Comparative study of primary pulmonary cryptococcosis with multiple nodules or masses by CT and pathology

Abstract

The manifestations of pulmonary cryptococcosis with multiple nodules or masses on computed tomography (CT) are diverse and difficult to differentiate from those of lung cancer and pulmonary tuberculosis. The present study compared the multislice spiral CT signs with pathological results and used the pathological results to explain the CT signs with the aim of improving the accuracy of the diagnosis of this disease. A retrospective analysis of 20 patients with primary pulmonary cryptococcosis with multiple nodules or masses was performed. Based on the CT signs, eight patients had been misdiagnosed with lung cancer accompanied by intrapulmonary metastasis andthree patients had been misdiagnosed with tuberculosis. The major CT manifestations were a cluster of nodules or masses located within 2 cm below the pleura and distributed along the bronchi. A total of nine patients had primary lesions with diameters of 1.1–2.0 cm and 12 patients had satellite lesions with diameters of 0.1–1.0 cm. Regarding treatment, 5 patients underwent surgical monotherapy, 12 patients underwent antifungal monotherapy and three patients received surgery in combination with antifungal therapy. HE staining indicated that Cryptococcus neoformans was engulfed by macrophages, which were surrounded by massive infiltrating lymphocytes and a large amount of fibrous tissue, which formed multinucleated macrophages or granulomas. Periodic acid-Schiff staining was positive and acid fast staining was negative. In conclusion, comparison of CT signs with the pathological manifestation of pulmonary cryptococcosis with multiple nodules or masses indicated that the pathological results may explain certain imaging signs. Combination of CT and pathological examination may provide a deeper understanding of this disease and improve the accuracy of its diagnosis.

CT imaging changes of corona virus disease 2019(COVID-19): a multi-center study in Southwest China

“…(5) Bacterial pneumonia is often community-acquired or hospital-acquired, with increased WBCs and neutrophils and imaging often showing patchy, nodular, or consolidation shadows distributed along the bronchi or lung segments, which can be distinctly recognized [25]. (6) In cases of cryptococcus infections, lesions are mostly located under the pleura with single or multiple consolidations and nodular shadows, and the disease progresses slowly [26].…”

CT Imaging Changes of Corona Virus Disease 2019 (COVID-19): A multi-center study in Southwest China

“…The disease is commonly complicated by pleural effusion and enlarged mediastinal and hilar lymph nodes [22]. Bacterial pneumonia is often community-acquired or hospital-acquired, with increased WBCs and neutrophils and imaging often showing patchy, nodular, or consolidation shadows distributed along the bronchi or lung segments, which can be distinctly recognized [23] In cases of cryptococcus infections, lesions are mostly located under the pleura with single or multiple consolidations and nodular shadows, and the disease progresses slowly [24].…”

CT Imaging Changes of Corona Virus Disease 2019 (COVID-19):A multi-center study in Southwest China

“…5Bacterial pneumonia is often community-acquired or hospital-acquired, with increased WBCs and neutrophils and imaging often showing patchy, nodular, or consolidation shadows distributed along the bronchi or lung segments, which can be distinctly recognized [25]. (6) In cases of cryptococcus infections, lesions are mostly located under the pleura with single or multiple consolidations and nodular shadows, and the disease progresses slowly [26].…”