PAT3 Diagnosis of cryptococcus by fine needle aspiration biopsy. (Pathology).

PAT3 DIAGNOSIS OF CRYPTOCOCCUS BY FINE NEEDLE ASPIRATION BIOPSY Naiel A. Hafez, MD, and Richard B. Bowlin, BA. Department of Pathology, University of Mississippi Medical Center, Jackson.

Opportunistic fungal infection is a major cause of morbidity and mortality in immunocompromised patients. These infections occur primarily in acquired immunodeficiency syndrome, post-chemotherapy, and immunosuppressive treatment after organ or bone marrow transplantation. We describe two cases of cryptococcal abscesses that were diagnosed by fine needle aspiration biopsy, that were clinically considered to be malignant, presented to the University Medical Center of Mississippi. The patient in Case 1 was a 39-year-old female, HIV positive, who was presented to the hospital with left hip pain. Plain x-ray of the pelvis revealed a 4.5 cm lytic lesion in the left superior iliac crest. The patient in Case 2 was a 41-year-old male who was diagnosed with AIDS. He was presented to the hospital with intractable cough and persistent chest pain. CT scan of the chest demonstrated a 4.0 cm mass in the lower lobe of the left lung. CT and fluoroscopy-guided fine needle aspiration was performed. Smears stained with Diff-Quik , cytospins, and cell block sections were examined. Special stains for fungus were performed which included mucicarmine, methenamine silver (GMS), Alcian blue, and periodic acid schiff (PAS). Budding yeast forms of fungi morphologically were consistent with Cryptococcus. Fungal cultures confirmed the diagnosis of cryptococcus neoformans. Fine-needle aspiration biopsy is an excellent diagnostic tool for prompt identification of Cryptococcus. Since cryptococcal abscesses may clinically mimic malignant neoplasm, FNA biopsy can serve as a rapid and non-invasive diagnostic modality.