Cryptococcal Infection of the Larynx Simulating Laryngeal Carcinoma
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Abstract:
Cryptococcus neoformans is an encapsulated yeast that can cause primary pulmonary infections or disseminate and cause infections of the central nervous system, meninges, skin, and bone in the immunocompromised host. We present here an unusual case of an immunocompetent patient who had laryngitis due to C. neoformans that mimicked a laryngeal carcinoma on clinical examination and imaging studies.Keywords:
Meninges
Laryngitis
Cryptococcosis is a subacute or chronic infection caused by the fungus Cryptococcus neoformans (torula histolytica). It most commonly infects the brain and meninges, but all parts of body can be involved. Bone involvement is infrequent.The present study describes a 63-year-old man with pathologic fracture of the clavicle by Cryptococcus neoformans. Amphotericin B wet dressing and 5-FC treatment were administered.
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Objective To study the ultrastructural characteristics of pulmonary cryptococcosis(PC).Methods Tissues obtained from 17 patients with PC were observed by light microscope and electron microscope.Results Microscopically,the cryptococcosis granuloma formation was observed.Vacuolar cryptococcus spore could be seen in plasma of multinuclear giant cell,macrophage and mesenchyma,which stained in red color with PAS and mucicarmine.Electron microscopy revealed that most of cryptococcus neoformans(CN) had a simple structure with a few organelles.The capsule was seen in all organisms.Gemmation of CN could be observed.Conclusion PC is an infrequent fungal disease in lung.The clinical manifestation and imaging of PC are nonspecific.It can be differentiated from other diseases based on histopathological features and ultrastrual observation.
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A series of 76 cases of laryngeal carcinoma was examined in transverse slices using a motorized slicing machine. Eleven cases of ventriculosaccular carcinoma were detected by this method and the topography and gross appearances of the tumours in the larynges are described. Microscopy of the tumour indicates a keratinizing squamous cell carcinoma the mode of growth of which seems to be by concentric expansion through the whole margin rather than by invading tongues of tumour. In no case was there invasion of laryngeal cartilages or extension to the surgical cut surface of the specimen. The clinical, radiological and biopsy features in 10 of the 11 patients are described. In follow-up studies, which were 12 years or longer in five patients, none had lymph node metastases or recurrences of the laryngeal carcinoma of any sort. The following features may suggest the diagnosis of ventriculosaccular carcinoma before laryngectomy: (1) a ventricular tumour, (2)a supraglottic bulge above it, (3)a paraglottic swelling on CT scan radiology covered by a smooth laryngeal lining and (4) biopsy appearances of a well differentiated ‘folded carcinoma’.
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A study on experimental infection of cryptococcosis was carried out through oral, mucosal and subcutaneous inoculations. The results were as follows:
1. Encephalomeningitis was found only in the cases inoculated subcutaneously with mucin in the buccal region. In mice, 7 cases out of 8 (88%) and in rats, 5 cases out of 6 (83%) gave positive results.
2. Among these, meningitis was seen in 6 cases (86%) in mice and in 5 cases (100%) in rats, respectively. In these cases, histopathologic study revealed invasion of Cryptococcus neoformans in the lymphatic spaces of the brain.
3. Among the routes of infection of Cryptococcus neoformans the infection through the lymphatic vessel from the skin lesion of the head or the neck to the meninges proved to be efficient.
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Medical microbiology
Histopathology
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Cryptococcus neoformans is a yeastlike fungus of worldwide distribution that can infect healthy persons as well as those who are chronically ill or immunocompromised [1 ]. The lung, brain, and meninges are the most frequently involved areas in systemic cryptococcosis. Involvement of the eyes is relatively uncommon [2-5]. We report a case of intraocular cryptococcosis shown by sonography and confirmed after enucleation.
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Cryptococcus neoformans is an encapsulated yeast that can cause primary pulmonary infections or disseminate and cause infections of the central nervous system, meninges, skin, and bone in the immunocompromised host. We present here an unusual case of an immunocompetent patient who had laryngitis due to C. neoformans that mimicked a laryngeal carcinoma on clinical examination and imaging studies.
Meninges
Laryngitis
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Abstract The clinical diagnosis of laryngoceles simultaneously occurring with squamous cell carcinoma of the larynx is infrequent; however, when specimens from patients with laryngeal cancer have been examined closely, the two entities have been associated in 4.9% to 28.8% of cases. Despite this apparent relationship, the literature has failed to address the potential impact of a concurrent laryngocele on surgical decision making. Also, the wide variation in the reported rates of simultaneous occurrence of these two entities is unexplained. We performed whole‐organ histo‐pathologic analysis on a laryngeal specimen with bilateral external laryngoceles associated with squamous cell carcinoma and correlated this to computed tomography findings. Based on this information and other reports concerning the pattern of spread of carcinoma within laryngoceles, it appears that su‐praglottic laryngectomy is oncologically sound in the presence of a laryngocele as long as the usual criteria for this procedure are met.
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