Pulmonary inflammatory pseudotumor caused by Cryptococcus presenting multiple nodules in bilateral lungs

Abstract

Pulmonary inflammatory pseudotumor is one of the rare benign tumors of lung. Its causes and pathogenesis are still not very clear by now. Most reported cases present a solitary nodule or mass in lung field and their causes are still not confirmed even after operation. Here we report a rare case of pulmonary inflammatory pseudotumor with confirmed cause of Cryptococcus infection presenting multiple nodules in bilateral lungs.A 44-year-old man was admitted to our hospital because of radiographic evidence of pulmonary nodules during his routine physical examination. But he was absent from any symptoms, such as fever, cough, hemoptysis, chest pain, hoarsness, dyspnea, dysphagia and no obvious manifestations of thoracic diseases. This patient had no history of smoking and other systemic diseases, but he had worked in Malaysia for 2 years.A radiograph of the chest showed bilateral pulmonary nodules (Fig. 1). A computed tomography (CT) scanning of the chest disclosed tumorous lesions, 2×3 cm in diameter in the left inferior lobe and 2×1.8 cm in diameter in the right inferior lobe, with a high density and obvious spicule sign ( Fig. 2a and 2b, Fig. 3a and 3b). In the mediastinal windows there were no obvious enlarged lymph nodes. Serous tumor markers, including NSE, CYFRA, CEA were examined and the results were all normal, so did the ultrasound examination of the abdominal organs. Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) scanning was considered and showed that these lesions had a high radioactive concentration ( Fig. 2c and 2d, Fig. 3c and 3d). So the patient was initially diagnosed as lung carcinoma with metastasis in bilateral lungs.Other examinations, such as blood cell count, lung function, ECG, hepatic and renal function, were all performed and no contraindications of surgery were found. Because the lesions were limited in both inferior lobes, lobectomy or wedge resection was found necessary. Intraoperative frozen section pathological examination was also prepared before the operation.Bilateral thoracotomy was considered and the first procedure was the left thoracotomy by the sixth intercoastal incision, then the right side. Four lesions were found in the inferior lobe, with 1 bigger and 3 smaller (Fig. 4). The sizes of lymph nodes around the hilus pulmonis were all normal. So the inferior lobe resection was performed and the result of frozen section pathological examination from lesion tissues was that suspicious malignant cells were found under microscopy. So lymph nodes dissection were also carried out. Before closing the incision a watersealed chest tube was placed, so that the residual lobe of the left lung could inflate and ventilate well to guarantee the right thoracotomy safe. Then placed this patient's body to left lateral position and performed the right thoracotomy. There were 2 nodules in the right inferior lobe (Fig. 5) and other lobes were normal. Because of separation of the two nodules, wedge resection or segmentectomy were not indicated. The inferior lobectomy was also c...

Syphilitic Pulmonary Inflammatory Pseudotumor: A Diagnostic Challenge

“…7 In this location also, a number of different organisms have been implicated, including mycobacteria, Coxiella , Histoplasma , and Cryptococcus . 8 -11…”

“…7 In this location also, a number of different organisms have been implicated, including mycobacteria, Coxiella, Histoplasma, and Cryptococcus. [8][9][10][11] Syphilis is a chronic disease caused by Treponema pallidum and is usually transmitted by sexual contact, from mother to child and rarely by blood-borne infection. If untreated, syphilis has a long progressive natural history consisting of primary, secondary, and tertiary stages.…”