Cytopathology Conference 10/20/2005

Case 5 FNA from a 1.5 cm left lung mass in a 61-year-old male.

Differential Diagnosis Histoplasmosis Coccidiodes Blastomycosis Cryptococcus

Histoplasmosis

Coccidiodes

Blastomycosis

Cryptococcus

Diagnosis?

Coccidioides immitis

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

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

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.

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.

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

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