Gross features: A 15 x 6 x 2 cm piece of lung with a 1 cm nodule was removed from the right lung, and a 17 x 6 x 3 cm piece of lung with a 1 cm nodule from the left.

Examine the following three images of one nodule (A, B, & C) (both were similar), and give a diagnosis.

A

B

C

Diagnosis? Answer

Clinical summary Image 2

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Answer: Chronic inflammation with fungal hyphae. There is no evidence of cancer.

Histologic changes: A section from the nodular lesion on the right has a purulent focus (asterisk) surrounded by chronically-inflamed tissue with scattered blue lymphoid aggregates. A similar lesion was present on the left.

At higher magnification, a cavitating abscess (asterisk at center) with a chronically-inflamed, fibrotic wall is seen.

The abscess showed organisms among the PMNs. What specific type of organism is present, and what special stain would show them better? Answer

Clinical summary Image 2

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Answer

This photo from another patient shows similar organisms--aspergillus--stained with the Gomori methenamine silver stain. Note the septate hyphae that branch dichotomously at acute angles. In the present case, the tissue was not cultured. By morphology alone, the organisms cannot be distinguished from Pseudallescheria boydii. Clinically, the most likely diagnosis is aspergillosis. This chronic lesion caused by aspergillus would be classified as an example of chronic necrotizing pulmonary aspergillosis.

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