Cryptococcal parotitis presenting as a cystic parotid mass: Report of a case diagnosed by fine-needle aspiration cytology

Abstract

We report the fine needle aspiration (FNA) cytology findings that allowed us to diagnose cryptococcal parotitis in a 31-year-old HIV positive patient. The patient presented with painful and enlarged right parotid gland and a CT scan showed a cystic lesion with rim enhancement. The FNA cytology revealed yeasts of variable size, some of which had bright eosinophilic capsules in Diff-Quik stained preparations. Mucicarmine and silver stain supported the diagnosis of cryptococcal parotitis, which was later confirmed by fungal culture of the aspirated material. We thus show that fungal infection can present as a cystic parotid mass in an immunosuppressed patient and that the diagnosis can be made by FNA cytology.

Review of HIV-Related Cytopathology

“…FNA from these cysts yields clear to yellow-brown watery fluid, and cytologic findings comprise of admixed anucleated, superficial and intermediate squamous cells with lymphocytes, and tingible body macrophages [106]. Other disease entities arising within salivary glands in HIV-positive patients are low-risk lymphoma arising in BLEC, intraparotid lymphadenopathy, diffuse infiltrative lymphocytosis syndrome, and sialadenitis secondary to unusual infections, such as cytomegalovirus [107, 108] and cryptococcus [109]. Even the thyroid gland in HIV patients can rarely be involved by CMV infection [110] and pneumocystis [111].…”

Tuberculosis of the Parotid Gland Mimicking Neoplasia

“…12 Granulomatous sialoadenitis may accompany or precede neoplastic conditions as reported along with an extramedullary plasmacytoma preceding a B-cell lymphoma in the parotid. 13 Granulomatous parotitis has also been reported to be induced by D-penicillamine therapy in rheumatoid arthritis.…”

Diagnosis ofStrongyloides stercoralis in a routine cervical smear

“…The presence of C. neoformans in the parotid gland has rarely been reported and seems to be associated with the disseminative form of the infection in immunosuppressed patients. 4 Two cases of parotid cryptococcosis have been recently published 5,6 and, to the best of our knowledge, this is the third English-language case report of a clinical manifestation of C. neoformans infection in the parotid gland. FNAC was performed to confirm the initial suspicion of parotid gland tumour, but it rather identified the presence of C. neoformans.…”

“…The diagnosis of cryptococcosis by FNAC has been reported in several organs, including the lung, thyroid, spleen, lymph nodes and pancreas. 6 Cytologically, C. neoformans presents a spherical shape and measures approximately 5-15 lm, occasionally exhibiting narrow-base budding. The strong pink-to-red colour of the thick mucinous capsule of C. neoformans after mucicarmin staining also contributes to the diagnosis of cryptococcosis.…”