular fibrin deposition.
- Fungal clots and fibrin contribute to blood stasis and disease progression.
Implications:
- Provides detailed histopathological insights into semi-invasive PA.
- Highlights the critical role of vascular pathology in chronic lung destruction.
- Enhances understanding of the pathogenesis of this severe fungal infection.