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Khaitan N, Booth CN, Hoda RS. Cokeromyces recurvatus: A rare fungus in the Pap test of an asymptomatic woman. Diagn Cytopathol 2021; 49:894-895. [PMID: 34003605 DOI: 10.1002/dc.24758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Neha Khaitan
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christine N Booth
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Raza S Hoda
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
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2
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Sharma N, Schwartzman JD, Gutmann EJ, Marotti JD, Liu X. Cokeromyces recurvatus in a Papanicolaou test: An exceedingly rare finding that can be mistaken for Paracoccidioides brasiliensis. Cytojournal 2018. [PMID: 29531572 PMCID: PMC5840961 DOI: 10.4103/cytojournal.cytojournal_35_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Cokeromyces recurvatus is a zygomycetes yeast form that is very rarely detected in Papanicolaou (Pap) tests, in which it typically represents an innocuous colonizer. Its morphology closely resembles that of the better known Paracoccidioides brasiliensis, which can disseminate widely and cause clinically significant disease. We present a case of C. recurvatus detected in a cervical liquid-based preparation obtained from a 38-year old healthy woman. Careful cytomorphologic evaluation, in combination with culture and molecular techniques, was utilized to make a diagnosis and prevent the misdiagnosis of P. brasiliensis.
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Affiliation(s)
- Ninu Sharma
- Address: Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | | | | | | | - Xiaoying Liu
- Address: Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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Garza-Guajardo R, Canales-Martínez LC, Rodríguez-Sánchez IP, Sánchez-Chaparro MM, Gómez-Macías GS, Vilches-Cisneros N, Barboza-Quintana O. Aspergillus in liquid-based cervicovaginal cytology in a postmenopausal patient: A case report. Biomed Rep 2017; 7:306-308. [PMID: 29085626 DOI: 10.3892/br.2017.974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 02/16/2017] [Indexed: 11/06/2022] Open
Abstract
Aspergillus is an opportunistic fungus present in humid environments, whose natural environment is in soil, hay and compost. It is a frequent contaminant in the clinical laboratory. Because of this, the fungus is often inhaled, affecting those with an underlying pulmonary disease or immune deficiency. Fungal genitourinary tract infections are relatively common. A rare Aspergillus spp cervical infection diagnosed via liquid-based cytology is presented in the current study. The 57-year-old woman attended her annual check-up without any relevant medical history. The result of a gynecological examination by Papanicolaou smear was normal and routine liquid-based cytology was performed. The specimen exhibited fungal organisms characterized by septate hyphae branching at acute angles, most consistent with the Aspergillus species. Subsequent cytology demonstrated the same results. Antifungal treatment was initiated and a second post-treatment smear only exhibited atrophy. The cytomorphological features of Aspergillus spp. are discussed in the current study and a brief review of the few reported cases of a primary cervical infection in the literature is provided. In addition, the liquid-based cytology was established as a tool to diagnose the rare Aspergillus infection.
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Affiliation(s)
- Raquel Garza-Guajardo
- Department of Pathological Anatomy and Cytopathology, Universidad Autonoma de Nuevo Leon, Hospital Universitario 'Dr José Eleuterio González', Monterrey, Nuevo León 64460, Mexico
| | - Luis Carlos Canales-Martínez
- Department of Pathological Anatomy and Cytopathology, Universidad Autonoma de Nuevo Leon, Hospital Universitario 'Dr José Eleuterio González', Monterrey, Nuevo León 64460, Mexico
| | - Irám Pablo Rodríguez-Sánchez
- Department of Genetics, Universidad Autonoma de Nuevo Leon, College of Medicine, Monterrey, Nuevo León 64460, Mexico
| | - María Marisela Sánchez-Chaparro
- Laboratory of Immunology and Virology, Universidad Autonoma de Nuevo Leon, College of Biological Sciences, San Nicolás de los Garza, Nuevo León 66450, Mexico
| | - Gabriela Sofía Gómez-Macías
- Department of Pathological Anatomy and Cytopathology, Universidad Autonoma de Nuevo Leon, Hospital Universitario 'Dr José Eleuterio González', Monterrey, Nuevo León 64460, Mexico
| | - Natalia Vilches-Cisneros
- Department of Pathological Anatomy and Cytopathology, Universidad Autonoma de Nuevo Leon, Hospital Universitario 'Dr José Eleuterio González', Monterrey, Nuevo León 64460, Mexico
| | - Oralia Barboza-Quintana
- Department of Pathological Anatomy and Cytopathology, Universidad Autonoma de Nuevo Leon, Hospital Universitario 'Dr José Eleuterio González', Monterrey, Nuevo León 64460, Mexico
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4
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Barizzi J, Merlo E, Grassi P, Togni B, Bruderer V, Müller F, Fulciniti F. Vaginal colonisation by Mucor circinelloides. Case report with cytopathology, molecular sequencing and epidemiology. Cytopathology 2016; 27:491-494. [PMID: 27000466 DOI: 10.1111/cyt.12327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J Barizzi
- Laboratorio di Citopatologia Clinica, Istituto Cantonale di Patologia, Locarno, Switzerland
| | - E Merlo
- Laboratorio di Citopatologia Clinica, Istituto Cantonale di Patologia, Locarno, Switzerland
| | - P Grassi
- Laboratorio di Citopatologia Clinica, Istituto Cantonale di Patologia, Locarno, Switzerland
| | - B Togni
- Laboratorio di Citopatologia Clinica, Istituto Cantonale di Patologia, Locarno, Switzerland
| | - V Bruderer
- Institut für Medizinische Mikrobiologie, Universität Zürich, Zürich, Switzerland
| | - F Müller
- Institut für Medizinische Mikrobiologie, Universität Zürich, Zürich, Switzerland
| | - F Fulciniti
- Laboratorio di Citopatologia Clinica, Istituto Cantonale di Patologia, Locarno, Switzerland
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Odronic SI, Scheidemantel T, Tuohy MJ, Chute D, Procop GW, Booth CN. Two Cases of Cokeromyces recurvatus in Liquid-Based Papanicolaou Tests and a Review of the Literature. Arch Pathol Lab Med 2012. [DOI: 10.5858/arpa.2011-0493-cr] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present 2 cases of Cokeromyces recurvatus in routine, liquid-based Papanicolaou tests (ThinPrep). Patient 1 is a healthy, asymptomatic, 26-year-old woman with no pertinent past medical history. Patient 2 is a healthy, asymptomatic, 47-year-old woman with no pertinent past medical history. The Papanicolaou tests from both patients showed many fungal-like elements as globose, yeastlike forms measuring 10 to 30 µm in diameter with multiple, narrowly attached apparent “daughter” buds. This morphology was consistent with Paracoccidioides brasiliensis. However, broad-range fungal polymerase chain reaction and deoxyribonucleic acid sequence analysis performed with GenBank Basic Local Alignment Search Tool showed an exact match for C recurvatus. Our cases highlight the importance of molecular techniques to prevent misdiagnosis of C recurvatus as P brasiliensis, based on morphology alone. There have been 8 previously published cases of C recurvatus infection in humans, 3 of which were reported in the female genital tract.
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Affiliation(s)
- Shelley I. Odronic
- From the Cleveland Clinic, Pathology and Laboratory Medicine Institute, Cleveland, Ohio
| | - Thomas Scheidemantel
- From the Cleveland Clinic, Pathology and Laboratory Medicine Institute, Cleveland, Ohio
| | - Marion J. Tuohy
- From the Cleveland Clinic, Pathology and Laboratory Medicine Institute, Cleveland, Ohio
| | - Deborah Chute
- From the Cleveland Clinic, Pathology and Laboratory Medicine Institute, Cleveland, Ohio
| | - Gary W. Procop
- From the Cleveland Clinic, Pathology and Laboratory Medicine Institute, Cleveland, Ohio
| | - Christine N. Booth
- From the Cleveland Clinic, Pathology and Laboratory Medicine Institute, Cleveland, Ohio
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Khalbuss WE, Michelow P, Benedict C, Monaco SE, Pantanowitz L. Cytomorphology of unusual infectious entities in the Pap test. Cytojournal 2012; 9:15. [PMID: 22919422 PMCID: PMC3424702 DOI: 10.4103/1742-6413.97763] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 05/04/2012] [Indexed: 11/25/2022] Open
Abstract
Rare entities in the Pap test, including neoplastic and non-neoplastic conditions, pose challenges due to their infrequent occurrence in the daily practice of cytology. Furthermore, these conditions give rise to important diagnostic pitfalls. Infections such as tuberculosis cervicitis may be erroneously diagnosed as carcinoma, whereas others, such as schistosomiasis, are associated with squamous cell carcinoma. These cases include granuloma inguinale (donovanosis), tuberculosis, coccidioidomycosis, schistosomiasis, taeniasis, and molluscum contagiosum diagnosed in Pap tests. Granuloma inguinale shows histiocytes that contain intracytoplasmic bacteria (Donovan bodies). Tuberculosis is characterized by necrotizing granulomatous inflammation with Langhans-multinucleated giant cells. Coccidioidomycosis may show large intact or ruptured fungal spherules associated with endospores. Schistosoma haematobium is diagnosed by finding characteristic ova with a terminal spine. Molluscum contagiosum is characterized by the appearance of squamous cells with molluscum bodies. This article reviews the cytomorphology of selected rare infections and focuses on their cytomorphology, differential diagnosis, and role of ancillary diagnostic studies.
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Affiliation(s)
- Walid E Khalbuss
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Dias PHGF, Zeni M, Taques GR, Romero FR, Bueno FHT, Rocha LCA. Genitourinary paracoccidioidomycosis complicated with urinary outflow obstruction-a report of two cases and a review of the literature. Clinics (Sao Paulo) 2010; 65:1207-10. [PMID: 21243297 PMCID: PMC2999720 DOI: 10.1590/s1807-59322010001100025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Deb P, Srivastava A. Aspergillus in a cervico-vaginal smear of an adult postmenopausal female: An unusual case. J Cytol 2009; 26:123-4. [PMID: 21938172 PMCID: PMC3168015 DOI: 10.4103/0970-9371.59401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
There are several case reports documenting opportunistic fungal infection in the female genital tract, withr Aspergillus spp being a rarely reported causative organism. We hereby report a case of Aspergillus infection in a 48 year-old, postmenopausal female with carcinoma of the cervix. She presented with features of pelvic inflammatory disease, and an initial routine cervico-vaginal smear revealed severe inflammation along with fungal bodies. The features were consistent with the presence of Aspergillus spp, while the background epithelial cells were negative for intraepithelial malignancy. She was offered therapy for pelvic inflammatory disease. A repeat Papanicolaou smear after two weeks was negative for intraepithelial organisms, but showed the evidence of a high-grade squamous intraepithelial lesion, with biopsy confirming squamous cell carcinoma.
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Affiliation(s)
- Prabal Deb
- Department of Pathology, Armed Forces Medical College, Pune, India
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Lionakis MS, Samonis G, Kontoyiannis DP. Endocrine and metabolic manifestations of invasive fungal infections and systemic antifungal treatment. Mayo Clin Proc 2008; 83:1046-60. [PMID: 18775205 DOI: 10.4065/83.9.1046] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Systemic fungal infections are increasingly reported in immunocompromised patients with hematological malignancies, recipients of bone marrow and solid organ allografts, and patients with AIDS. Mycoses may infiltrate endocrine organs and adversely affect their function or produce metabolic complications, such as hypopituitarism, hyperthyroidism or hypothyroidism, pancreatitis, hypoadrenalism, hypogonadism, hypernatremia or hyponatremia, and hypercalcemia. Antifungal agents used for prophylaxis and/or treatment of mycoses also have adverse endocrine and metabolic effects, including hypoadrenalism, hypogonadism, hypoglycemia, dyslipidemia, hypernatremia, hypocalcemia, hyperphosphatemia, hyperkalemia or hypokalemia, and hypomagnesemia. Herein, we review how mycoses and conventional systemic antifungal treatment can affect the endocrine system and cause metabolic abnormalities. If clinicians are equipped with better knowledge of the endocrine and metabolic complications of fungal infections and antifungal therapy, they can more readily recognize them and favorably affect outcome.
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Affiliation(s)
- Michail S Lionakis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA
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Alsharif M, Martin AU, Shelton JB, Pambuccian SE. Paracoccidioides brasiliensisin a liquid‐based Papanicolaou test from a pregnant woman: Report of a case. Diagn Cytopathol 2008; 36:557-60. [DOI: 10.1002/dc.20847] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Hitchcock T, Avant C, Colello C, Hoda RS. Chaetomium fungal elements in a conventional vaginal smear. Diagn Cytopathol 2007; 35:376-8. [PMID: 17497666 DOI: 10.1002/dc.20644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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