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Related Experiment Videos

Cryptococcal inflammatory pseudotumors.

Yetish Sing1, Pratistadevi K Ramdial

  • 1Department of Anatomical Pathology, Nelson R Mandela School of Medicine, University of KwaZulu Natal and National Health Laboratory Service, Durban, KwaZulu Natal, South Africa.

The American Journal of Surgical Pathology
|September 27, 2007
PubMed
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This study identifies five cases of cryptococcal inflammatory pseudotumors (IPTs) in HIV-positive patients. These rare fungal masses highlight the need to investigate IPTs for infectious agents like Cryptococcus neoformans.

Area of Science:

  • Pathology
  • Mycology
  • Infectious Diseases

Background:

  • Inflammatory pseudotumors (IPTs) are a diverse group of conditions presenting as a mass with spindle cell proliferation and inflammation.
  • While various microorganisms can cause infective IPTs, mycobacterial infections are most frequently reported.
  • Cryptococcal infections, particularly in immunocompromised individuals, can manifest in unusual ways beyond typical presentations.

Purpose of the Study:

  • To document and characterize previously unreported cases of solitary cryptococcal inflammatory pseudotumors (IPTs).
  • To investigate the immunophenotype of spindle cells within these lesions.
  • To explore the potential pathogenetic mechanisms driving pseudotumoral reactions to Cryptococcus neoformans.

Main Methods:

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  • Retrospective analysis of five patient cases diagnosed with solitary cryptococcal IPTs.
  • Histopathological examination of tissue specimens, including routine and special stains, to identify Cryptococcus neoformans.
  • Immunophenotyping of spindle cells to determine their lineage (histiocytic, myofibroblastic).

    • Main Results:

    • Five cases of solitary cryptococcal IPTs were identified in the soft tissues of HIV-positive patients previously treated for disseminated cryptococcosis.
    • Histology revealed spindle cell proliferation with inflammatory background, lymphocytes, plasma cells, fibrosis, giant cells, and necrosis.
    • Cryptococcus neoformans yeasts were confirmed within vacuolated spindle and polygonal cells; immunophenotyping showed a mixed histiocytic and myofibroblastic lineage.

    Conclusions:

    • This study reports the first five cases of pseudotumoral spindle cell reactions to Cryptococcus neoformans, termed cryptococcal IPTs.
    • It emphasizes the critical need for thorough investigation of all IPTs for infectious etiologies using appropriate stains and diagnostic methods.
    • A complex interplay between the host's immune response, the fungus, and potentially incomplete antifungal therapy may drive this pseudotumoral presentation.