title: Clinicopathological features of pulmonary cryptococcosis with cryptococcal titan cells: a comparative analysis of 27 cases.
abstract: In addition to the typical size, Cryptococcus neoformans can enlarge its size to form titan cells during infection, and its diameter can reach up to 100 μm. Clinical reports about cryptococcal titan cells are rare. Most studies focus on aspects of animal models of infection with titan cells. Herein, we report the clinical and imaging characteristics and histopathologic features of 3 patients with titan cells and 27 patients with pathogens of typical size, and describe the morphological characteristics of titan cells in details. Histologically, 3 patients with titan cells show necrosis, fibrosis and macrophage accumulation. The titan cells appear in necrotic tissue and between macrophages, and have thick wall with unstained halo around them and diameters range from 20 to 80 μm with characteristic of narrow-necked single budding. There are also organisms with typical size. All 27 patients with normal pathogens show epithelioid granulomatous lesions. There is no significantly difference in clinical and imaging feature between the two groups. Cryptococcus neoformans exhibits a striking morphological change for the formation of titan cells during pulmonary infection, which will result in misdiagnosis and under diagnosis. The histopathological changes may be new manifestation, which need to be further confirmed by the study with animal models of infection and the observation of more clinical cases. Careful observation of the tissue sections is necessary.
authors.affiliation: Department of Pathology, Affiliated Drum Tower Hospital of Nanjing University Medical School Nanjing, Jiangsu, China ; Department of Medical Genetics, Jiangsu Key Laboratory of Molecular Medicine, Nanjing University Medical School Nanjing, China.
authors.forename: Jing-Mei
authors.initials: JM
authors.lastname: Wang
authors.affiliation: Department of Pathology, Affiliated Drum Tower Hospital of Nanjing University Medical School Nanjing, Jiangsu, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Zhou
authors.affiliation: Department of Respiratory Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School Nanjing, Jiangsu, China.
authors.forename: Hou-Rong
authors.initials: HR
authors.lastname: Cai
authors.affiliation: Department of Respiratory Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School Nanjing, Jiangsu, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhuang
authors.affiliation: Department of Pathology, Affiliated Drum Tower Hospital of Nanjing University Medical School Nanjing, Jiangsu, China.
authors.forename: Yi-Fen
authors.initials: YF
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Affiliated Drum Tower Hospital of Nanjing University Medical School Nanjing, Jiangsu, China.
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: Xin
authors.affiliation: Department of Pathology, Affiliated Drum Tower Hospital of Nanjing University Medical School Nanjing, Jiangsu, China.
authors.forename: Fan-Qing
authors.initials: FQ
authors.lastname: Meng
authors.affiliation: Department of Medical Genetics, Jiangsu Key Laboratory of Molecular Medicine, Nanjing University Medical School Nanjing, China.
authors.forename: Ya-Ping
authors.initials: YP
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D003453:Cryptococcosis / Q000382:microbiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000382:microbiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged
keywords: Cryptococcus neoformans; cryptococcosis; histopathology; pulmonary infection; titan cells