Table I.
Clinical characteristics of the patients with primary pulmonary cryptococcosis with multiple nodules or masses (n=20).
| No./age/gender | History | Symptoms | Location | Size (cm) | No. of nodules | CT presentation | CT primary diagnosis | Biopsy style | Pathology | Treatment | Prognosis |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1/M/30 | Contact with birds | Cough, expectoration | RIL | Max: 1.9×1.7; around nodule: 1.6–2.0 | 3 | A near-pleural mass with clusters of round satellite lesions along bronchus, irregular margin, air bronchogram, halo sign around nodule, cavity | Infected lesions | Paracentesis | Granulomatous lesions, Cryptococcus in macrophages, PAS (+) | Fluconazole for 20 months | Significant reduction and disappearance, no re-examination |
| 2/F/55 | Breast cancer surgery | Cough | RIL | Max: 5.2×3.6; around nodule: 1.1–1.5 | 4 | A near-pleural mass with clusters of round satellite lesions along bronchus, air bronchogram, lymphonodus (+) | Lung cancer with intrapulmonary metastasis | Paracentesis | Granulomatous lesions, Cryptococcus in macrophages, lymph nodes exhibited reactive hyperplasia, PAS (+) | Fluconazole for 12 months | No re-examination |
| 3/M/54 | Hypertension | Stomachache | RIL+LUL | Max: 2.3×1.7; around nodule: 0.6–1.0 | 3 | A mass with clusters of round satellite lesions along bronchus, irregular margin, halo sign and air bronchogram | Granuloma | Paracentesis | Granulomatouslesions, Cryptococcus in macrophages, PAS (+), acid fast stain (−) | Fluconazole for 9 months | Significant reduction and disappearance, no re-examination |
| 4/M/68 | Pulmonary tuberculosis | Chest pain | RUL | Max: 3.1×2.0; around nodule: 1.6–2.0 | 4 | A near-pleural mass with clusters of round satellite lesions along bronchus, irregular margin, long spicule, irregular calcification | Tuberculosis or lung cancer with intrapulmonary metastasis | Operation | Granulomatous lesions with necrosis, Cryptococcus and Candidain necrotic tissue, pulmonary interstitial lymphocytic infiltration PAS (+), acid fast stain (−) | Fluconazole for 3 months | No re-examination |
| 5/M/39 | Hypertension | Chest pain | LIL | Max: 3.2×1.8; around nodule: 0.6–1.0 | 5 | Three masses, clusters of distribution, with round satellite lesions along bronchus, some with lobulation, irregular margin, pleural indentation and cavity | Tuberculosis | Operation | Granulomatous lesions, Cryptococcus in macrophages, PAS (+) | None | No recurrence |
| 6/M/78 | Hypertension | Elevated temperature, cough, chill | RIL | Max: 2.1×1.3; around nodule: 0.1–0.5 | 4 | A near-pleural mass with clusters of satellite lesions along bronchus, spicule | Infected lesions | Paracentesis | Granulomatous lesions without necrosis, Cryptococcus inmacrophages, PAS (+) | Fluconazole for 13 months | No recurrence |
| 7/M/45 | Reflux esophagitis | Chest pain | RIL | Max: 1.9×1.3; around nodule: 0.1–0.5 | 4 | A near-pleural mass with satellite lesions along bronchus, irregularmargin, air bronchogram, long spicule, pleural indentation, SUV 5.43 on PET-CT | Lung cancer with intrapulmonary metastasis | Operation | Granulomatous lesions, Cryptococcus in macrophages, PAS (+), acid fast stain (−) | Fluconazole for 3 months | Unknown |
| 8/M/37 | None | Cough, expectoration | RUL+LIL | LIL: 3.0×2.2 RUL: 2.0×1.6 | 2 | LIL: Mass, irregular margin, lobulation, cavity, air bronchogram, long spicule; RUL: A mass with a nodule, irregular margin, air bronchogram, spicule | Infected lesions | Paracentesis | Granulomatous lesions, Cryptococcus in macrophages, PAS (+) | Caspofungin, itraconazole for 15 days, fluconazole for 6 months | Significant reduction and disappearance, no re-examination |
| 9/M/65 | Hypertension | None | RML | Max: 2.0×1.6; around nodule: 0.6–1.0 | 4 | A nodule with clusters of satellite lesions along bronchus, lobulation, short spicule, air bronchogram, pleural indentation, lymphonodus (+) | Lung cancer with intrapulmonary metastasis | Operation | Granulomatous lesions, organized lesions, Cryptococcus in macrophages, lymph nodes with reactive hyperplasia, PAS (+), acid fast stain (−) | None | No re-examination |
