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Aortic lesions in aspergillosis: histopathological study of two autopsy cases
M Shintaku1, A Sangawa, A Yonezawa
1Department of Pathology, Osaka Red Cross Hospital, Tennoji, Japan.
Abstract:
The involvement of the aorta in aspergillosis is relatively rare, and its histopathological features have not been described in detail. In two autopsy cases of invasive aspergillosis in immunologically compromised patients with hematological disorders, the aspergillotic lesions of the aorta showed different characteristic histopathological features depending on the three layers of aortic wall. Intimal lesions were formations of the mural thrombus composed of aggregates of numerous fungal hyphae arranged perpendicularly to the aortic wall. In the media, smooth muscle cells were completely necrotic (anemic infarct of the media), while the framework of elastic fibers was well preserved, with only a few fungal hyphae detected. In the adventitia, an intense, partly granulomatous chronic inflammatory change with fibrosis was observed in association with mycotic embolic occlusion of the vasa vasorum. These histopathological changes were considered to represent one of the typical tissue reaction patterns in the wall of an elastic artery in aspergillosis.
Insights
Aspergillosis rarely affects the aorta, but autopsy cases reveal distinct histopathological patterns. Fungal hyphae invade aortic layers, causing necrosis and inflammation, offering insights into this rare condition.
Area of Science:
- Pathology
- Mycology
- Cardiovascular Medicine
Background:
- Invasive aspergillosis is a serious fungal infection, particularly in immunocompromised individuals.
- Aortic involvement in aspergillosis is uncommon and poorly documented.
- Detailed histopathological descriptions of aortic aspergillosis are lacking.
Observation:
- Two autopsy cases of invasive aspergillosis in patients with hematological disorders were analyzed.
- Aortic lesions exhibited distinct features across the intima, media, and adventitia.
- Fungal hyphae were observed within mural thrombi, necrotic media, and inflamed adventitia.
Findings:
- Intimal lesions showed fungal hyphae within mural thrombi, perpendicular to the aortic wall.
- Medial lesions demonstrated smooth muscle cell necrosis (anemic infarct) with preserved elastic fibers.
- Adventitial lesions revealed chronic inflammation, fibrosis, and mycotic occlusion of vasa vasorum.
Implications:
- The observed histopathological changes represent a characteristic tissue reaction pattern in elastic arteries affected by aspergillosis.
- Understanding these patterns aids in diagnosing and managing rare cases of aortic aspergillosis.
- This study contributes to the detailed description of aortic pathology in invasive fungal infections.