Diagnosis of adrenal histoplasmosis by fine needle aspiration cytology: an analysis based on five cases

Clinical and Morphological Spectrum of Histoplasmosis on Cytology Along with the Review of Literature

OBJECTIVE

The aim of the study was to study the clinical and morphological spectrum of histoplasmosis diagnosed by fine needle aspiration cytology (FNAC).

STUDY DESIGN

A total of 17 patients diagnosed with histoplasmosis on FNAC were studied over a period of 5 years. The cytology smears were studied and analysed for the cytomorphological spectrum of histoplasmosis.

RESULTS

Among the 17 patients studied, the mean age was 51.3 years (range 6-84 years). Male-to-female ratio was 3.25:1 with 4 females and 13 males. The frequent sites of involvement were the lung (5), lymph node (4), adrenal gland (4), and skin (4). The most common cytological patterns were histiocytic collection, followed by granulomas and multinucleated giant cells. Necrosis was noted in only 4 cases.

CONCLUSION

Fine needle aspiration is a highly accurate, rapid, and cheap technique for the diagnosis of histoplasmosis due to its distinct morphological features.

Bilateral adrenal histoplasmosis in an immunocompetent man from Texas

Disseminated histoplasmosis affecting the adrenal gland(s) of immunocompetent adults is a very rare infection. Here, we present a case of bilateral adrenal histoplasmosis in an immunocompetent, 62-year-old gentleman from Texas along with a brief review of the published literature. Given the risk of patient decompensation secondary to adrenal insufficiency and the wide availability of effective treatments, adrenal histoplasmosis must be considered even in immunocompetent adults who acquire adrenal masses.

Cytodiagnosis of disseminated histoplasmosis in an immunocompetent individual with molluscum contagiosum-like skin lesions and lymphadenopathy

Disseminated histoplasmosis is caused by the dimorphic fungus Histoplasma capsulatum (H. capsulatum). The early clinical manifestations are nonspecific, often lead to diagnostic difficulty, and is misdiagnosed as tuberculosis and seen usually in immunosuppressed states. Fine needle aspiration cytology (FNAC) is a simple, safe, and quick technique to establish the initial diagnosis of H. capsulatum, thereby prompting early treatment. The skin involvement is rare in disseminated disease and we describe a case of disseminated histoplasmosis in an immunocompetent patient with unusual molluscum contagiosum like umbilicated skin lesions and FNAC of the cervical lymph node was the only tool for rapid and early confirmatory diagnosis.