Isolated Pulmonary Cryptococcosis - Report of Six Cases and Review of the Korean Cases -
김나래, 하승연, 정동해, 한정호, 이경수, 권오정, 김관민,
소속 상세정보
김나래 ( Kim Na-Rae )
가천의대 길병원 병리과
하승연 ( Ha Seung-Yeon )
가천의대 길병원 병리과
정동해 ( Chung Dong-Hae )
가천의대 길병원 병리과
한정호 ( Han Joung-Ho )
성균관대학교 의과대학 삼성서울병원 병리과
이경수 ( Lee Kyung-Soo )
성균관대학교 의과대학 삼성서울병원 방사선과
권오정 ( Kwon O-Jung )
성균관대학교 의과대학 삼성서울병원 내과학교실
김관민 ( Kim Kwan-Min )
성균관대학교 의과대학 삼성서울병원 흉부외과
KMID : 0357920030370030193
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.
Conclusion: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.
키워드
Cryptococcus neoformans;Coin Lesion;Pulmonary;Tuberculosis;Korea
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