PMC5608563_01
Clinical image of the patient obtained via direct laryngoscopy discloses a vegetative and infiltrative lesion at the left true vocal fold. The granular surface with hemorrhagic dots resembles the classic mulberrylike aspect of PCM mucosal lesions.
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Laryngoscopic examination revealed an infiltrative and vegetative lesion with an erythematous aspect at the superior part of the left true vocal fold (Fig. 1). A computed tomography scan of the thorax (Fig. 1B) showed bilateral, multifocal, non-calcified pulmonary nodular opacities and focal areas of ground-glass attenuation, as well as multiple localized round and oval areas containing central ground-glass opacities and ring of consolidation, known as the reversed halo sign (RHS).
(A) Chest x-ray discloses bilateral, interstitial opacities in upper, middle, and basal lung zones, as well as confluent alveolar opacities mainly in basal zones. (B) Computed tomography scan of the thorax shows bilateral, multifocal, non-calcified pulmonary nodular opacities and focal areas of ground-glass attenuation, as well as multiple localized round and oval areas containing central ground-glass opacities and ring of consolidation, known as the reversed halo sign.
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A chest x-ray, which was normal three months earlier, disclosed bilateral, interstitial opacities in upper, middle, and basal lung zones, as well as confluent alveolar opacities mainly in basal zones (Fig. 2A).
Histopathological analyses of the true vocal fold vegetative and infiltrative lesion. A) Hematoxylin and eosin stain (original magnification 40x) discloses a chronic granulomatous inflammatory reaction, with the presence of Langhans giant cells, epithelioid histiocytes, plasmocytes, neutrophils, and eosinophils. Numerous yeast-like elements can be seen inside multinucleated giant cells and histiocytes. A budding element is indicated in the circle. B) Detail of a multinucleated giant cell harboring yeast-like structures (original magnification 100x). C) Grocott's methenamine silver stain (original magnification 40x) unmasks countless darkly-stained yeast-like structures of variable sizes. D) detail of budding structures from mother cells in a pattern of "steering wheel" or "Mickey Mouse" appearance (original magnification 100x).
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Histopathological analyses revealed a chronic, granulomatous inflammation with countless yeast-like elements inside multinucleated giant cells (Fig. 3).