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Cytopathology Conference 10/20/05 - Case 5
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Cytopathology Conference 10/20/05 - Case 5

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Cytopathology Conference 10/20/05 - Case 5

Cytopathology Conference 10/20/05 - Case 5

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  • 1. Cytopathology Conference 10/20/2005
  • 2. Case 5 FNA from a 1.5 cm left lung mass in a 61-year-old male.
  • 3.  
  • 4.  
  • 5.  
  • 6.  
  • 7.  
  • 8. Differential Diagnosis
    • Histoplasmosis
    • Coccidiodes
    • Blastomycosis
    • Cryptococcus
  • 9. Diagnosis?
  • 10. Coccidioides immitis
  • 11. Coccidioides immitis
    • Dimorphic fungus: filamentous, mycelia form and spherule form in tissues
    • Coccidomycosis, a.k.a. Valley Fever or San Joaquin Valley fever
    • Inhalation of arthrospores from the soil
    • Endemic in Southwest
  • 12.  
  • 13.  
  • 14. Coccidioides immitis
    • 60% of primary infections are asymptomatic
    • Remaining 40% usually recover form a flu-like illness (cough, fever, pleuritic chest pain)
    • Dissemination more likely in Filipino, African American, Mexican and American Indian races.
  • 15. Coccidioides immitis
    • Diagnosis:
      • Chest x-ray: hilar adenopathy, cavitations
      • IgM precipitins present after 4 weeks of symptoms; complement fixing IgG antibodies appear later.
      • Complement fixations titer > 1:16 or 1:32 is consistent with extrapulmonary dissemination
    • Rx:
      • Amphotericin B, Ketaconazole