Incidental Pulmonary Tumorlets in a Patient With Bronchiectasis and Aspergillus Infection: A Case Report

Background:Pulmonary carcinoids are rare pulmonary neuroendocrine neoplasms with incompletely understood pathogenesis.Although chronic inflammation is a suspected contributing factor, the specific association between bronchiectasis and pulmonary tumorlet development remains unclear. Case Report:A 65-year-old nonsmoking woman exhibited recurrent respiratory symptoms and infections associated with bronchiectasis.She also had a history of Aspergillus fumigatus infection for which she had not received regular treatment.She was admitted for surgical management due to recurrent pulmonary infections and poorly tolerated symptoms, including persistent cough and sputum production.Chest computed tomography revealed cystic bronchiectasis without evidence of tumor-related lesions.After surgical resection of the affected pulmonary segment, histopathological examination revealed subepithelial tumor infiltration beneath the endobronchial lining, comprising nests of uniform, cytologically bland cells with centrally located nuclei, moderately granular cytoplasm, and a characteristic "salt-and-pepper" chromatin pattern.The largest lesion measured less than 5 mm, and mitotic figures were rare (< 2 per 2 mm 2 ).The patient was diagnosed with bronchiectasis with cystic dilatation, fungal infection, and associated pulmonary tumorlets.Immunohistochemical staining showed broad positivity for chromogranin A and synaptophysin, with a Ki-67 proliferation index of approximately 2%, determined by counting all tumor cells.At the 3-month postoperative follow-up, no new bronchiectatic changes or pulmonary nodules were observed. Conclusions:This report describes the incidental discovery of peripheral pulmonary tumorlets in an older nonsmoking woman with bronchiectasis and Aspergillus infection.These tumorlets were only detected during postoperative histopathological examination.Such findings underscore the importance of systematic pathological sampling to avoid overlooking occult neuroendocrine proliferative lesions, particularly in bronchiectasis cases.