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Stellmacher F, Perner S. [Overview: granulomatous diseases of the lung]. DER PATHOLOGE 2021; 42:64-70. [PMID: 33475808 DOI: 10.1007/s00292-020-00893-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 11/26/2022]
Abstract
The spectrum of pulmonary granulomatoses is wide and includes infectious and noninfectious entities, each with very different therapeutic consequences. The first step of histological examination discriminates between necrotizing and non-necrotizing granulomatosis. After this, an infectious cause of the granulomatosis has to be excluded by special histological stains and molecular-pathologic methods, if necessary. Diagnosis also includes clinical, radiological, and microbiological findings. The process of pathological examination should be standardized as described.
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Affiliation(s)
- Florian Stellmacher
- Pathologie, Forschungszentrum Borstel, Leibniz Lungenzentrum, Parkallee 1-40, 23845, Borstel, Deutschland.
| | - Sven Perner
- Pathologie, Forschungszentrum Borstel, Leibniz Lungenzentrum, Parkallee 1-40, 23845, Borstel, Deutschland
- Institut für Pathologie, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
- Airwary Research Center North (ARCN), Deutsches Zentrum für Lungenforschung (DZL), Gießen, Deutschland
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Abstract
Aspergillomas are fungal balls within lung cavities. The natural history is variable. Hemoptysis is a dangerous sequela. Medical therapy is ineffective because of the lack of a lesion blood supply. Randomized trials are lacking. Surgery should be the treatment of choice in cases of hemoptysis, and even in asymptomatic patients, if lung function is not severely compromised. Cavernostomy and cavernoplasty may be options for high-risk patients. Percutaneous therapy should be reserved for patients who are not fit for surgery. Bronchial artery embolization is appropriate for symptomatic patients not suitable for surgery. Embolization could be considered a preoperative and temporary strategy.
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Ma JE, Yun EY, Kim YE, Lee GD, Cho YJ, Jeong YY, Jeon KN, Jang IS, Kim HC, Lee JD, Hwang YS. Endobronchial aspergilloma: report of 10 cases and literature review. Yonsei Med J 2011; 52:787-92. [PMID: 21786444 PMCID: PMC3159936 DOI: 10.3349/ymj.2011.52.5.787] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE A retrospective investigation of the clinical and radiologic features as well as the bronchoscopic appearance was carried out in patients with endobronchial aspergilloma. MATERIALS AND METHODS Ten patients with endobronchial aspergilloma diagnosed by bronchoscopy and histological examination were identified at the Gyeongsang University Hospital of Korea, from May 2003 to May 2009. RESULTS The patients included 9 men and 1 woman, and the age of the patients ranged from 36 to 76 (median, 58 years). The associated diseases or conditions were: previous pulmonary tuberculosis in 7 patients, lung cancer in 2 patients, pulmonary resection in 1 patient, and foreign body of the bronchus in 1 patient. The chest radiologic finding showed fibrotic changes as a consequence of previous tuberculosis infection in 6 patients and a mass-like lesion in 2 patients. Two patients had a co-existing fungus ball, and an endobronchial lesion was suspected in only 2 patients on the CT scan. The bronchoscopic appearance was a whitish to yellow necrotic mass causing bronchial obstruction in 7 patients, foreign body with adjacent granulation tissue and whitish necrotic tissue in 1 patient, whitish necrotic tissue at an anastomosis site in 1 patient, and a protruding mass with whitish necrotic tissue in 1 patient. CONCLUSION An endobronchial aspergilloma is a rare presentation of pulmonary aspergilosis and is usually incidentally found in immunocompetent patients with underlying lung disease. It usually appears as a necrotic mass causing bronchial obstruction on bronchoscopy and can be confirmed by biopsy.
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Affiliation(s)
- Jeong Eun Ma
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Eun Young Yun
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - You Eun Kim
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Gi Dong Lee
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Yu Ji Cho
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Yi Yeong Jeong
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Kyoung-Nyeo Jeon
- Department of Diagnostic Radiology, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - In Seok Jang
- Department of Thoracic Surgery, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Ho Cheol Kim
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Jong Deok Lee
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Young Sil Hwang
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
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