PMC10361833_01
(a) Low-power view (H&E * 100) showing laminated membrane of ectocyst (blue arrow) along with fungal elements (green arrow). (b) High-power view (H&E * 400) showing septate hyphae with acute angle branching (black arrow) supporting evidence of Aspergillus in hydatid cyst cavity. (c) PAS stain showing Aspergillus hyphae with acute angle branching and thin septa (red arrow). (d) CECT chest (coronal view) showing segmental bronchus within the cyst with possibility of communication with the cyst (blue arrow). There is segmental collapse and upward pulling of the right hemidiaphragm. No obvious pleural or chest wall communication seen. (e) CECT chest (axial view) showing well-defined nonenhancing cystic lesion in anterior basal segment of right lower lobe adjacent to major fissure (green arrow). Multiple air foci are seen within it.
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No obvious pleural or chest wall communication was seen (Figures 1 (d) and (e)). What was exceptional was the presence of a laminated membrane of the ectocyst along with fungal elements (Aspergillus) in the form of septate hyphae with acute angle branching in hematoxylin and eosin stain (H&E) (Figures 1 (a) and (b)). To further confirm this finding, Periodic acid-Schiff (PAS) staining was done which also showed acute angle branching with thin septa (Figure 1 (c)).