Clinical images: Pulmonary cryptococcoma in a 34-year-old woman

A previously healthy 34-year-old woman from Vancouver, British Columbia was referred for a left upper lobe lung mass. Main differential diagnoses were infection and malignancy. She underwent a bronchoscopy with endobronchial ultrasound-guided biopsy. Analysis of the bronchoscopic specimens revealed Cryptococcus gattii. Further investigations including neuroimaging and lumbar puncture for cerebrospinal fluid analysis excluded central nervous system involvement. Due to the size and proximity of the pulmonary cryptococcoma to the mediastinum, she was treated with Amphotericin and Flucytosine as induction therapy and oral Fluconazole as maintenance therapy. We review the clinical, radiological and pathological features of this disease entity in this report.