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Hiroaki Kawamoto, Norihiro Teramoto, Tsuyoshi Ueno, Hiroshi Suehisa, S ...
2015 Volume 29 Issue 1 Pages
15-19
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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The patient was a 60-year-old male. Six years after thoracoscopic lung biopsy (right upper lung) for organizing pneumonia, an abnormal shadow was identified in the right upper lung on radiograph. Computed tomography (CT) of the chest revealed part-solid ground-glass nodules of 25 mm in the right S
1; however, no clear swelling of the lymph nodes was observed. On a diagnosis of right lung cancer, a right superior lobe resection and ND2a lymph node dissection were performed. Pathological examination revealed that the tumor in the superior lobe was well-differentiated adenocarcinoma; however, large cell carcinoma was observed in the 4
th mediastinal lymph node. Follow-up was conducted on the suspicion of synchronous double Stage IA, pT1N0M0 well-differentiated pulmonary adenocarcinoma and mediastinal lymph node large cell carcinoma of unknown origin. After 10 years of follow-up with no recurrence, a tumor suggestive of left superior lobe lung cancer appeared. On conducting left superior lobe resection, the tumor was histologically found to be pleomorphic carcinoma. The right superior lobe adenocarcinoma and left superior lobe pleomorphic carcinoma were considered unlikely to be the primary lesion of the mediastinal lymph node carcinoma of unknown primary origin. Mediastinal lymph node carcinoma of unknown primary origin is rare, and when incidentally discovered during surgery for lung cancer, the primary lesion may be hidden in the resected lung. If the primary lesion cannot be identified in spite of careful pathological examination, close follow-up is necessary.
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Takayuki Imakiire, Satoshi Makihata, Satoshi Yoneda, Shinichi Yamashit ...
2015 Volume 29 Issue 1 Pages
20-24
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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Ganglioneuroma involving the posterior mediastinum is rare. We report two resected cases of ganglioneuroma. Case 1: A 40-year-old female presented with epigastralgia. Chest CT showed a 6×5×11-cm spindle-shaped tumor in the left paravertebral area. We resected it under video-assisted thoracoscopic surgery. Case 2: A 16-year-old female was found to have an abnormality on a chest radiograph. CT showed a large 10×12×17-cm mass in the right paravertebral area. MRI showed a whorled appearance. We resected it by open thoracotomy. Ganglioneuroma was diagnosed histopathologically.
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Masaki Ikeda, Koji Takahashi, Teruya Komatsu, Tatsuo Kato, Takuji Fuji ...
2015 Volume 29 Issue 1 Pages
25-30
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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We report a 79-year-old man who was diagnosed with multiple metastases of occult primary cancer presenting as thin-walled cavities detected during pneumothorax. The first onset of the left pneumothorax was in July and the second onset was in September 20xx. Computed tomography during the second pneumothorax revealed multiple lung cysts, which were considered to represent pulmonary emphysema. However, the multiple pulmonary cavitary lesions were also suspected to be malignant tumors and several tumor markers were examined. The cytokeratin 19 fragment (CYFRA), which is a tumor marker, was at a high level. While an additional examination was being considered, the patient experienced a third left pneumothorax one month after the second pneumothorax. At that time, the patient was referred to our hospital for close examination and treatment. Pneumothorax was treated by drainage and autologous pleurodesis. F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) showed strong FDG accumulation in the right neck lymph node and low accumulation in a right faucial tonsil, both lungs, and the prostate. Thoracoscopic left lung biopsy and right neck lymph node biopsy were performed, and pathological examination revealed squamous cell carcinoma in both tissues. The cancer was unlikely to be head and neck cancer or prostate cancer according to close inspection. We decided to treat the patient with chemotherapy and radiotherapy of the cervical lymph node as an occult primary squamous cell carcinoma. He is currently alive and being treated for cancer 17 months after the diagnosis.
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Atsushi Fujiwara, Norihito Okumura, Akihiko Yamashina, Takashi Nakashi ...
