[Pathological diagnosis and ultrastructure features of primary pulmonary cryptococcosis: a study of 27 cases].
OBJECTIVE
To investigate diagnostic histopathology and ultrastructure features of primary pulmonary cryptococcosis (PC).


METHODS
Clinical data and pathologic findings of 27 cases of PC were retrospectively reviewed, light and electron microscopic evaluations and histochemistry stain studies were performed.


RESULTS
The specimens consisted of 2 fine-needle aspiration lung biopsies and 25 cases of open lung biopsies. Cryptococcosis granuloma formation was identifiable by histopathological examination in 25 of 27 cases, with gum-like lesion and fungi in the remaining 2 cases. The detection rates of cryptococcus neoformans (CN) by mucicarmine (MC), periodic acid-Schiff (PAS), alcian blue (AB) and Grocott methenamine-silver (GMS) were 87.0% (20/23), 100% (27/27), 66.7% (18/27), and 100% (23/23) respectively. Under the electron microscope, most CN had a simple structure with a few organelles. The capsule was seen in all organisms. A percentage of the organisms showed nuclei, nucleoli, mitochondria and vacuoles. The detection rate of CN by EM was 91.7% (11/12).


CONCLUSIONS
The clinical manifestation and imaging of PC are nonspecific for PC. Lung biopsy is the major diagnostic modality. The detection rate by electron microscopy was quite high. Therefore, a correct diagnosis of pulmonary cyrptococcosis should rely on the combination of histopathological evaluation, histochemistry staining and/or electron microscopic examination.
Yi
Xiang-hua
XH
Department of Pathology, Shanghai Pulmonary Hospital, Shanghai 200433, China. yixhxf@yahoo.com.cn
Kong
Jie
J
Zhu
Mei-fang
MF
Zhang
Yun
Y
Chen
Xiao-feng
XF
Zhong
Ci-sheng
CS
D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D003453:Cryptococcosis / Q000382:microbiology / Q000473:pathology*; D003455:Cryptococcus neoformans / Q000302:isolation & purification* / Q000648:ultrastructure; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000473:pathology / Q000648:ultrastructure*; D008172:Lung Diseases, Fungal / Q000145:classification / Q000382:microbiology / Q000473:pathology*; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D012189:Retrospective Studies