The patient underwent bronchoscopy and biopsy of the largest lingular lesion.

Histopathology

MICROSCOPIC APPEARANCE: Sections show fragments of bronchial wall including mucosa, smooth muscle, submucosal glands and cartilage together with adjacent lung parenchyma. In one of the lung fragments, there is an area of necrosis with palisaded fibroblasts and histiocytes at the periphery. In the necrotic material are scattered encapsulated PAS+ yeasts about 5 microns in diameter. The lung parenchyma elsewhere retains normal architecture. Pigment bearing macrophages are present in some air spaces and there is an interstitial infiltrate of lymphocytes, histiocytes and plasma cells.

DIAGNOSIS: Biopsy of lingular of lung: Cryptococcosis.