1. Pathologic Findings in Benign Pulmonary Histoplasmosis
HENRY C. SWEANY, M.D., F.C.C.P., DAVID GORELICK, M.D., FRED C. COLLER, M.D., JAMES L. JONES, H.T. 
Diseases of the Chest 
Volume 34, Issue 2, Pages (August 1958)
DOI: /chest
Copyright © 1958 The American College of Chest Physicians Terms and Conditions

2. Figure 1
This is designated as A which represents typical histoplasmomas. They are to be contrasted with typical tuberculomas which are found in the B group. H & E Stain, a. M. S., A20—No. 24,674, is the stained section of a 1½ mm. spherical lesion from the lung parenchyma of a 57 year old housewife, negative tuberculin, strongly positive histo. skin reaction. Numerous yeast-like bodies were found. b. N. O., A30—No. 26,079, similar section from 2½ cm. spherical lesion taken from the lung parenchyma of a 51 year old housewife. Both tuberculin and histo. skin tests were strongly. positive. Innumerable yeast bodies were found in the central part of the lesion. c. E. S., A15—No. 24,493, similar section from the lung parenchyma of a 49 year old housewife. Tuberculin test was weakly positive, histo. skin test strongly positive. Large number of yeast bodies were found. d. M. B., A23—No. 25,217, similar section from a 46 year old housewife. Tuberculin test weakly positive, histo. skin test slightly more positive. Many yeast bodies found in the lesion. e. H. S., A9—No. 23,517, a 61 year old carpenter. Tuberculin weakly positive; histo. strongly positive. Many yeast bodies found. f. L. B., A21—No. 24,797, from the parenchyma of a 44 year old housewife. Tuberculin negative; histo. skin test weakly positive. A few yeast bodies were found. g. O. I., A12—No. 24,302, was the same from a 42 year old truck driver. Tuberculin and histo. skin tests were both weakly positive. There were many yeast bodies found. h. W. F., A41—No. S-0591 from St. John's Hospital. This is a 52 year old white male having lesion discovered on routine x-ray. A few typical yeast bodies were found.
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3. Figure 2
Designated as B, represents 8 spherical lesions in which acid fast bacilli have been found and no yeast bodies. a. A47—No. X-117 from a 40 year old male taken many years ago in Chicago. This was a lesion quite similar to many of the lesions found in histoplasmosis. It seemed to have been built up from a central focus. Acid fast bacilli were found in the periphery. It shows that the two diseases run parallel in many respects. However, there are many more of this type that are histoplasmosis than are tuberculous. Another point is that in the center of the lesion the parasites of histoplasmosis appear to live longer and produce more caseation and calcification with actual growth of the parasites, whereas tubercle bacilli are usually smothered after a few years. b. B. S., All—No. 23,701, a spherical lesion from a 19 year old housewife. Weakly positive tuberculin, negative histo. skin reaction. Acid fast bacilli found. c. C. J., A14—No. 26,118, from a 37 year old cafe manager. Both tuberculin and histo. skin tests were positive. Acid fast bacilli were found. d. G. P., A16—No. 24,645, from a 46 year old housewife. Tuberculin strongly positive, histo. not done. Many acid fast bacilli found. e. C. P., A6—No. 22,584, a 45 year old farmer, strongly positive tuberculin, histo. not done. Many acid fast bacilli found. f. A larger section from another spherical lesion in the same patient, in which AFB were found. g. I. C., A5—No. 22,206, strongly positive tuberculin, histo. test not done. Many acid fast bacilli were found. h. F. A., A25—No. 25,057, skin test, tuberculin negative. Histo. skin test weakly positive. Section from spherical lesion of a 38 year old housewife. Acid fast bacilli found. The A and B in these two figures are not to be confused with the same letters in the two main groups.
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4. Figure 3
(A) A stained section of a spherical lesion of M. S., A39, S , showing the ring formation from the center outward. Note the heavy callous on one side. This heavy button-like plaque on one side is present on several spherical lesions and its cause is not understood. H. & E. ×4.5.
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5. Figure 4
(B) A higher magnification of area marked off in Fig. 3. The calcification does not follow the fibrils, but is more related to distance from the center. H. & E. ×20.
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6. Figure 5
(A) A reduced roentgenogram of E. L. S., A-15, No. 24,493. Showing a spherical lesion in the left midfield with pleuritis at the left base and bronchiectasis in the right middle lobe.
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7. Figure 6 (B) An enlargement of the spherical lesion of Fig. 5.
