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The Korean Journal of Pathology 2003;37(3): 193-198.
Isolated Pulmonary Cryptococcosis: Report of Six Cases and Review of the Korean Cases.
Na Rae Kim, Seung Yeon Ha, Dong Hae Chung, Joungho Han, Kyung Soo Lee, O Jung Kwon, Kwan Min Kim
1Department of Pathology, Gachon Medical School Gil Medical Center, Incheon, Korea.
2Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jhhan@smc.samsung.co.kr
3Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
4Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
5Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
ABSTRACT
BACKGROUND: Isolated pulmonary cryptococcosis is uncommon, and it can be seen in both immunocompetent and immunocompromised individuals. In Korea, twenty cases have been described thus far. METHODS: We report six additional cases of isolated pulmonary cryptococcosis, which were diagnosed by surgical biopsies or fine needle aspiration cytology. We also reviewed the clinicoradiologic and pathologic findings of all the previously published Korean cases of isolated pulmonary cryptococcosis. RESULTS: Only two patients out of six cases exhibited mild cough and/or fever. Radiologically, three cases presented with multiple subpleural nodules, two with a solitary pulmonary nodule, and one with patchy pneumonic infiltration. On systemic steroid therapy, one case was in severe immunocompromised status at the time of the diagnoses; but three cases had histories of gastric or uterine cervix carcinomas, raising the initial clinical impression of hematogeneous pulmonary metastatic nodules, and one case was accompanied by synchronous pulmonary adenocarcinoma. After reviewing all twenty-six cases of isolated pulmonary cryptococcosis (twenty reported in Korea and our six additional cases), the most common radiologic finding was solitary pulmonary nodule (50%), followed by subpleurally located, multiple nodules (26.9%), pneumonic infiltrates (19.2%), and pleural effusion with thickened pleura (3.8%). Two cases were also accompanied by hilar lymphadenopathy (7.7%). Clinically, presenting symptoms varied: 18 of 26 cases (69.2%) were accompanied by cough and mild fever, but 8 of 26 cases (30.8%) were entirely asymptomatic. CONCLUSIONS: Since isolated pulmonary cryptococcosis presents itself with nonspecific clinicoradiologic findings, early recognition and differentiation from malignant tumors and pulmonary tuberculosis -the most common causes of solitary pulmonary nodules in Korea- are important to avoiding unnecessary treatment.