Autopsy and Case Reports
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Conidial heads (Fruiting Bodies) as a hallmark for histopathological diagnosis of angioinvasive aspergillosis

Luciana Depiere Lanzarin; Livia Caroline Barbosa Mariano; Maria Cristina Martins de Almeida Macedo; Marjorie Vieira Batista; Amaro Nunes Duarte Neto

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Aspergillosis is a mycosis that afflicts immunocompetent and immunocompromised hosts; among the former it exhibits different clinical pictures, and among the latter the infection renders an invasive form of the disease. The histologic diagnosis of invasive aspergillosis is somewhat challenging mostly because of some morphological similarities between other fungi. However, when present, the conidial heads are pathognomonic of aspergillosis. The authors present the case of a 68-year-old woman who was submitted to autologous hematopoietic stem cell transplantation in the pursuit of multiple myeloma treatment. The post-transplantation period was troublesome with the development of severe neutropenia, human respiratory syncytial virus pneumonia, and disseminated aspergillosis, which was suspected because of a positive serum galactomannan antigen determination, and resulted in a fatal outcome. The autopsy findings showed diffuse alveolar damage associated with angioinvasive pulmonary aspergillosis with numerous hyphae and conidial heads in the lung parenchyma histology. The authors call attention to the aid of autopsy in confirming the diagnosis of this deep mycosis, since only the research of the galactomannan antigen may be insufficient and uncertain due to its specificity and of the possibility of false-positive results.


Aspergillus, Neutropenia, Hematopoietic Stem Cell Transplantation, Autopsy


Centers for Disease Control and Prevention – CDC. Etymologia: Aspergillus. Emerg Infect Dis. 2006;12(3). [].

Micheli PA. Nova plantarvm genera ivxta Tovrnefortii methodvm disposita. 1729. Typis Bernardi Paperinii. Firenze; Plate 91.

Sherif R, Segal BH. Pulmonary aspergillosis: clinical presentation, diagnostic tests, management and complications. Curr Opin Pulm Med. 2010;16(3):242-50. [PMID:20375786]

Camargo JF, Husain S. Immune correlates of protection in human invasive aspergillosis. Clin Infect Dis. 2014;59(4):569-77. []. [PMID:24803380]

De Pauw B, Walsh TJ, Donnelly JP, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46(12):1813-21. []. [PMID:18462102]

Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis. 2006;42(10):1417-27. []. [PMID:16619154]

Guarner J, Brandt ME. Histopathologic diagnosis of fungal infections in the 21st century. Clin Microbiol Rev. 2011;24(2):247-80. []. [PMID:21482725]

Anila KR, Somanathan T, Mathews A, Jayasree K. Fruiting bodies of Aspergillus: An unusual finding in histopathology. Lung India. 2013;30(4):357-9. []. [PMID:24339500]

Panke TW, McManus AT Jr, McLeod CG Jr. “Fruiting bodies” of Aspergillus on the skin of a burned patient. Am J Clin Pathol. 1978;69(2):188-9. [PMID:343572]

Falsey AR, Goldsticker RD, Ahern MJ. Fatal subcutaneous aspergillosis following necrotizing fasciitis: a case report. Yale J Biol Med. 1990;63(1):9-13. [PMID:2356626]

Shinohara MM, Miller CJ, Seykora JT. Pigmented fruiting bodies and birefringent crystals in a surgical wound: A clue to Aspergillus niger infection. J Cutan Pathol. 2011;38(8):603-6. []. [PMID:21762198]

Khurana U, Raghubanshi G, Handa U, Chander J. “Fruitingbodies” of Aspergillus flavus: A rare finding in histopathology. Int J Surg Pathol. 2012;20(1):60-1. []. [PMID:22084428]

Chandra S, Gaur D, Harsh M, Chaturvedi J, Kishore S. An unusual presentation of Aspergillus species in a routine cervicovaginal pap smear: A case report. Acta Cytol. 2009;53(2):229-31. []. [PMID:19365982]

Hoda RS, Colello C, Roddy M, Houser PM. “Fruiting body” of Aspergillus species in a routine cervico-vaginal smear (Pap test). Diagn Cytopathol. 2005;33(4):244-5. []. [PMID:16138367]

Lee S, Yun NR, Kim KH, et al. Discrepancy between histology and culture in filamentous fungal infections. Med Mycol. 2010;48(6):886-8. []. [PMID:20092421]

Montone KT, Guarner J. In situ hybridization for rRNA sequences in anatomic pathology specimens,applications for fungal pathogen detection: a review. Adv Anat Pathol. 2013;20(3):168-74. []. [PMID:23574773]

Boon A, O’Brien D, Adams DH. 10 year review of invasive aspergillosis detected at necropsy. J Clin Pathol. 1991;44(6):452-4. []. [PMID:2066421]

Antinori S, Nebuloni M, Magni C, et al. Trends in the postmortem diagnosis of opportunistic invasive fungal infections in patients with AIDS: a retrospective study of 1,630 autopsies performed between 1984 and 2002. Am J Clin Pathol. 2009;132(2):221-7. []. [PMID:19605816]

Lewis RE, Cahyame-Zuniga L, Leventakos K, et al. Epidemiology and sites of involvement of invasive fungal infections in patients with haematological malignancies: a 20-year autopsy study. Mycoses. 2013;56(6):638-45. []. [PMID:23551865]


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