PDF(Pubmed)
Abstract：
BACKGROUND: Pulmonary cryptococcal infections occur mainly in immunocompromised individuals, such as those with malignancies. Preoperative diagnosis of pulmonary cryptococcosis (PC) can be challenging for both clinicians and radiologists because of nonspecific clinical manifestations and variable radiologic features, as it is easily misdiagnosed as metastatic lung cancer.
METHODS: In case 1, a 76-year-old woman with a history of cervical cancer presented with lung nodules detected on chest computed tomography (CT) 13 months after completing concurrent chemoradiotherapy. In case 2, a 56-year-old woman with a history of ovarian cancer presented with pulmonary nodules on chest CT 19 months after completing chemotherapy. Both patients were clinically asymptomatic, and tumor markers were not elevated.
METHODS: In case 1, chest CT revealed multiple enhanced nodules with lobulated margins in the left lower lobe, and positron emission tomography (PET)-CT showed uptake in the nodule with a standardized uptake value of 3.7. In case 2, chest CT revealed several nodules in the right upper lobe abutting the right major fissure, and PET-CT revealed fluorodeoxyglucose uptake in the nodules. Pathology revealed granulomatous inflammation with cryptococcal infection, and mucicarmine and periodic acid-Schiff staining confirmed cryptococcal infection in both cases.
METHODS: Presumptive diagnoses of lung metastases were made in both cases and thoracoscopic lobectomy was performed. Postoperatively, the patients received antifungal therapy with fluconazole.
RESULTS: PC was differentially diagnosed and effectively managed. The patients remained disease-free for both PC and gynecological cancers during subsequent follow-ups.
CONCLUSIONS: Recognition that PC can mimic lung metastasis is important for managing gynecological cancers. PC should be considered in the differential diagnosis when single or multiple nodules are detected on chest radiography without elevation of tumor markers in patients with gynecological cancer.
METHODS: In case 1, a 76-year-old woman with a history of cervical cancer presented with lung nodules detected on chest computed tomography (CT) 13 months after completing concurrent chemoradiotherapy. In case 2, a 56-year-old woman with a history of ovarian cancer presented with pulmonary nodules on chest CT 19 months after completing chemotherapy. Both patients were clinically asymptomatic, and tumor markers were not elevated.
METHODS: In case 1, chest CT revealed multiple enhanced nodules with lobulated margins in the left lower lobe, and positron emission tomography (PET)-CT showed uptake in the nodule with a standardized uptake value of 3.7. In case 2, chest CT revealed several nodules in the right upper lobe abutting the right major fissure, and PET-CT revealed fluorodeoxyglucose uptake in the nodules. Pathology revealed granulomatous inflammation with cryptococcal infection, and mucicarmine and periodic acid-Schiff staining confirmed cryptococcal infection in both cases.
METHODS: Presumptive diagnoses of lung metastases were made in both cases and thoracoscopic lobectomy was performed. Postoperatively, the patients received antifungal therapy with fluconazole.
RESULTS: PC was differentially diagnosed and effectively managed. The patients remained disease-free for both PC and gynecological cancers during subsequent follow-ups.
CONCLUSIONS: Recognition that PC can mimic lung metastasis is important for managing gynecological cancers. PC should be considered in the differential diagnosis when single or multiple nodules are detected on chest radiography without elevation of tumor markers in patients with gynecological cancer.
摘要：
背景：肺隐球菌感染主要发生在免疫功能低下的个体中，比如那些恶性肿瘤。肺隐球菌病（PC）的术前诊断对于临床医生和放射科医生来说都是具有挑战性的，因为其临床表现是非特异性的，放射学特征也是可变的。因为它很容易被误诊为转移性肺癌。
方法：病例1，一名76岁女性，有宫颈癌病史，在完成同步放化疗13个月后，胸部计算机断层扫描（CT）检测到肺结节。在病例2中，一名有卵巢癌病史的56岁女性在完成化疗19个月后胸部CT显示肺结节。这两个病人临床上无症状,肿瘤标志物没有升高。
方法：在病例1中，胸部CT显示左下叶有小叶边缘的多个增强结节，和正电子发射断层扫描（PET）-CT显示结节中的摄取，标准化摄取值为3.7。病例2，胸部CT显示右上叶多个结节邻接右大裂，PET-CT显示结节中氟脱氧葡萄糖摄取。病理提示肉芽肿性炎症伴隐球菌感染，和粘液碱和高碘酸希夫染色证实了两种情况下的隐球菌感染。
方法：两种病例均对肺转移进行了诊断，并进行了胸腔镜肺叶切除术。术后,患者接受氟康唑抗真菌治疗.
结果：PC得到了鉴别诊断和有效管理。在随后的随访中，患者的PC和妇科癌症均无病。
结论：认识到PC可以模拟肺转移对于治疗妇科癌症很重要。当妇科癌症患者在胸片上检测到单个或多个结节而没有肿瘤标志物升高时，应在鉴别诊断中考虑PC。
方法：病例1，一名76岁女性，有宫颈癌病史，在完成同步放化疗13个月后，胸部计算机断层扫描（CT）检测到肺结节。在病例2中，一名有卵巢癌病史的56岁女性在完成化疗19个月后胸部CT显示肺结节。这两个病人临床上无症状,肿瘤标志物没有升高。
方法：在病例1中，胸部CT显示左下叶有小叶边缘的多个增强结节，和正电子发射断层扫描（PET）-CT显示结节中的摄取，标准化摄取值为3.7。病例2，胸部CT显示右上叶多个结节邻接右大裂，PET-CT显示结节中氟脱氧葡萄糖摄取。病理提示肉芽肿性炎症伴隐球菌感染，和粘液碱和高碘酸希夫染色证实了两种情况下的隐球菌感染。
方法：两种病例均对肺转移进行了诊断，并进行了胸腔镜肺叶切除术。术后,患者接受氟康唑抗真菌治疗.
结果：PC得到了鉴别诊断和有效管理。在随后的随访中，患者的PC和妇科癌症均无病。
结论：认识到PC可以模拟肺转移对于治疗妇科癌症很重要。当妇科癌症患者在胸片上检测到单个或多个结节而没有肿瘤标志物升高时，应在鉴别诊断中考虑PC。
