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J Infect. 2009 Aug;59(2):134-8. doi: 10.1016/j.jinf.2009.06.002. Epub 2009 Jun 11.

A clinicopathological study of pulmonary mucormycosis in cancer patients: extensive angioinvasion but limited inflammatory response.

Author information

1
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.

Abstract

OBJECTIVES:

Pulmonary mucormycosis (PMM) is an emerging, frequently lethal fungal infection in immunosuppressed cancer patients. We sought to characterize the histopathologic features of PMM in this population.

METHODS:

We identified patients with PMM who underwent autopsy or lung biopsy between 1990 and 2007. Histopathology slides were blindly reviewed by a pathologist and findings were scored on standardized forms. Pathologic findings were correlated with demographic and clinical data abstracted from patient's medical records.

RESULTS:

Twenty patients with PMM were included in this study. Nineteen patients (95%) had hematologic malignancies. High frequencies of angioinvasion (100%), hemorrhagic infarction (90%), coagulative necrosis (85%), and intra-alveolar hemorrhage (85%) were observed, whereas inflammatory infiltrates were uncommon (30%). Neutropenic patients had more extensive angioinvasion compared with non-neutropenic patients (77% versus 29%, P=0.06). Allogeneic hematopoietic stem cell transplantation (HSCT) recipients, all of whom had graft-versus-host disease, had more inflammatory cell infiltration but less intra-alveolar hemorrhage than non-HSCT patients (67% versus 14%, P=0.04; 50% versus 100%, P=0.02, respectively).

CONCLUSIONS:

PMM in immunocompromised cancer patients is characterized by extensive angioinvasion and coagulative necrosis. The different histopathologic features of PMM in neutropenic, non-neutropnic, and HSCT patients may reflect differences in the pathobiology of PMM in these populations.

PMID:
19576639
PMCID:
PMC7006840
DOI:
10.1016/j.jinf.2009.06.002
[Indexed for MEDLINE]
Free PMC Article

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