Affiliations: Institute of Pathology, University of Innsbruck,
Müllerstr. 44, A-6020 Innsbruck, Austria |
Note: [] Address for correspondence: Dr. A. Tzankov Institute of
Pathology Müllerstr.44 A-6020 Innsbruck Austria Tel. 0043 512 507 36 92
Fax 0043 512 58 20 88
Abstract: Organ transplantation and sophisticated radio-chemotherapy regimens
are increasingly applied therapeutic options. Subsequently, the complications
of iatrogenic immunosuppression, particularly invasive mycoses, have become a
major clinical and diagnostic problem. An outstanding representative of such
opportunistic fungi is Aspergillus. Aspergillus species preferentially colonize
the lungs and upper respiratory tract. These organs play a major role in fungal
spread and invasion. The gastro-intestinal organs have not been studied as
further targets of Aspergillus settlement and gateways of invasion. We report a
40 year old woman, who was admitted for amputation of the rectum due to an
adenocarcinoma. The patient was given a neoadjuvant radiotherapy regimen.
Histological examination revealed discrete vital remnants of a moderately
differentiated rectal adenocarcinoma. The appendix, resected at this surgical
opportunity, showed a discrete catarrhalic inflammation and dilated lumen
plugged up with an Aspergilloma. The present case is particularly remarkable,
as it demonstrates a mycetoma in a slightly immunocompromized tumor patient
within a digestive whole organ. This "dormant" fungus reservoir could be quite
hazardous, as invasion and dissemination, especially during episodes of
neutropenia, might occur. Pathologist and clinicians should be aware of the
possibility that Aspergillus can also colonize non-respiratory organs.