| 10/M/47 | Hypertension, diabetes | None | RUL+LIL | LIL-Max: 3.4×2.8; around nodule: 1.1–1.5 | 6 | LIL: A near-pleural mass with clusters of satellite lesions alongbronchus, irregular margin, lobulation, SUV9.3 in PET-CT; RUL: A nodule with lobulation, blood vessel convergence, SUV5.56 on PET-CT | Lung cancer with intrapulmonary metastasis | Paracentesis | Granulomatous lesions, organized lesions, Cryptococcus in macrophages, PAS(+), acid fast stain (−) | Fluconazole for 10 months | No re-examination |
| 11/M/67 | Cirrhosis, spleen resection | None | LIL | Max: 1.0×0.7; around nodules: 0.1–0.5 | 4 | A near-pleural mass with clusters of satellite lesions along bronchus, air bronchogram, lobulation | Lung cancer with intrapulmonary metastasis | Paracentesis | Granulomatous lesions, Cryptococcus in macrophages, PAS (+) | Fluconazole for 5 months | No re-examination |
| 12/F/38 | None | None | Whole lung | Max: 1.5×1.4; around nodule: 0.1–0.5 | 9 | Multiple nodules in the whole lung, particularly one nodule with clusters of satellite lesions along bronchus | Uncertain | Paracentesis | Granulomatous lesions, Cryptococcus in macrophages, PAS (+) | Fluconazole for 6 months | No re-examination |
| 13/M/54 | None | None | RUL | Max: 1.1×0.8; around nodule: 0.1–0.5 | 3 | A nodule with clusters of satellite lesions along bronchus, irregular margin, long spicule, air bronchogram | Lung cancer with intrapulmonary metastasis | Operation | A solid region composed of hyperplastic fibrous tissue, granulomatouslesions, organized lesions, Cryptococcus in macrophages, PAS (+), acid fast stain (−) | None | No re-examination |
| 14/F/30 | None | Cough | RML+RIL | Max: 2.1×2.0; around nodule: 0.6–1.0 | 4 | Two masses with clusters of satellite lesions along bronchus, one mass with halo sign, another with lobulation | Infected lesion | Paracentesis | Granulomatous lesions, organized lesions, Cryptococcus in macrophages, PAS (+) | Fluconazole for 10 months | No re-examination |
| 15/M/51 | None | None | LIL | Max: 1.6×1.3; around nodules: 0.1–0.5 | 5 | A nodule with clusters of satellite lesions along bronchus, lobulation, spicule, pleural indentation, blood vessel convergence, calcification | Lung cancer with intrapulmonic metastasis | Operation | Granulomatous lesions with necrosis, Cryptococcus in necrotic tissue PAS (+), acid fast stain (−) | None | No re-examination |
| 16/F/44 | Non-Hodgkin lymphoma | Elevated temperature | LIL | Max:1.3×1.2; around nodule: 0.6–1.0 | 3 | Three masses with clusters of round satellite lesions along bronchus, lobulation in certain instances, irregular margin, cavity, halo sign, blood vessel convergence | Infected lesion | Paracentesis | Granulomatous lesions, organized lesions, Cryptococcus in macrophages, PAS (+) | Fluconazole for 13 months | Significant reduction and disappearance |
| 17/M/50 | None | None | RUL | Max: 2.5×1.6; around nodule: 1.1–1.5 | 8 | A near-pleural mass with clusters of satellite lesions along bronchus, lobulation in certain instances | Infected lesion | Paracentesis | Granulomatous lesions, Cryptococcus in macrophages, foam cells in alveolar space, PAS (+), acid fast stain (−) | Fluconazole for 5 months | No re-examination |
| 18/M/60 | Non-Hodgkin lymphoma | None | RML | Max: 1.7×1.5; around nodule: 0.1–0.5 | 6 | A mass with clusters of round satellite lesions along bronchus, some with lobulation, halo sign, blood vessel convergence | Infected lesion | Operation | Granulomatous lesions with necrosis, Cryptococcus and Candidain necrotic tissue, PAS (+), acid fast stain (−) | None | No re-examination |
| 19/F/27 | None | Chest pain | LIL | Max: 4.6×4.1; around nodule: 2.1–2.5 | 3 | Three near-pleural masses, cavity, lobulation in certain instances | Tuberculosis | Paracentesis | Granulomatous lesions with necrosis, Cryptococcus and Candidain necrotic tissue, PAS (+), acid fast stain (−) | Fluconazole for 9 months | No re-examination |
| 20/F/53 | Thyroid cancer surgery; radioiodine therapy | Cough | RIL+LIL | Max: 2.7×2.5; around nodule: 1.5–2.0 | 7 | Multiple round nodules of unequal size, air bronchogram | Pulmonary metastasis | Paracentesis | Granulomatous lesions, Cryptococcus and Candidain necrotic tissue, PAS (+), acid fast stain (−) | Fluconazole for 12 months | No re-examination |
PAS, periodic acid Schiff stain; CT, computed tomography; M, male; F, female; LUL, left upper lobe; RIL, right inferior lobe; RML, right middle lobe; PET, positron emission tomography; SUV, standardized uptake value.