PMC9307142_01
Chest radiography and computed tomography upon initial presentation: (a) RUL cavitary lesion and two cystic lesions within the bilateral upper lung field and (b and c) a cavity with a ball-in-hole lesion in RUL and two small cystic lesions in the bilateral upper lobes.
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Chest radiography showed a right upper lobe (RUL) cavitary lesion and two cystic lesions within the bilateral upper lung field (Figure 1a). Chest computed tomography revealed a cavity with a ball-in-hole lesion in the RUL and two small cystic lesions in the bilateral upper lobes (Figure 1b and c).
Pathology of metastatic squamous cell carcinoma coexisting with Aspergillus fumigatus: (a) clumps of septated fungal hyphae in hematoxylin and eosin stain. (H&E, 200x), (b) Aspergillus fumigatus in Grocott's methenamine silver stain. (GMS, 200x); inset of a high-power microphotograph of GMS staining (GMS, 400x), (c) polygonal tumor cells arranged in solid nests and immunohistochemical study reveals positivity for p40 (IHC, p40, 100x); inset of a 200x microphotograph of p40 immunostaining (IHC, p40, 200x), and (d) polygonal tumor cells arranged in solid nests and immunohistochemical positivity for p53 (IHC, p53, 100x); inset of a 200x microphotograph of the p53 staining (IHC, p53, 200x).
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Aspergillus conidia (Figure 2a and b). Aspergillus fumigatus was isolated from the bronchoalveolar lavage culture, and a serum Aspergillus galactomannan antigen test was found to be positive. TTF-1), which was concurrent with aspergillosis (Figure 2c and d). The patient also received diagnostic wedge resection for the cystic lesion of the left upper lobe to differentiate between the fungal infection and the malignancy.
(a-c) Chest radiography and computed tomography following voriconazole administration and subsequent chemotherapy: regression of the pulmonary lesions on follow-up.
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The latter resulted in the partial remission of pulmonary lesions, as confirmed at follow-up (Figure 3(a-c)).