We report a case of primary pulmonary cryptococcosis in a post-renal transplant patient. A 65-year-old male renal transplant patient was admitted to the hospital with a low grade fever of 1 month, radiologically mimicking tuberculosis (TB). Broncho-alveolar fluid (BAL) shows capsulated yeast, and Cryptococcus neoformans was grown on culture supported by cytology and histopathological examination. Cryptococcal antigen was positive (32-fold) in serum and was negative in cerebrospinal fluid (CSF). The patient was given amphotericin B and 5-flucytosine and clinical improvement was seen on a weekly follow up. The serum cryptococcal antigen test might contribute to the early detection and treatment of pulmonary cryptococcosis. The results of antifungal susceptibility were aid in selecting the drug of choice for treatment.

A 55‐year‐old man presented with an ulcer on the right sole present for 8 years. The ulcer measured 6.5 × 3 cm and affected the entire distal sole of the right foot; the margins were everted and an intermittent serosanguineous discharge was present. The general condition of the patient was good, with findings limited to the ulcerated lesion. There was no history of hypertension, diabetes mellitus, or venous stasis. A biopsy taken from the ulcer edge was interpreted as squamous cell carcinoma, Grade I. A transmetatarsal amputation was carried out and the specimen sent for histopathologic examination. Histologically, the epidermis showed ulcerated areas; adjacent areas showed hyperkeratosis and irregular acanthosis. Keratin cysts containing well‐developed lamellar keratin were present in the upper dermis (Fig. 1). Nests and strands of squamous and basaloid cells, having scanty eosinophilic cytoplasm, alternated with the cysts. Areas of ductular differentiation were also noted. The epithelial strands were separated by concentric bands of moderately cellular fibrous tissue in the upper and mid‐dermis. In the deeper areas of the tumor the epithelial nests became progressively smaller in size, diminishing to small clusters of two or three cells, and were surrounded by a sclerotic stroma. Cytologic atypia was minimal and no significant mitotic figures were identified. The neoplasm showed extensive infiltration of subcutaneous fat and striated muscle with frequent perineural involvement in the deeper parts. There was no extension to bone or perichondrium. Immunoperoxidase staining carried out for carcinoembryonic antigen (CEA) showed positivity in the lumina and lining cells of the ducts (Fig. 2). Based upon the classical microscopic appearance, a diagnosis of microcystic adnexal carcinoma was made. The patient has been followed for a period of 3 years with no evidence of tumor recurrence.

Primary leiomyomas are rare benign tumors of the lung and only 25 cases have been documented in children, most of which are endobronchial. Leiomyomas are benign smooth muscle neoplasms, usually diagnosed on morphological characteristics. However, immunohistochemistry plays a crucial role in the lineage differentiation when these are encountered at unusual sites or with unexpected morphological features. We report a case of endobronchial tumor of a 13-year-old male child who presented with a dry cough and hemoptysis. A mass lesion in the right main bronchus was detected by bronchoscopy and contrast-enhanced computed tomography. On histopathological examination of the resected specimen, a diagnosis of myxoid leiomyoma was made. To the best of our knowledge, this is the first case of myxoid leiomyoma to be reported in the respiratory tract. This case also demonstrates the need for a high index of suspicion and the role of immunomarkers in the diagnosis of such challenging cases.

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