A Case of Concomitant Surgical Treatment of Lung Aspergilloma and Cancer

Background: Among mycotic diseases of the lung, pulmonary aspergillosis is encountered most frequently in Japan. A definitive diagnosis of aspergilloma is usually established by the characteristic appearance of a fungus ball on the chest Xray and chest CT scan findings. The management of pulmonary aspergilloma is controversial. On the other hand, a cavitary lesion is sometimes found in a lung squamous cell carcinoma. Few cases of the aspergilloma associated with lung cancer have been reported. Case: A 64 year-old man was admitted to our hospital with nonproductive cough. His chest x-ray roentogenogram and chest CT revealed two lesions. One of them was suspected to be pulmonary mycosis of the fungus ball type. Diagnosis of pulmonary mycosis was made by a bronchoalveolar lavage. However preoperative cultures of sputum were negative. In present case, preoperative bronchofiberscopic alveolar lavage fluid indicated aspergillus. The other cavitary lesion with a thick and rough wall was suspected to be a lung cancer. Diagnosis of lung cancer was not ascertained by a transbronchial lung biopsy, but was based on the surgically resected specimen as a squamous cell carcinoma. The patient with pulmonary carcinoma (squamous cell carcinoma) and pulmonary aspergilloma was treated with concomitant surgical resection of both lesions. To the best our knowledge, reported cases in which a lung cancer complicated with pulomonary aspergillom were in the same one lesion. Conclusion: We performed concomitant surgical treatments, which connected of lobectomy for the lung cancer and partial resection of the right upper lobe for the aspergilloma.