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Cryptococcus infection in a patient with nasopharyngeal carcinoma: imaging findings mimicking pulmonary metastases

Departments of ¹ Radiation Oncology, ² Radiology, ³ Pathology and ⁴ Division of Thoracic and Cardiovascular Surgery, Department of Cardiovascular Surgery and ⁵ Division of Infectious Diseases, Department of Internal Medicine, Chang Gung University and Chang Gung Memorial Hospital Kaohsiung Center, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan

An asymptomatic pulmonary mass was found in a 42-year-old unmarried male with controlled nasopharyngeal carcinoma (NPC) during routine follow-up chest radiography 8 months following completion of radiotherapy. Chest CT demonstrated a 3x2 cm² left lower lobe (LLL) mass, with further small nodules in the same lobe. A presumptive diagnosis of lung metastases was made, and the patient underwent surgical resection with left lower lobectomy and mediastinal lymph node dissection. Pathologic examination of the masses in the LLL revealed granulomatous inflammation with cryptococcus infection. The dissected lymph nodes revealed anthracosis. The patient received 6 months of antifungal treatment with fluconazole. His NPC showed no evidence of local recurrence or distant metastases. Recognition that pulmonary cryptococcus infection can mimic metastases is important in reaching the correct diagnosis and therefore determining the correct treatment.