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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

View larger version (157K): [in a new window]   Figure 1. Frontal chest radiograph showing a soft tissue mass in the left lower lobe.

View larger version (113K): [in a new window]   Figure 2. Axial CT demonstrating a 3x2 cm2 left lower lobe mass (arrow) with attachment to the adjacent pleura. There is another nodule affecting the posterior basal segment more centrally (white arrowhead).

View larger version (172K): [in a new window]   Figure 3. (a) The lung tissue reveals chronic granulomatous inflammation, with fibrosis and consolidation of the interstitium. There are dense lymphocytic and histiocytic infiltrates, with scattered multinucleated giant cells (arrowheads) noted (haematoxylin & eosin stain, x100). (b) Numerous, variable size yeast forms of fungi (arrows) are present in the giant cells or in the extracellular areas (periodic acid Schiff stain, x400).

View larger version (124K): [in a new window]   Figure 4. Encapsulated forms of cryptococcus (arrows) are well demonstrated by mucicarmine stain (x1000).