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The histological spectrum of chronic necrotizing forms of pulmonary aspergillosis
1Department of Pathology, Montefiore University Hospital, University of Pittsburgh Medical Center, PA 15213-2582, USA.
Abstract:
Chronic necrotizing pulmonary aspergillosis (CNPA) is a rare locally destructive form of chronic aspergillosis that is recognized as a clinical syndrome, but has been poorly defined histologically. In this study, 10 cases of CNPA were evaluated from a morphological perspective. Three distinct forms of CNPA emerged. One form (n = 4) resembled a necrotizing granulomatous pneumonia centered around a central zone of infarct-like necrosis of parenchyma resulting from angioinvasive aspergillus. The second pattern (n = 4) was that of a granulomatous bronchiectatic cavity with a central fungus ball and subtle tongues of necrosis and inflammation extending into and through the fibrous wall of the cavity. A final form (n = 2) had a bronchocentric granulomatosis-like appearance with a necrotizing granulomatous bronchitis/bronchiolitis associated with luminal necrotic debris and replacement of mucosa by a palisaded histiocytic reaction. Despite the varied histomorphology, all patients survived the aspergillus infection after antifungal therapy and surgical resection. The different forms of pulmonary aspergillosis are briefly discussed, and the differential diagnosis, with particular regard to mycetomas and allergic forms of bronchocentric granulomatosis, is highlighted.
Insights
Chronic necrotizing pulmonary aspergillosis (CNPA) presents three distinct histological patterns. All patients with these rare forms of invasive aspergillosis survived antifungal therapy and surgery.
Area of Science:
- Pulmonology
- Pathology
- Infectious Diseases
Background:
- Chronic necrotizing pulmonary aspergillosis (CNPA) is a rare, locally destructive form of chronic aspergillosis.
- Its histological definition has been poorly characterized, leading to diagnostic challenges.
Purpose of the Study:
- To evaluate the morphological spectrum of chronic necrotizing pulmonary aspergillosis (CNPA).
- To identify distinct histological patterns of CNPA.
- To aid in the differential diagnosis of pulmonary aspergillosis.
Main Methods:
- Retrospective analysis of 10 cases of CNPA.
- Detailed morphological and histological evaluation of lung tissue specimens.
- Correlation of histological findings with clinical outcomes.
Main Results:
- Three distinct histological patterns of CNPA were identified.
- Pattern 1 (n=4): Necrotizing granulomatous pneumonia with angioinvasive aspergillus.
- Pattern 2 (n=4): Granulomatous bronchiectatic cavity with fungus ball and necrosis.
- Pattern 3 (n=2): Bronchocentric granulomatosis-like with necrotizing granulomatous bronchitis/bronchiolitis.
Conclusions:
- CNPA exhibits varied histomorphology, including necrotizing granulomatous pneumonia, bronchiectatic cavities, and bronchocentric granulomatosis-like patterns.
- Despite diverse presentations, all patients achieved survival with antifungal therapy and surgical resection.
- Distinguishing CNPA from mycetomas and allergic bronchocentric granulomatosis is crucial.