P53 Cryptococom as a Differential Diagnosis of Pulmonary Metastase in a Patient with Challenging Adenocarcinoma: Case Report

Abstract

Pulmonary cryptococcosis is a potentially serious fungal disease that may have several clinical presentations. Radiologically, it can be found as single or multiple nodules, thus being able to mimic primary neoplasms of lung or metastasis. It usually presents asymptomatically and is detected by incidental radiological findings. Retrospective case report based on medical record analysis, surgical pathology result and immunohistochemical evaluation. The present report describes the case of a female patient, 42 years old, who presented with rectum adenocarcinoma for 2 years, who had already undergone chemotherapy and radiotherapy, and was considered to have eradicated disease. During control examinations, the presence of pulmonary nodule in the basal segment of the right lower lobe, in the upper left apical segment and in the posterior apex of the left upper lobe, with characteristics of pulmonary metastases, was evidenced in Thoracic Computed Tomography (CT). She was then admitted to the Thoracic Surgery Service of the Oswaldo Cruz University Hospital (HUOC-Recife), and atypical segmentectomy was performed to remove right nodulation. The anatomopathological result of the surgical resection showed cryptococoma, being indicated, together with the Service's pulmonology, the accomplishment of systemic treatment for cryptococcosis, in addition to a new surgical approach for the removal of contralateral cryptococoma. Thus, the differential diagnosis of infectious diseases, even with any scenario conducive to neoplasia, is essential. The benefit of doubt in such cases may not only change prognosis but also add disease-free survival. In this new context, therefore, it is urgent to create a specific treatment standard, either with systemic therapy or alone.