Allergic Bronchopulmonary Aspergillosis: A Diagnostic ChallengeSaraswati Pokharel*, Lourdes Ylagan and Richard Cheney
Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, USA
- *Corresponding Author:
- Saraswati Pokharel
Roswell Park Cancer Institute
Elm and Carlton St, Buffalo, NY 14263, USA
Tel: 716 845 4959
Fax: 716 845 2370
Email: sar[email protected]
Received Date: October 23, 2014; Accepted Date: November 28, 2014,; Published Date: December 01, 2014
Citation: Pokharel S, Ylagan L, Cheney R (2014) Allergic Bronchopulmonary Aspergillosis: A Diagnostic Challenge. J Cytol Histol S4:021. doi: 10.4172/2157-7099.S4-021
Copyright: © 2014 Pokharel S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Allergic bronchopulmonary aspergillosis (ABPA) is an immunologic condition that results from an allergic immune response to Aspergillus fumigatus, most often occurring in a patient with bronchial asthma or cystic fibrosis. ABPA is diagnosed by constellation of clinical, laboratory, and radiographic criteria. In the absence of typical presentation, ABPA can be misdiagnosed. Our patient presented with a 3 cm right lower lobe lung mass and sub-centimeter right upper lobe lung nodules. The clinical features led to a presumptive diagnosis of lung carcinoma. The patient underwent preoperative bronchial washing and endobronchial biopsy. The washing sample showed large amount of thick mucus containing abundant eosinophils, Charcoat-Leyden crystals, and degenerated cellular debris consistent with “allergic mucin”. These findings were initially overlooked and considered non-specific. Repeat sampling (needle biopsy) showed marked reactive pneumocyte hyperplasia in the background of inflammation, which was misdiagnosed as adenocarcinoma with lepidic growth pattern. The correct diagnosis was made only after the surgical resection of the lesion. Diagnosis of ABPA can be missed due to general unfamiliarity with this entity and its clinical presentation similar to the lung tumor. Accurate diagnosis can be derived from the bronchial washing if the features of “allergic mucin” are recognized and confirmed with microbiological examination.