Mass-forming hepatic cryptococcosis: a mimicker of metastatic tumors

Hoshiai, Sodai; Hiyama, Takashi; Kawasaki, Hiroshi; Saitoh, H; Mori, Kensaku; Nasu, Katsuhiro; Amano, Taishi; Minami, Manabu

doi:10.1007/s00261-020-02437-2

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…27 To the authors' knowledge, such lesions have not previously been reported in feline or canine cryptococcosis and have been rarely reported in people with histopathologically confirmed cryptococcomas. 28,29 T2 hypointense lesions have, however, been identified in 2 dogs with noncryptococcal fungal brain granulomas in the US.. 30 In the present study, T1 signal was variable but tended to be hypo-to isointense in most of the T2 hypointense lesions. Possible explanations for T2 hypointense lesions in feline and canine cryptococcosis include fungal production of melanin as a virulence factor (although this would typically be T1 hyperintense) 31 ; accumulation of mineral substances such as calcium, which has been identified histologically in a person with hepatic and pulmonary cryptococcomas 29 ; high mucin or protein composition of cryptococcal lesions due to the accumulation of capsular material; or hypercellular lesions such as cryptococcomas.…”

Section: Discussioncontrasting

confidence: 48%

Brain magnetic resonance imaging and computed tomography findings in cats and dogs with central nervous system cryptococcosis in Australia: 23 cases (2009–2020)

Jacobson,

Podadera,

Siow

et al. 2024

javma

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OBJECTIVE To describe the imaging findings in Australian cats and dogs with CNS cryptococcosis. ANIMALS 23 cases (10 cats; 13 dogs) with CNS cryptococcosis and brain MRI or CT studies available to review. METHODS Retrospective, multi-institutional case series. Brain MRI or CT studies were reviewed by a board-certified radiologist. Imaging findings were described and the differences between cats and dogs explored. RESULTS Morphologic features were consistent with extra-axial lesions in all (n = 13) dogs and either intra-axial (5/10) or extra-axial (4/10) lesions in cats, with 1 cat having no detectable lesions in low-field brain MRI scans. Meningeal abnormalities were most common, followed by forebrain and cerebellar lesions. Intracranial MRI lesions were typically T2 hyperintense and T1 hypo- to isointense. Four cases had T2 hypointense lesions affecting the brain, sinonasal cavity, or regional lymph nodes. Intracranial CT lesions were mostly soft tissue attenuating. Contrast enhancement was present in all cases with contrast series available, with ring enhancement shown only in cats. Osteolysis was more common in dogs than cats, particularly affecting the cribriform plate. All 13 dogs and many (6/10) cats had at least 1 lesion affecting sinonasal or contiguous tissues, and locoregional lymphadenomegaly was common (7/10 cats; 11/13 dogs). CLINICAL RELEVANCE Imaging lesions in cryptococcal meningoencephalitis were extra-axial in dogs but could be intra-axial or extra-axial in cats. Careful examination for extracranial lesions (sinonasal, retrobulbar, facial soft tissue, tympanic bullae, or locoregional lymph nodes) is important to provide alternative safe biopsy sites. T2 hypointense lesions, while rare, should prompt consideration of cryptococcosis.

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Section: Discussioncontrasting

confidence: 48%

Brain magnetic resonance imaging and computed tomography findings in cats and dogs with central nervous system cryptococcosis in Australia: 23 cases (2009–2020)

Jacobson,

Podadera,

Siow

et al. 2024

javma

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“…[6][7][8][9] The liver is not a common site of C. neoformans infection, but several cases of hepatobiliary cryptococcosis have been reported as a manifestation of disseminated or isolated cryptococcosis in immunocompromised patients. 6,7,[9][10][11] In these previous reported hepatobiliary cryptococcosis cases, obstructive jaundice and low-attenuated mass extending along the hepatoduodenal ligament with bilateral intrahepatic bile duct dilation were dominant manifestations and the diagnosis of cholangiocarcinoma or primary sclerosing cholangitis (PSC) was suspicious but C. neoformans infection was confirmed by a microscopic examination or a bile culture. 6,7,[9][10][11] In our report, the patient, who presented with increased serum CA19-9 level, family cancer history and intrahepatic multiple nodules was initially suspected of having metastatic liver malignancy.…”

Section: Discussionmentioning

confidence: 99%

“…6,7,[9][10][11] In these previous reported hepatobiliary cryptococcosis cases, obstructive jaundice and low-attenuated mass extending along the hepatoduodenal ligament with bilateral intrahepatic bile duct dilation were dominant manifestations and the diagnosis of cholangiocarcinoma or primary sclerosing cholangitis (PSC) was suspicious but C. neoformans infection was confirmed by a microscopic examination or a bile culture. 6,7,[9][10][11] In our report, the patient, who presented with increased serum CA19-9 level, family cancer history and intrahepatic multiple nodules was initially suspected of having metastatic liver malignancy. But no sign of the malignant tumor was found after comprehensive examinations including endoscopy, PET-CT, and liver biopsy.…”

Section: Discussionmentioning

confidence: 99%

Rare Hepatic Cryptococcosis Mimicked Metastatic Liver Cancer and Confirmed by Metagenomic Next-Generation Sequencing in an Immunocompetent Patient: A Case Report

Zhu¹,

Wang²,

Wang³

et al. 2022

IDR

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Background Cryptococcus neoformans ( C. neoformans) is commonly presented in immunocompromised individuals and causes cryptococcosis mostly in the respiratory and/or central nervous system. Liver cryptococcosis is exceedingly rare and sometimes difficult to diagnose through conventional assays. Case Presentation The present study reports a rare case of liver cryptococcosis characterized by increased serum carbohydrate antigen 19–9 (CA19-9) level and intrahepatic multiple nodules without other symptoms in an immunocompetent woman. Her cancer family history and imaging examinations initially suspected metastatic liver malignancy. But no sign of the malignant tumor was found after endoscopy, 18-fluorine fluorodeoxyglucose positron emission tomography-computed tomography, and liver biopsy. The histopathology of the liver biopsy specimen indicated chronic inflammatory granuloma and then infectious diseases were suspected. However, traditional microbiologic testing failed to identify any potential pathogen. Eventually, metagenomic next-generation sequencing (mNGS) was applied to identify the definite diagnosis of liver cryptococcosis by acquiring the genome sequence of C. neoformans . Fortunately, after 6-month diagnostic anti-fungal therapy of fluconazole, the liver nodules effectively faded away and the serum CA19-9 level gradually regressed to the normal range. Conclusion We identified a rare case of hepatic cryptococcosis by mNGS in an immunocompetent patient. When conventional methods have difficulties in the diagnosis of a specific pathogen, mNGS has the advantage of early and accurate identification of potential pathogens from the specimen.

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Cryptococcosis in Liver Transplant Candidates and Recipients

Gore

Forrest

2020

Curr Fungal Infect Rep

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Mass-forming hepatic cryptococcosis: a mimicker of metastatic tumors

Cited by 5 publications

References 12 publications

Brain magnetic resonance imaging and computed tomography findings in cats and dogs with central nervous system cryptococcosis in Australia: 23 cases (2009–2020)

Brain magnetic resonance imaging and computed tomography findings in cats and dogs with central nervous system cryptococcosis in Australia: 23 cases (2009–2020)

Rare Hepatic Cryptococcosis Mimicked Metastatic Liver Cancer and Confirmed by Metagenomic Next-Generation Sequencing in an Immunocompetent Patient: A Case Report

Cryptococcosis in Liver Transplant Candidates and Recipients

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