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

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

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