Incidental finding of pulmonary tumorlet in a case of surgically treated bronchiectatic cavity superimposed by aspergilloma

Abstract

Introduction. Intracavitary aspergilloma is the consequence of a saprophytic infection of the lung with cavitary disease. Pulmonary tumorlet are nodular proliferations of the neuroendocrine cells less than 5 mm in diameter. Both aspergilloma in the bronchiectatic cavity of the lung and pulmonary tumorlet has rare been seen. Case outline. We present a 71-year-old woman with a medical history of recurrent pneumonia complicated with cough and hemoptysis. Computed tomography (CT) scan of the chest showed pulmonary soft tissue mass in the right lower lobe of the lung 42 × 50 mm in diameter. Direct microscopy of the specimens of bronchioalveolar lavage showed spores of Aspergillus. Galactoman Ag test was also positive. Right lower lobectomy and mediastinal lymph node sampling was performed via thoracotomy. Pathohistological findings showed aspergilloma with the presence of pulmonary tumourlet and diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) in the lymphovascular spaces. Five years follow up showed no abnormalities on the CT scan, and the patient remained alive without medical problems. Conclusion. The concomitant occurrence of bronchiectasis, aspergilloma, and precancerous lesions such as pulmonary tumourlet and DIPNECH is rare and further increases the risk of developing malignant tumors as well as recurrent infections. Therefore, surgical treatment can prevent the development of premalignant lesions and the occurrence of recurrent infections accompanied by dyspnea and hemoptysis as the main symptoms. The question of the connection between pulmonary tumourlet and chronic inflammatory lung diseases is raised. We hope that future researches will provide answers to this question.

Keywords

• bronchyectasis
• aspergilloma
• pulmonary tumourlet
• dipnech