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Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 23 December 2011, last major update August 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.


● Hyphate fungus (mold) that presents as secondary colonization of lung abscess, aspergilloma (fungus ball, Indian J Pathol Microbiol 2008;51:342), allergic bronchopulmonary aspergillosis, bronchocentric granulomatosis or invasive aspergillosis in immunocompromised (Clin Microbiol Rev 2009;22:447)

Clinical features

● Aspergillus infection is associated with solid organ or bone marrow transplants and antileukemic chemotherapy; relatively uncommon in AIDS patients
Allergic bronchopulmonary aspergillosis: bronchocentric granulomas in asthmatics that contain numerous eosinophils and non-invasive aspergillus organisms or other fungi (Clin Dev Immunol 2011;2011:843763); patients have elevated IgE directed against aspergillus antigens, also thick mucus plugs; impacted mucus may form cast of airways (plastic bronchitis); over time, bronchi become dilated, causing bronchiectasis; patients develop intractable bronchospasm; rarely other fungi cause similar disease
Bronchocentric granulomatosis: cell mediated reaction to aspergillus in airway; circumferential granulomatous inflammation surrounding small airways with mucus and cellular debris and loss of lining epithelium within airway (Radiographics 2007;27:617); may be isolated or part of allergic bronchopulmonary aspergillosis; rarely due to other fungi
● References: J Bras Pneumol 2009;35:1238


Invasive aspergillosis by Aspergillus fumigatus

Gross description

● Invasive disease usually shows targetoid lesions with peripheral consolidation and central thrombosed vessels due to angioinvasive fungi; variable bronchopneumonia or lobar pneumonia

Gross images



Micro description

● Dichotomous (into two nearly equal branches, or 45 degrees) branching, hyphae with frequent septation, diameter ranges from 2.5 to 4.5 um
● May see aspergillus fruiting body (other fungi may mimic aspergillus, in general, should not definitively diagnose aspergillosis in tissue without the presence of a fruiting body), and often invades vessels

Micro images

Fungus ball


Bronchocentric granulomatosis in asthma patient

conidiophore of Aspergillus flavus

Phialoconidia of Aspergillus fumigatus

Conidial head of Aspergillus niger

PAS stain

PAS stains-contributed by Professor Venna Maheshwar, Drs. Kiran Alam and Anshu Jain, J. N. Medical College, India

PAS stains-contributed by Dr. Claudia Mendez, Bogota, Columbia

Aspergilloma: Left-GMS, middle-H&E, right-PAS; contributed by Dr. Claudia Mendez, Bogota, Columbia

GMS stain

Virtual slides

Aspergilloma (fungal ball)

Cytology images

Invasive aspergillus tracheobronchitis: abundant necrotic material with multiple mycelia, consisting of septate hyphae branching at 45 degrees

Allergic bronchopulmonary aspergillosis with coexistant aspergilloma

End of Lung-nontumor > Infections > Aspergillus

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