title: Histoplasmosis mimicking malignant adenopathy during diagnostic thyroid lobectomy.
abstract: OBJECTIVE
  Benign granulomatous disease may mimic malignant disease in the evaluation of mediastinal or pulmonary lesions. However, histoplasmosis as a cause of cervical lymphadenopathy is relatively rare. We report the first case of Histoplasma infection mimicking malignant adenopathy discovered during diagnostic thyroid lobectomy.
  
  
  METHODS
  A 2.5-cm, calcified, right paratracheal lymph node intimately involving the recurrent laryngeal nerve was discovered during lobectomy for a follicular lesion of undetermined significance with a positive NRAS mutation. Although metastatic thyroid cancer was the most probable diagnosis, results of gross inspection of the bisected thyroid nodule suggested a benign process. Partial removal of the node, sparing the nerve, established the diagnosis of Histoplasma capsulatum infection.
  
  
  CONCLUSIONS
  Histoplasmosis is a rare cause of cervical adenopathy that should be considered in cases in which a discordance arises between the malignant gross appearance of the adenopathy and the benign gross appearance of an associated thyroid nodule.
authors.affiliation: Section of Endocrine Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Frank
authors.affiliation: Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles.
authors.forename: Miguel Fernando
authors.initials: MF
authors.lastname: Palma Diaz
authors.affiliation: Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles.
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Uslan
authors.affiliation: Section of Endocrine Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Yeh
mesh_terms: D003937:Diagnosis, Differential; D006660:Histoplasmosis / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007432:Intraoperative Period; D008206:Lymphatic Diseases / Q000175:diagnosis* / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012009:Recurrent Laryngeal Nerve; D016606:Thyroid Nodule / Q000601:surgery; D013965:Thyroidectomy