These delayed manifestations are divided into 3 main categories: 1) histoplasmoma, 2) broncholithiasis, and 3) mediastinal granuloma and mediastinal fibrosis.
In some patients, however, the primary focus may continue to enlarge and is thus termed histoplasmoma. (13,14) The exact etiology of this enlargement is unclear, although various explanations have been theorized.
Enlarging pulmonary histoplasmoma. Am Rev Respir Dis.
The enlarging histoplasmoma: Concept of a tumor-like phenomenon encompassing the tuberculoma and coccidiodoma.
Instead, organisms persist in a walled-off nodule characterized by a well-formed, necrotizing granuloma similar to a tuberculoma (eg, histoplasmoma, cryptococcoma, coccidioidoma).
In a study by Goodwin and Snell, (32) 10 of 17 histoplasmomas were diagnosed only after an effort was made to include the necrotic center in a recut.
The second is well-formed necrotizing granulomatous inflammation, exemplified by histoplasmomas but also seen in chronic pulmonary histoplasmosis.
While Histoplasma is readily identifiable within macrophages in disseminated histoplasmosis, it is not visible on H&E-stained sections within necrotizing granulomas (histoplasmomas).10-13 Although organisms are present within the necrotic areas, they cannot be resolved from the background necrotic debris on H&E-stained sections (Figure 2, A).