Intraappendicular Aspergilloma with catarrhalic appendicitis after neoadjuvant radiotherapy for rectal adenocarcinoma

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.