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Histoplasmomas of uncommon size
Bradley W Richmond1, John A Worrell2, Julie A Bastarache1
1Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN.
Abstract:
Histoplasma capsulatum infection demonstrates a broad spectrum of acute and chronic clinical manifestations. Unlike the acute reaction to proliferating organisms, the chronic complications are often the result of excessive or prolonged host response with a paucity of organisms. Lung nodules (histoplasmomas) may be noted decades after initial infection and present a challenging clinical problem, as they can be difficult to distinguish from malignancy or tuberculomas. Typically, histoplasmomas are small (<1 cm), asymptomatic, and may be stable in size or slowly enlarge over time. Here we report three patients with unusually large, or giant, histoplasmomas (>3 cm) and describe their extreme phenotype. Importantly, two of the patients presented with subacute symptomatic disease, a presentation that is very atypical for histoplasmoma. The term "buckshot" calcification has been used to describe dozens of small (2-4 mm) calcified nodules, so it may be appropriate to label masses that exceed 3 cm as "cannonball" histoplasmoma.
Insights
Giant histoplasmomas, larger than 3 cm, are rare and can mimic malignancy. These "cannonball" histoplasmomas may present with atypical symptoms, challenging diagnosis.
Area of Science:
- Infectious Diseases
- Pulmonology
- Radiology
Background:
- Histoplasma capsulatum infection causes diverse clinical presentations, ranging from acute to chronic.
- Chronic histoplasmosis complications often stem from prolonged host immune responses with minimal fungal presence.
- Pulmonary nodules, or histoplasmomas, can persist for decades and pose diagnostic challenges, often resembling tumors or tuberculomas.
Observation:
- Histoplasmomas are typically small (<1 cm), asymptomatic, and stable or slowly growing.
- This study details three cases of unusually large, or giant, histoplasmomas (>3 cm) exhibiting an extreme phenotype.
- Two patients presented with subacute symptomatic disease, an atypical presentation for histoplasmoma.
Findings:
- Giant histoplasmomas (>3 cm) represent an extreme phenotype of pulmonary histoplasmosis.
- Atypical presentations, including subacute symptoms, were observed in patients with giant histoplasmomas.
- The term "cannonball" histoplasmoma is proposed for these large masses, distinct from "buckshot" calcifications.
Implications:
- The findings expand the clinical spectrum of histoplasmoma presentation.
- "Cannonball" histoplasmoma may aid in differentiating these rare, large nodules from other pulmonary pathologies.
- Recognizing atypical presentations is crucial for accurate diagnosis and management of histoplasmoma.
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