cytopathology conference 10/20/05 - case 5
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Cytopathology Conference 10/20/05 - Case 5TRANSCRIPT
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Cytopathology Conference
10/20/2005
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Case 5
FNA from a 1.5 cm left lung mass in a 61-year-old male.
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Differential Diagnosis
• Histoplasmosis
• Coccidiodes
• Blastomycosis
• Cryptococcus
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Diagnosis?
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Coccidioides immitis
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Coccidioides immitis
• Dimorphic fungus: filamentous, mycelia form and spherule form in tissues
• Coccidomycosis, a.k.a. Valley Fever or San Joaquin Valley fever
• Inhalation of arthrospores from the soil
• Endemic in Southwest
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Coccidioides immitis
• 60% of primary infections are asymptomatic
• Remaining 40% usually recover form a flu-like illness (cough, fever, pleuritic chest pain)
• Dissemination more likely in Filipino, African American, Mexican and American Indian races.
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Coccidioides immitis
• Diagnosis:
– Chest x-ray: hilar adenopathy, cavitations
– IgM precipitins present after 4 weeks of symptoms; complement fixing IgG antibodies appear later.
– Complement fixations titer > 1:16 or 1:32 is consistent with extrapulmonary dissemination
• Rx: – Amphotericin B, Ketaconazole