Focalized Pulmonary Histoplasmosis (Coin Lesion): A Report of 58 Cases

¹ Department of Thoracic Surgery, Missouri State Sanatorium, Mt. Vernon

Focalized histoplasmosis is often indistinguishable from neoplasms and other granulomatous lesions in their gross appearance, clinical manifestations, and roentgenographic examination. However, in a few cases the diagnosis of histoplasmoma can be strongly suspected from roentgenographic evidence of the characteristic laminated or stippled calcification. The presence of calcium within the nodule does not rule out carcinoma, and exploratory thoracotomy is indicated to establish a definitive diagnosis. We have operated on 58 patients with proved histoplasmoma with no mortality and only two minor postoperative complications. There is no evidence of recurrence of the disease with an average followup of 50 months. The inability to culture the organisms from the resected tissue is probably caused by their not being viable and suggest the benign nature of the disease. Wedge resection is the operation of choice and there is no evidence to indicate that dissemination of the disease results from surgical removal of the focalized lesion. We believe amphotericin B therapy is not indicated in the treatment of focalized histoplasmosis unless the patient develops recurrence of the disease, which is very rare.