PMC4290366_01
Figs. 1-A through 1-D The magnetic resonance images of the left shoulder depict the fluid-filled histoplasmosis lesion (X) that is confluent with the joint and attenuating the deltoid muscle. It tracks along the anterior surface of the subscapularis muscle medial to the conjoint tendon and measures 12 cm in its greatest dimension. There is a smaller extension of the lesion posterior to the humeral head (H) between the deltoid muscle and the rotator cuff. Fig. 1-A T2-weighted fat-suppression sagittal oblique image. Fig. 1-B T2-weighted fat-suppression axial image. Fig. 1-C T1-weighted sagittal oblique image. Fig. 1-D T1-weighted axial image. Ant = anterior and Post = posterior.
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F1
The long head of the biceps tendon was completely torn, and there was circumferential labral tearing and degeneration (Figs. 1-A through 1-D).
Hematoxylin and eosin staining (200x magnification) of tissue highlighting the necrotizing granulomatous inflammation.
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F2
Pathologic examination of the permanent section revealed necrotizing granulomatous inflammation (Fig. 2); therefore, additional microbiologic staining and cultures were performed.
GMS staining (50x magnification) of tissue highlighting yeast forms that are morphologically consistent with H. capsulatum.
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F3
Gram staining revealed 1 + PMN cells, but no organisms. Gomori methenamine silver (GMS) staining revealed numerous yeast forms that are morphologically consistent with Histoplasma species (Fig. 3).