Australian Society of Cytology - Pursuit of Excellence
Australian Society of Cytology

Case of the Month

May 2005 - Answer and Discussion

Answer: Cryptococcoma

FNA Findings:

Numerous pleomorphic, spherical, thin-walled cells on both Diff Quik and PAP stained slides and mucin positive PAS slide.

Discussion

Cryptococcus neoformans is a yeast-like fungus that is normally found in soil and bird droppings particularly those of pigeons.  It causes disease by aerosolization and inhalation.  Clinically pulmonary and cerebromeningeal infections predominate and organs less commonly involved include skin, bones, lymph nodes, kidneys, prostates, spleen and liver.
Although pulmonary cryptococcal infections occur in both immunocompetent and immunocompromised individuals, it is more often encountered as an opportunist.  The rise in C. neoformans infection is linked to global increase in the number of immunocompromised individuals mostly due to AIDS epidemic.  In immunocompetent patients pulmonary cryptococcoma is unusual.  Pulmonary involvement of C. neoformans includes;

  • cryptococcoma (residual pulmonary nodule)
  • asymptomatic colonisation of the transbronchial tree without tissue invasion
  • self-limited or progressive pulmonary disease with or without extrapulmonary dissemination.

Even though C. neoformans the is best diagnosed isolating in culture, in our case the organism did not grow in culture possibly due to insufficient specimen or infectious particles being dormant or dead.  But the cytologic findings were confirmed by positive serology test for C. neoformans antigen. The patient underwent antifungal therapy and fully recovered.  It was later discovered that the patient had been caring for two budgies for the last six years, which most likely was the source of the infection.  This case highlights the effectiveness of FNA biopsies especially on lung mass lesions where radiology findings can give false positives.

References:

  1. Bibbo, M (ed) 1991, Comprehensive Cytopathology, WB Saunders Company, Philadelphia
  2. Dail, DH & Hammar, SP (eds) 1988, Pulmonary Pathology,Springer-Verlag, New York
  3. Murray, PR, Baron, EJ, Jougensen, JH, Pfaller, MA & Yolken, RH 2003, Manual of Clinical Microbiology, vol 2, 8th ed, American Society of Microbiology Press, Washington DC.
  4. Saldana, MJ (ed) 1994, Pathology of Pulmonary Disease, JB Lippincott Company, Philadelphia
  5. Enstein, K & Askin, 1997, Surgical Pathology of Non-neoplastic Lung Disease, vol 13, 3rd ed, WB Saunders Company, Philadelphia

 

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