Pulmonary cryptococcosis coexisting with lung cancer: a Chinese multicenter retrospective study

Pulmonary cryptococcosis (PC) can appear as nodules or masses on chest imaging, resembling lung cancer. Multiple nodules may be misdiagnosed as metastatic cancer, whereas solitary nodules may be mistaken for lung cancer and removed surgically. Reports of PC coexisting with lung cancer are rare, mostly limited to case reports. This retrospective case series study screened 46 cases of nodular PC coexisting with lung cancer from 22 tertiary hospitals across China to explore the potential imaging manifestations and clinical characteristics of this patient population.

A total of 4,763 cases of PC were identified from the pathology systems of multiple hospitals. A further search for keywords such as "cancer" or "malignancy" from the above cases identified 70 cases that met the conditions simultaneously. The exclusion of cases that did not meet the screening criteria resulted in the final screening of 46 cases.

We observed four types of imaging manifestations of nodular PC coexisting with lung cancer-type I: solitary nodule (n=6), type II: ground-glass nodules + solid nodules (n=14), type III: multiple nodules (≥2) (n=18), and type IV: new nodules after lung cancer surgery (n=8). Most of the cases were coexisting with lung adenocarcinoma, had an insidious onset, and lacked typical clinical symptoms. The most common presenting symptoms included cough (15/46 cases, 32.6%), sputum production (8/46, 17.4%), and fever (3/46, 6.5%), whereas hemoptysis (1/46, 2.2%) and chest pain (2/46, 4.3%) were less frequent. Laboratory tests showed no significant differences in white blood cells (WBC, P=0.316), liver function (P=0.851), and serum creatinine (Scr, P=0.086) between the 2 based on the presence or absence of underlying diseases.

Multiple pulmonary nodules should raise suspicion for PC alongside lung cancer, not just metastasis. New nodules after lung cancer surgery may indicate PC rather than recurrence.