Aspergilloma in combination with adenocarcinoma of the lung
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
Aspergilloma in combination with adenocarcinoma of the lung Mohamed Smahi1*, Mounia Serraj2, Yassine Ouadnouni1, Laila Chbani3, Kaoutar Znati3, Afaf Amarti3 Abstract A 60 year old male with a long standing history of smoking was referred to our department for surgery of aspergilloma in right upper lung lobe diagnosed by computed tomography and confirmed by computed tomography guided needle aspiration biopsy. A lobectomy was performed. Histological study of the surgical specimen revealed a pulmonary adenocarcinoma associated with aspergilloma. By presenting this case we suggest that every case of pulmonary aspergillome should be examined for malignancies, especially in smokers. In Morocco, pulmonary aspergilloma is most commonly diagnosed in a patient with a healed tuberculous cavity. It rarely affects healthy people with an intact immune response, but those with preexisting structural lung disease, atopy, occupational exposure or impaired immunity are susceptible. Aspergillosis can remain asymptomatic or present with hemoptysis, which can be life-threatening [1]. In this report, we describe a fortuitous discovery of unsuspected lung adenocarcinoma in surgical resection performed for aspergilloma of the right upper lobe.
Case A 60 -year-old man, with social history included a 25 packs/year smoking habit, who was otherwise healthy, presented with history of cough productive with some episodes of small hemoptysis for 7 weeks. There was no history of chest pain, shortness of breath, fever or chills, and he denied any history of weight loss. On physical examination, he appeared healthy with normal findings. Chest radiography revealed a cavitary lesion with “air crescent sign” characteristic of an intracavitary mycetoma (Figure 1), and on CT, there was a cavitary lesion on horseback on the segments of the right upper lung lobe, with a central heterogeneous rounded density, changing position with the patient’s movements evoking an aspergilloma (Figure 2). No lesion was detected on fiberoptic bronchoscopy and biopsies were negative. His * Correspondence: [email protected] 1 Department of thoracic surgery, Hassan II University Hospital of Fez, Morocco Full list of author information is available at the end of the article
antifungal serum antibodies were non reactive. CT guided needle aspiration biopsy of the lesion was performed and showed a large number of fungal hyphae of Aspergillus. Preoperative pulmonary function tests gave normal results. On thoracotomy, a soft mass was palpable in the right upper lobe. Right upper lobectomy was performed. This revealed the presence of an unsuspected 30 mm differentiated and infiltrated lung adenocarcinoma surrounding the 45 mm cavity containing the aspergilloma (Figure 3). Peribronchial and interbronchial nodes were disease free. The patient had an uncomplicated postoperative recovery. The final histological finding confirmed the diagnosis of a T1N0M0 differentiated adenocarcinoma. Chemotherapy or radiotherapy were not con
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