Maria Luisa C. Policarpio-Nicolas, Jacob Rattin, Sanjay Mukhopadhyay
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引用次数: 0
Abstract
Endobronchial ultrasound (EBUS) guided fine needle aspiration is a modality for diagnosing lung nodules as well as fungal organisms. One of the most frequently isolated fungal organisms from immunocompromised patients or immunocompetent patients with severe COPD is Aspergillus spp., which is characterized by septate hyphae with progressive dichotomous branching. However, this finding is not entirely specific to Aspergillus spp. since it can be seen in non-Aspergillus fungi. Nonetheless, the presence of fruiting bodies, background inflammation, and in correlation with the clinical and radiologic findings are supportive of Aspergillus infection. This case report describes a 73-year-old male smoker with severe COPD who presented with multiple lung nodules and hilar lymphadenopathy. An EBUS guided fine needle aspiration of the largest left lung cavitary nodule showed the presence of uniformly sized, septate hyphae with progressive dichotomous branching. There were randomly distributed fruiting bodies composed of a smooth stalk, a swollen vesicle at the terminal end of the stalk, and a single row of phialides occupying the upper two-thirds of the vesicle. The background showed marked acute inflammation and singly dispersed conidia (spores). The GMS stain highlighted the presence of fruiting bodies, dichotomous branching septate hyphae, and singly dispersed conidia. The Fungal PCR result confirmed the presence of Aspergillus fumigatus. Hence, the presence of fruiting bodies is extremely helpful in the identification of the Aspergillus spp. over the other non-Aspergillus fungi. While species identification is often performed in culture, the cytomorphology of the fruiting body could favor Aspergillus spp., which could facilitate prompt medical management.
期刊介绍:
Diagnostic Cytopathology is intended to provide a forum for the exchange of information in the field of cytopathology, with special emphasis on the practical, clinical aspects of the discipline. The editors invite original scientific articles, as well as special review articles, feature articles, and letters to the editor, from laboratory professionals engaged in the practice of cytopathology. Manuscripts are accepted for publication on the basis of scientific merit, practical significance, and suitability for publication in a journal dedicated to this discipline. Original articles can be considered only with the understanding that they have never been published before and that they have not been submitted for simultaneous review to another publication.