PMC8113984_01
Upper left: CT of the chest showing the mass in left upper lobe. Upper right: Core biopsy shows a sheetlike histiocytic proliferation with abundant eosinophilic foamy cytoplasm and eccentric nuclei. Scattered collections of neutrophlic infiltrates around the histiocytes are present. These features are consistent with malakoplakia. No evidence of Michaelis-Gutmann bodies is identified. Lower left: PAS stain with diastase performed on the core biopsy shows the cytoplasms of the histiocytes is packed with PAS positive organisms (400X). Lower right: GMS stain performed on the core biopsy show scattered intracytoplasmic small organisms, some have diploid cocobacilli appearance (400x).
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African-American male with type 2 diabetes mellitus (A1C 7.6 %), hypertension, end stage renal disease requiring kidney transplant from a living donor 9 years prior presented with night sweats, decreased appetite, and weight loss for six months. A left upper lobe mass (8.1 x 7.4 x 8.5 cm) was found on computed tomography (CT) of the chest (Fig. 1). Histoplasma were negative, as well as the Cryptococcus serum antigen. He later underwent a CT-guided biopsy of the lung mass, with histopathology revealing organisms suggestive of Histoplasma within histiocytes (Fig. 1, lower left). Histopathology of lung tissue and lymph node showed necrotizing granulomatous inflammation and organisms on PAS and GMS suggestive of Histoplasma (Fig. 1, lower left and lower right).