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Indian Journal of Medical and Paediatric Oncology
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IMAGES IN ONCOLOGY
Year : 2019  |  Volume : 40  |  Issue : 3  |  Page : 432-433  

A man with pulmonary and bilateral adrenal lesions


1 Department of Radiodiagnosis, Shri Balaji Diagnostic Centre, Kota, Rajasthan, India
2 Department of Paediatrics, Government Medical College, Kota, Rajasthan, India
3 Department of Medical Oncology, Cancer Research Centre, Kota, Rajasthan, India

Date of Submission12-Nov-2019
Date of Acceptance18-Nov-2019
Date of Web Publication04-Dec-2019

Correspondence Address:
Hemant Dadhich
Department of Medical Oncology, Cancer Research Centre, Kota, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmpo.ijmpo_231_19

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How to cite this article:
Rawat LK, Khandelwal S, Dadhich H. A man with pulmonary and bilateral adrenal lesions. Indian J Med Paediatr Oncol 2019;40:432-3

How to cite this URL:
Rawat LK, Khandelwal S, Dadhich H. A man with pulmonary and bilateral adrenal lesions. Indian J Med Paediatr Oncol [serial online] 2019 [cited 2020 Jan 28];40:432-3. Available from: http://www.ijmpo.org/text.asp?2019/40/3/432/272251



A 65-year-old male, smoker presented with complaints of dry cough, chest pain, and low-grade fever for the last 3 months in the pulmonary department. Multifocal dense consolidations involving bilateral lungs fields were discovered on simple chest X-rays [Figure 1]. His vital signs on admission were normal and laboratory results were white blood cells 5400/mm3, hemoglobin 15.2 g/dL, hematocrit 39.2%, platelet 188 k/mm3, and erythrocyte sedimentation rate 5 mm/h. A serology test and culture for mycoplasma and tuberculosis were all negative. Chest and abdomen computed tomography showed multifocal dense consolidations involving bilateral lungs with perihilar predominance and hypodense bilateral adrenal masses [Figure 2]. Bronchoscopic findings were nonspecific.
Figure 1: Chest X-ray posteroanterior view

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Figure 2: Chest and abdomen computed tomography

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  What Is the Diagnosis? Top


  1. Carcinoma lung with Mets
  2. Infective causes.



  Answer Top


• Histoplasmosis.

Fine needle aspiration cytology from both lung and adrenal glands showed uniform round-to-ovoid budding yeast surrounded by clear ring of space are seen intracellularly (in macrophages) as well as extracellularly. Background also shows chronic inflammatory cells. On periodic acid schiff (PAS) staining [Figure 3] and hematoxylin and eosin (H and E) staining [Figure 4], numerous capsulated yeasts such as fungal organism with budding were evident morphologically Histoplasma species.
Figure 3: H and E, ×20

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Figure 4: PAS, ×40

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.




    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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