Korean J Thorac Cardiovasc Surg.  2018 Oct;51(5):350-355. 10.5090/kjtcs.2018.51.5.350.

Surgery for Pulmonary Fungal Infections Complicating Hematological Malignancies

Affiliations
  • 1Department of General Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan. tak13star.winning@gmail.com

Abstract

BACKGROUND
The complication rate of fungal disease is higher among patients with hematological malignancies. We investigated the clinicobacteriological outcomes of resected pulmonary fungal infections complicating hematological malignancies.
METHODS
Between 2001 and 2017, 21 patients with pulmonary fungal infections complicating hematological malignancies underwent resection, and their clinical records and survival were retrospectively reviewed.
RESULTS
The median age of the patients was 47 years, and 13 were male. The histological diagnoses were pulmonary aspergillosis (19 cases), mucormycosis (1 case), and cryptococcosis (1 case). The indications for surgery were resistance to antifungal therapy and the necessity of surgery before hematopoietic stem cell transplantation in 13 and 8 cases, respectively. The diagnoses of the hematological malignancies were acute myelogenous leukemia (10 cases), acute lymphocytic leukemia (5 cases), myelodysplastic syndrome (3 cases), and chronic myelogenous leukemia, malignant lymphoma, and extramedullary plasmacytoma (1 case each). The surgical procedures were partial resection (11 cases), segmentectomy (5 cases), lobectomy (4 cases), and cavernostomy (1 case). The size of the lesions was 0.9-8.5 cm. Fourteen cases had cavitation. There were no surgical-related deaths or fungal progression.
CONCLUSION
Pulmonary fungal infections are resistant to treatments for hematological malignancies. Since the treatment of the underlying disease is extended and these infections often recur and are exacerbated, surgery should be considered when possible.

Keyword

Mycoses; Hematologic neoplasms; Thoracic surgery

MeSH Terms

Cryptococcosis
Diagnosis
Hematologic Neoplasms*
Hematopoietic Stem Cell Transplantation
Humans
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Leukemia, Myeloid, Acute
Lung Diseases, Fungal*
Lymphoma
Male
Mastectomy, Segmental
Mucormycosis
Mycoses
Myelodysplastic Syndromes
Plasmacytoma
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Pulmonary Aspergillosis
Retrospective Studies
Thoracic Surgery
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