55) By far the most common form of Histoplasma-related lung disease encountered by surgical pathologists is a histoplasmoma (Figures 1, E and F, and 2, A and B).
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.
11,58) Histoplasma seldom grows in culture from histoplasmomas probably because the organisms are nonviable in most of these lesions.
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.
6 Meningitis, parenchymal mass lesions or histoplasmomas
of the brain (cerebral histoplasmosis), diffuse encephalitis, and symptomatic cerebral emboli associated with endocarditis are recognized forms of CNS histoplasmosisi (6,7) Since Wheat et a1 (6) reviewed GNS histoplasmosis in 1990, the triazole antifungal agents itraconazole and fluconazole have assumed a prominent role in the management of patients with histoplasmosis and other systemic mycoses.