Histoplasmosis Mimicking Malignant Adenopathy During Diagnostic Thyroid Lobectomy | Endocrine Surgery | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Case Report/Case Series
July 2014

Histoplasmosis Mimicking Malignant Adenopathy During Diagnostic Thyroid Lobectomy

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
Abstract

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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