Pulmonary Cryptococcosis Mimicking Lung Metastasis in a Patient with Pancreatic Cancer: A Case Report and Review of the Literature.
Kaho Uesugi, Reiko Yamada, Yoshifumi Nakamura et al.
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Case in brief
A man with pancreatic head cancer, liver metastases, and a germline BRCA2 mutation received FOLFOX chemotherapy. Although the primary tumor responded and CA19-9 levels declined, imaging showed a rapidly enlarging solitary pulmonary nodule, raising concern for lung metastasis. Thoracoscopic partial lung resection established pulmonary cryptococcosis. He received postoperative fluconazole, had no reported recurrence, and resumed systemic chemotherapy.
What made this case unusual
The pulmonary nodule enlarged rapidly despite a favorable response of the pancreatic primary and falling CA19-9 levels, creating a discordant pattern that proved to be infection rather than metastasis.
Diagnostic / clinical pearl
When a solitary lung nodule behaves discordantly from the known cancer during treatment, histopathological confirmation may be needed to distinguish metastasis from pulmonary cryptococcosis.