Expanding the spectrum of chronic necrotising (semi-invasive) aspergillosis: a series of eight cases presenting as radiologically solid lung nodules mimicking malignancy.

AIM: To clinicopathologically characterise a subset of aspergillosis cases characterised by radiologically solid lung nodules.

METHODS AND

RESULTS

We reviewed our archives for lung biopsies/resections with fungal hyphae on histology. Cases classifiable as a well-established form of aspergillosis were excluded. Unclassifiable cases with radiologically solid lung nodules and histological evidence of fungal hyphae consistent with Aspergillus were analysed in detail. Of 134 lung biopsies/resections with fungal hyphae, eight presented as a solid lung nodule on imaging and could not be classified as a well-recognised form of aspergillosis. All patients were non-immunocompromised/minimally immunocompromised adult smokers. Imaging showed solid, predominantly solitary, spiculated, subpleural, hypermetabolic upper lobe nodules in emphysematous lungs. Malignancy was suspected clinically in all cases. Histologically, the nodules were necrotising granulomas containing fungal hyphae consistent with Aspergillus. On follow-up, none of the nodules recurred or progressed to invasive disease.

CONCLUSIONS

Aspergillosis can present as a radiologically solid, spiculated lung nodule suspicious for malignancy.