Abstract
Eight years after right lower lobectomy for pulmonary adenocarcinoma (P-T0N0M0), severe hemoptysis occured in a 53-year-old man. On chest roentgenogram, a fungus ball was recognized in the right upper lobe. To control the hemoptysis right upper and middle lobectomy was performed. Histopathological examination revealed several cavities in the right upper lobe. The cavities in S^2 were of the conventional fungus ball type, while two cavities in S^3 were filled with bloody clots and, in the cavity wall, hemorrhage from a ruptured arterial wall was observed. The granulation tissue surrounding the cavity wall displayed hemorrhagic foci from the inside of small blood vessels, which contained some aspergillar hyphae. The entire pleura was thickened, and rupture of small blood vessels, hemorrhage and colonization of aspergillar hyphae were observed throughout. Furthermore, many aspergillar hyphae were found within the pulmonary artery and a few in the pulmonary vein. The causal relationship between the characteristic histopathological features and the hemoptysis in this case was discussed from the point of view of the action of hemolysin and the proteolytic enzymes released by aspergillar hyphae, which have recently been highlighted as pathogenic factors especially in chronic necrotizing pulmonary aspergillosis.
