Pulmonary vascular malformation complicating cryptococcal pneumonia in an immunocompetent patient.
An immunocompetent 50-year-old male presented with slight cough and occasional lung congestion. The radiologic findings included diffuse, bilateral reticular and one nodular opacity at the upper lobe of right lung without clear margin. A wedge resection of the lesion showed disordered distribution of the medium-sized vessels and arterioles, several arterioles densely gathered including a few occlusive arterioles, or medium veins dilated with irregular and elongated cavity, indicating the existence of vascular malformation. Interestingly, near to the malformed vessels, a large area of necrosis with granulomatous inflammation was found. Of note, numerous intracytoplasmic organisms with a nucleus, a wall and a thick capsule, were free in the alveoli or located within the macrophages and polykaryocytes, suggesting cryptococci infection. This is to our best knowledge the first case showing concurrent vascular malformation and local pulmonary cryptococcosis, and vascular malformation was likely an important pathological predisposing factor for local pulmonary cryptococcosis infection.
Department of Pathology, Tongji Hospital, Tongji University Graduate School of Medicine Shanghai 200065, China.
Fang
F
Liu
The Operating Room, Central Hospital of Shanghai Zhabei District Shanghai 200070, China.
Hanzhang
H
Chen
Department of Pathology, Tongji Hospital, Tongji University Graduate School of Medicine Shanghai 200065, China.
Hailong
H
Zhu
Department of Pathology, Tongji Hospital, Tongji University Graduate School of Medicine Shanghai 200065, China.
Shuai
S
Li
Department of Pathology, Tongji Hospital, Tongji University Graduate School of Medicine Shanghai 200065, China.
Pan
P
Gu
Department of Hematology, Tongji Hospital, Tongji University Graduate School of Medicine Shanghai 200065, China.
Xia
X
Fang
Department of Pathology, Tongji Hospital, Tongji University Graduate School of Medicine Shanghai 200065, China.
Yunjin
Y
Wu
Department of Pathology, Tongji Hospital, Tongji University Graduate School of Medicine Shanghai 200065, China.
Suxia
S
Zhang
Department of Pathology, University Medical Center of Princeton at Plainsboro Plainsboro, NJ, USA ; Department of Pathology, Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey New Brunswick, NJ, 08536 USA.
Lanjing
L
Zhang
Department of Pathology, Tongji Hospital, Tongji University Graduate School of Medicine Shanghai 200065, China.
Xianghua
X
Yi
D003453:Cryptococcosis / Q000150:complications*; D006801:Humans; D008168:Lung / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000382:microbiology*; D054079:Vascular Malformations / Q000473:pathology*
Pulmonary cryptococci; vascular malformation