PMC6174268_01
Thoracic computed tomography showed a neoplasm in the basal segment bronchi of right lower lobe. A: Parenchymal window. B: Mediastinal window. C: Coronal section.
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A chest CT scan showed a lesion in the basal segment of the right lower lobe bronchus, which was initially considered as secretion or space occupying lesion by radiologist (Fig. 1).
Bronchoscopic examination. A: Bronchoscopic examination revealed a white smooth-surfaced polypoid lesion completely occluding the medial basal segment of the right lower lobe bronchus. B: The endobronchial lesion diminished after 18 days of treatment with oral fluconazole. C: The endobronchial lesion disappeared after 6.5 months of treatment with oral fluconazole.
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It showed a white polypoid lesion completely occluding the medial basal segment of the right lower lobe bronchus. (Fig. 2A). After 18 days, a repeated fiberoptic bronchoscopy demonstrated that the endobronchial lesion in the basal segment of right lower lobe bronchus had diminished significantly (Fig. 2B). The endobronchial lesion was found disappeared completely remaining a narrow medial basal segment bronchus (Fig. 2C).
Histopathological examination of the endobronchial biopsy after fiberoptic bronchoscopy. A: Histopathological examination of the endobronchial biopsy specimen showed dense accumulation of the histiocytes and yeast-form fungi that did not uptake the Hematoxylin and Eosin(H&E) staining (H&E staining, 400x). B: These organisms were positive for Periodic Acid-Schiff stain (PAS, 400x) consistent with cryptococcosis (arrows).
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Notably, these organisms were positive for Periodic Acid-Schiff staining, that was consistent with cryptococcosis (Fig. 3).
Repeated thoracic computed tomography respectively after 3, 6, 9, 12 and 14 months of treatment, showing disappearance of the previous lesion in the basal segment bronchi of right lower lobe. A: CT scan after 3 month. B: CT scan after 6 months. C: CT scan after 9 months. D: CT scan after 12 months. E: CT scan after 14 months. a: Parenchymal window. b: Mediastinal window. c: Coronal section.
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During the 16 months' follow-up visits, the patient underwent repeated CT scanning for five times, respectively after 3, 6, 9, 12 and 14 months of therapy, and all the results were normal without any lesion in the previous lesion site (Fig. 4).