PMC8473730_01
Timeline. Timeline displaying symptoms and diagnostic assessments on the left side of the figure. The right side displays diagnosis and therapeutic management of cancer (in blue) and infectious diseases (in orange). CF, Complement fixation; CT, computed tomography; PCR, polymerase chain reaction; WBC, white blood cell count.
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F1
At the time of initial evaluation at our center in February 2019, she was noted to have a 4.6 x 4.7 cm recurrent vs. residual focus of disease between the left internal oblique and left transversus abdominus muscles for which the patient remains in observation (Figure 1).
Computed tomography images of disseminated coccidioidomycosis lesions. Computed tomography images show: an axial sclerotic bone lesion in December 2020 (A) and after 4 months of fluconazole treatment in April 2021 (B), the chest wall mass in December 2020 (C) and in April 2021 (D) and a right lower lobe lung nodule in December 2020 (E) and in April 2021 (F).
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F2
Follow-up CT imaging demonstrated new bilateral pulmonary nodules, a 4.8 x 2.7 cm right anterior chest mass extending from the pectoralis major muscle into the costochondral junction of the right third rib, areas of sclerotic foci in axial bones and a slow progression of the known left abdominal wall recurrent vs. residual liposarcoma measuring 5.5 x 5.1 cm (Figures 2A,C,E). CT imaging showed decrease in lung nodules and chest wall mass which now measured 3.2 x 1.3 cm (Figures 2D,F). The sclerotic bony lesions were unchanged (Figure 2B).
Histologic images of chest wall mass biopsy. Hematoxylin & Eosin stained microscopic sections show a diffuse granulomatous inflammation with areas of necrosis (A, 100x, black arrow pointing to necrosis). Rare intact organisms on are consistent with immature spherules of Coccidioides immitis (A, inset, 400x, red arrow pointing to organism). Grocott's methenamine silver stain highlights scattered spherical structures suggestive of yeast forms (B, 400x, red arrow pointing to organism).
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F3
The pathological examination found no evidence of malignant cells but revealed granulomatous inflammation with necrosis and rare spherical structures highlighted by Grocott's Methenamine Silver stain suggestive of fungal organisms (Figures 3A,B).