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8. Figure 7
(C) A low power section of spherical lesion. Note the two centers of dense caseation and calcification outlined by small dots at a and a′ and the partial rings of less marked calcification.
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9. Figure 8
(A) A microscopic field of a G. M. S. stained section in the dense central, calcification marked at “a” in Fig. 7, showing innumerable yeast bodies. ×3400.
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10. Figure 9
(B) A polariscopic view of same, showing “Maltese crosses.” ×3400.
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11. Figure 10
(C) A microscopic field of stained section extending outward into the zone marked “b” in Fig. 7. G. M. S. stain × 3400.
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12. Figure 11
(D) A microscopic field of stained section still further out toward the periphery.
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13. Figure 12 (E) Similar to Fig. (D.)
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14. Figure 13
(A) A zone marked by “c” in Fig. 7 where there is still fibrous tissue. The dark staining bodies are smaller and assume a round granular appearance. Most show no birefringence, but one in upper left is typical. G. M. S. stain × 3400.
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15. Figure 14
(B) Polariscopic view of Fig. 13. Only 2 or 3 show a faint birefringence. G. M. S. stain × 3400.
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16. Figure 15
(C) Still further out in the fibrous tissue. G. M. S. stain × 3400.
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17. Figure 16
(D) Polariscopic view of Fig. 15. Only one shows typical birefringence. Others only show points of light. They may be artefacts. ×3400.
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18. Figure 17
(A) A microphotograph of the central area of Fig. 7 (the blood vessel marks the general location). Note the outlines of the alveoli caused by the calcium deposits in the alveolar wall, and possibly to a calcium salt of nucleic acid in the disintegrated nuclei of the alveolar walls. ×48 Von Kossa stain.
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19. Figure 18 (B) Another view similar to that of Fig. 16.
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20. Figure 19
(A) Roentgenogram of D. H. B21, No. 25,139, taken on August 11, 1955, showing a fibroid and partly infiltrative lesion in right subapex.
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21. Figure 20
(B) Roentgenogram of T. P. B23, No. 25,223, taken on November 10, 1955 showing a more inflammatory type of lesion in the left subapex.
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22. Figure 21
(A) A low power view of two of the fibroid cavities shown in Fig. 17. H. & E. ×6.
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23. Figure 22
(B) A higher magnification of wall of cavity marked off in Fig. 19. H. & E. ×36.
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24. Figure 23
(A) A still higher magnification of wall of cavity of Fig. 19. Note palisade arrangement of cells. H. & E. ×160.
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25. Figure 24
(B) An area of chronic pneumonia in lung tissue showing alveoli packed with organizing fibrous exudate, with alveolar cells and macrophages. H. & E. ×132.
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26. Figure 25
(A) A sketch of resected upper lobe of T. P. B23, No. 25,223, purporting to show the cystic protrusion at “a,” the chronic pneumonia at “b,” and the atelectasis at “c.”
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27. Figure 26
(B) A slightly enlarged caseous focus from the consolidated region below the cystic cavity with early cavity formation. H. & E. ×4.5.
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28. Figure 27
(C) A low power photo of section of the chronic pneumonitis at “b” in Fig. 23. H. & E. ×4.5.
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29. Figure 28
(A) A higher magnification of area marked off in Fig. 25. H. & E. ×20.
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30. Figure 29
(B) A still higher magnification of an area of the chronic pneumonitis. Note the imperfect giant cells, fibroblasts, fibrosis, macrophages, and the few lymphocytes with no polymorphs. H. & E. ×140.
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31. Figure 30
(A) Roentgenogram of H. T., B28, No. 26,098, taken on September 16, 1949 showing a fibroid apical lesion in the left apex and a few nodules below. It was called a moderately advanced tuberculosis with an apical cavity.
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32. Figure 31
(B) Same case taken on August 31, 1956 showing what was thought to be a pneumothorax because of the fibrin body showing. Instead it was found to be a completely destroyed lung.
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33. Figure 32
(A) A low power view of dense ossified parenchymal lesion shown in Fig. 31. There was also a lymph node lesion left behind, perhaps the lymph node component of an old primary. Small dots encircle several areas in which yeast bodies were found. H. & E. ×4.5.
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34. Figure 33
(B) An enlarged area outlined in black ink. Note the bone and marrow.
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35. Figure 34
(C) Microscopic view of yeast bodies found in area outlined by dots in Fig. 32. G. M. S. stain × 3200.
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36. Figure 35
(D) Another field outlined by the dots in Fig. 32. G. M. S. stain × 3200.
Diseases of the Chest  , DOI: ( /chest )
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