Pulmonary Aspergilloma with DIPNECH; A Rare Case Report

Introduction: Pulmonary Aspergilloma (PA) usually presents with a fungus ball or mycetoma as a result of saprophytic colonization of Aspergillus fumigatus causing parenchymal damage and forming a cavitary lesion. The incidence of pulmonary aspergilloma with tumor lesions is rare. In our study, we aimed to present a patient diagnosed with diffuse idiopathic neuroendocrine cell hyperplasia (DIPNECH) in a patient who underwent anatomical resection for PA.Case: A 46-year-old woman with no history of comorbidities presented with a history of frequent pneumonia and recurrenthemoptysis. Thorax CT showed a 47x42 mm cavitary lesion with irregular walls in the lower lobe of the right lung, millimetricsolid nodular lesions and fungus ball appearance within the cavity, bronchiectatic changes and septal thickening. Spirometry wasperformed and after 7 days antibiotherapy with clinical improvement, the patient underwent lower lobectomy and mediastinallymph node dissection via right thoracotomy. Histopathologic examination revealed a 3 cm cavitary lesion in the lobe whichwas compatible with pulmonary aspergilloma. Histopathologic examination revealed a 3 cm cavitary lesion in the lobe whichwas compatible with pulmonary aspergilloma. It was observed to be consistent with diffuse idiopathic neuroendocrine cellhyperplasia.Conclusion: In DIPNECH, multifocal pulmonary nodules with mosaic attenuation are seen, which is rare. It is a generalizedintramucosal proliferation of pulmonary neuroendocrine cells clustered in monolayers or small groups that can protrude intothe bronchial lumen. DIPNECH was diagnosed in 5.4% of patients operated for carcinoid tumor and the recommendation inthe literature is to perform surgical resection in case DIPNECH is detected. PA and DIPNECH are two different entities andtheir coexistence is rare. DIPNECH, which is also associated with other diagnoses, can often be detected histopathologically incarcinoid tumors and surgical resection is the appropriate treatment method as we have stated in our study.