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Case Report/Case Series |

Histoplasmosis Mimicking Malignant Adenopathy During Diagnostic Thyroid Lobectomy

Paul N. Frank, BS1; Miguel Fernando Palma Diaz, MD2; Daniel Z. Uslan, MD3; Michael W. Yeh, MD1
[+] Author Affiliations
1Section of Endocrine Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles
2Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles
3Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
JAMA Otolaryngol Head Neck Surg. 2014;140(7):664-666. doi:10.1001/jamaoto.2014.806.
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Importance  Benign granulomatous disease may mimic malignant disease in the evaluation of mediastinal or pulmonary lesions. However, histoplasmosis as a cause of cervical lymphadenopathy is relatively rare. We report the first case of Histoplasma infection mimicking malignant adenopathy discovered during diagnostic thyroid lobectomy.

Observations  A 2.5-cm, calcified, right paratracheal lymph node intimately involving the recurrent laryngeal nerve was discovered during lobectomy for a follicular lesion of undetermined significance with a positive NRAS mutation. Although metastatic thyroid cancer was the most probable diagnosis, results of gross inspection of the bisected thyroid nodule suggested a benign process. Partial removal of the node, sparing the nerve, established the diagnosis of Histoplasma capsulatum infection.

Conclusions and Relevance  Histoplasmosis is a rare cause of cervical adenopathy that should be considered in cases in which a discordance arises between the malignant gross appearance of the adenopathy and the benign gross appearance of an associated thyroid nodule.

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Figures

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Figure 1.
Yeast Forms

Grocott-Gomori methenamine-silver nitrate stain shows yeast forms consistent with Histoplasma capsulatum (original magnification ×40).

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Figure 2.
Calcified Lymph Node

Low-power hematoxylin-eosin–stained image shows heavy calcification of the resected lymph node (original magnification ×10).

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Figure 3.
Calcifications on Chest Radiography

Posterior-anterior chest radiograph shows diffuse mediastinal and pulmonary calcifications compatible with old granulomatous disease.

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