title: Two cases of endobronchial carcinoid masked by superimposed aspergillosis: a review of the literature of primary lung cancers associated with Aspergillus.
abstract: We describe 2 cases of endobronchial pulmonary carcinoid tumor with superimposed Aspergillus colonization. The Aspergillus hyphae were associated with fibrin, ulcer debris, and granulomatous inflammation in part masking the carcinoid tumor. Presence of necrotic debris made diagnosis on biopsy difficult, and atypical carcinoid could not be ruled out. The association of carcinoid tumor with aspergillosis is rare and has been reported in 4 other cases thus far. A review of the literature reveals at least 35 cases of lung carcinoma with coexisting Aspergillus upon presentation. Most of these carcinomas are either cavitary squamous cell or adenocarcinomas harboring an aspergilloma. The other carcinomas are associated with bronchial obstruction as in carcinoids or are a minor component of a preexisting cavity raising the possibility of "scar carcinoma." As in aspergillomas not associated with carcinoma, upper lobe involvement predominates. Diagnosis can be challenging with delayed discovery of underlying neoplasm leading to suboptimal treatment.
authors.affiliation: Department of Pathology and Cytology, Karolinska University Hospital, Solna, Sweden. nilssonrobert77@hotmail.com
authors.forename: John Robert
authors.initials: JR
authors.lastname: Nilsson
authors.forename: Carlos S
authors.initials: CS
authors.lastname: Restrepo
authors.forename: Jaishree
authors.initials: J
authors.lastname: Jagirdar
mesh_terms: D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D001706:Biopsy; D001984:Bronchial Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D002276:Carcinoid Tumor / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D015897:Comorbidity; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008168:Lung / Q000382:microbiology / Q000473:pathology; D008875:Middle Aged; D011013:Pneumonectomy; D055732:Pulmonary Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole