case_images: PMC6334315_01
case_images: Chest X-ray in PA and Profile shows enlargement of the mediastinum (red arrows).
case_images: CRIRA2019-5970648.001.jpg
case_images: PMC6334315_01_CRIRA2019-5970648.001.jpg
case_images: fig1
case_images: He also performed same imaging studies such as chest X-ray (Figure 1), chest computed tomography (Figures 2, 3, and 4), and ultrasonography (Figure 5), which demonstrate mediastinal and left supraclavicular masses, interpreted as lymph node conglomerates of unknown etiology.
case_images: Chest tomography in axial section showing cervical and supraclavicular lymph nodes enlargement on the left. Left mediastinal masses with necrotic appearance (red arrows).
case_images: CRIRA2019-5970648.002.jpg
case_images: PMC6334315_01_CRIRA2019-5970648.002.jpg
case_images: fig2
case_images: He also performed same imaging studies such as chest X-ray (Figure 1), chest computed tomography (Figures 2, 3, and 4), and ultrasonography (Figure 5), which demonstrate mediastinal and left supraclavicular masses, interpreted as lymph node conglomerates of unknown etiology.
case_images: Chest tomography in coronal and sagittal sections demonstrating enlargement of the cervical and supraclavicular lymph node in the left. It also shows mediastinal masses and their extension (red arrows).
case_images: CRIRA2019-5970648.003.jpg
case_images: PMC6334315_01_CRIRA2019-5970648.003.jpg
case_images: fig3
case_images: He also performed same imaging studies such as chest X-ray (Figure 1), chest computed tomography (Figures 2, 3, and 4), and ultrasonography (Figure 5), which demonstrate mediastinal and left supraclavicular masses, interpreted as lymph node conglomerates of unknown etiology.
case_images: Chest tomography in axial, coronal and sagittal sections demonstrating the mediastinal masses and their relations with some mediastinal vessels (white and red arrows).
case_images: CRIRA2019-5970648.004.jpg
case_images: PMC6334315_01_CRIRA2019-5970648.004.jpg
case_images: fig4
case_images: He also performed same imaging studies such as chest X-ray (Figure 1), chest computed tomography (Figures 2, 3, and 4), and ultrasonography (Figure 5), which demonstrate mediastinal and left supraclavicular masses, interpreted as lymph node conglomerates of unknown etiology.
case_images: Ultrasonography of the neck demonstrating the shape and vascularization of left supraclavicular lymphadenopathy. It also demonstrates the puncture/biopsy by fine needle of the nodule (FNAB), highlighted by the yellow arrows.
case_images: CRIRA2019-5970648.005.jpg
case_images: PMC6334315_01_CRIRA2019-5970648.005.jpg
case_images: fig5
case_images: He also performed same imaging studies such as chest X-ray (Figure 1), chest computed tomography (Figures 2, 3, and 4), and ultrasonography (Figure 5), which demonstrate mediastinal and left supraclavicular masses, interpreted as lymph node conglomerates of unknown etiology. He underwent a fine needle aspiration (Figure 5) of the left supraclavicular mass.
case_images: Microscopy slides: (A) Hematoxylin and eosin staining (H & E) observing spherical to oval yeasts with size variability. (B) Granulomas with peripheral fibrosis showing the chronicity of the process. (C) Larger increase in the center of the granuloma by identifying numerous yeasts with thick capsules of mucopolysaccharide giving the characteristic appearance of having a free space around them. (D) FNA of supraclavicular lymph node showing multiple spherical yeast structures. (E) Grocott-methenamine silver (GMS) positive staining highlighting the wall of the fungus. (F) Positive mucicarmine staining by radiating the fungus capsule.
case_images: CRIRA2019-5970648.006.jpg
case_images: PMC6334315_01_CRIRA2019-5970648.006.jpg
case_images: fig6
case_images: Histopathology (Figures 6 and 7) showed a granulomatous inflammation with fungal identification, and immunohistochemistry was positive for Grocott-methenamine silver nitrate and mucicarmine (Figures 6 and 7). Ziehl-Neelsen coloration was negative (Figures 6 and 7).
case_images: Histopathological description.
case_images: CRIRA2019-5970648.007.jpg
case_images: PMC6334315_01_CRIRA2019-5970648.007.jpg
case_images: fig7
case_images: Histopathology (Figures 6 and 7) showed a granulomatous inflammation with fungal identification, and immunohistochemistry was positive for Grocott-methenamine silver nitrate and mucicarmine (Figures 6 and 7). Ziehl-Neelsen coloration was negative (Figures 6 and 7).
case_images: Surgical resection product.
case_images: CRIRA2019-5970648.008.jpg
case_images: PMC6334315_01_CRIRA2019-5970648.008.jpg
case_images: fig8
case_images: The lesion was almost entirely resected (Figures 8 and 9).
case_images: Chest tomography in coronal sections, in the lung and mediastinal windows, demonstrating the area of surgical manipulation and small residual lesion (yellow arrows).
case_images: CRIRA2019-5970648.009.jpg
case_images: PMC6334315_01_CRIRA2019-5970648.009.jpg
case_images: fig9
case_images: The lesion was almost entirely resected (Figures 8 and 9).