A case of squamous cell carcinoma of the lung preceded by pulmonary aspergillosis

Background. We report a case of squamous cell carcinoma of the lung preceded by pulmonary aspergillosis associated with interstitial pneumonia and diabetes mellitus. Case. An 81-year-old man had a consolidation in his left S⁹ detected by chest CT in March 2000, which was diagnosed as pulmonary aspergillosis. Despite antifungal therapy with itraconazole, rapid enlargement of the consolidation occured around November 2002. He was refered to our hospital for re-evaluation of the disease in March 2003. Squamous cell lung carcinoma was eventually detected by transbronchial biopsy and left lower lobectomy was performed. The pathological examination of the resected specimen showed aspergillus hyphae in the necrotic cavities of the squamous cell carcinoma, and interstitial pneumonia (nonspecific interstitial pneumonia: NSIP, group 2) was seen around the tumor. We speculate that saprophytic pulmonary aspergillosis occurred in the cysts formed by NSIP, and thereafter squamous cell carcinoma occured. Conclusion. When aspergillus infection is unresponsive to antimycotics, we should keep in mind that lung carcinoma may overlap fungal in-fection.