2015 Volume 29 Issue 1 Pages
31-36
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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We report three cases of pulmonary actinomycosis involving surgical resection. Case 1: An 87-year-old man presented complaining of bloody phlegm. Chest computed tomography revealed a 20-mm mass in the right middle lobe. Based on a suspected diagnosis of primary lung cancer, right middle lobe resection was performed, with a subsequent diagnosis of pulmonary actinomycosis. Case 2: A 73-year-old female undergoing follow-up for atypical mycobacterial disease was admitted with hemorrhagic shock resulting from massive hemoptysis. Bronchoscopic specimen culture was positive for pulmonary actinomycosis. To control hemoptysis, left basal segmentectomy was carried out. Case 3: A 65-year-old man presented complaining of bloody phlegm and back pain. Chest computed tomography revealed a 30-mm mass in the left upper lobe. Based on a suspected diagnosis of primary lung cancer, left upper superior segment resection was undertaken, with a subsequent diagnosis of pulmonary actinomycosis. In all three cases, there has been no recurrence of symptoms. Pulmonary actinomycosis is uncommon, and diagnosis difficult. Misdiagnosis as primary lung cancer is common, and the correct diagnosis is often obtained by pathological analysis following resection. Based on our results, physicians should consider resection in pulmonary actinomycosis patients who present with bloody phlegm, to lower the risk of hemoptysis.
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Masahiko Takata, Yoshifumi Miyamoto
2015 Volume 29 Issue 1 Pages
37-41
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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A 20-year old male was referred from another institution with a complaint of severe left-sided chest pain and an abnormal shadow on a chest roentgenogram. Chest computed tomography revealed a 2-cm, horn-like mass, which showed bone density, arising from the left fifth rib, and an abnormal soft tissue shadow at the pericardial pleura that expanded from the peak of the mass. Video-assisted thoracoscopic surgery revealed a bony, spiculated mass at the anterior portion of the fifth rib and thickening of the visceral and pericardial pleura opposite the mass. A mini-thoracotomy (2 cm) was performed through the fifth intercostal space just above the mass, which was subsequently resected using a Luer bone rongeur. A biopsy sample was obtained from the thickened pericardial pleura. Histopathological examination of the resected specimen confirmed osteochondroma. Pleural thickening was consistent with a reactive change that occurred in response to chronic stimulation by the mass. The left-sided chest pain disappeared shortly after surgery.
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Yoshimasa Tokunaga, Masaya Okuda, Toshihiro Ikeda, Kouichi Ito, Ayumu ...
2015 Volume 29 Issue 1 Pages
42-45
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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A 65-year-old man complained of hemosputum and was examined at a nearby hospital. Chest CT revealed a flat-shaped mass shadow in the right upper lobe, and trans-bronchoscopic biopsy failed to diagnose it. He was referred to our hospital for further examinations and one-year follow-up, which revealed the existence of a mass shadow with partial shrinkage. To diagnose and treat the patient, a right upper lobectomy by video-assisted thoracic surgery was performed due to the central lobar location of the mass.
Scedosporium apiospermum, a filamentous fungus like aspergilli, was detected in the mass but there was no malignant tissue. Unlike pulmonary aspergillosis, scedosporial infection is likely to disseminate on surgical resection, and so voriconazole was administered for two months as adjuvant chemotherapy.
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Taiki Hoshino, Masatoshi Yoshizawa, Hisao Ishida, Masayoshi Kuwabara
2015 Volume 29 Issue 1 Pages
46-50
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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The patient was a 74-year-old female who had frequently suffered from pneumonia, hemoptysis, and cough after food ingestion for forty years. She had been diagnosed with congenital bronchoesophageal fistula and referred to our hospital for surgery. The fistula was between the lower portion of the esophagus and right lower lobe of the lung. The right lower lobe was destroyed because of repeated pneumonia. She refused blood transfusion on religious grounds. To avoid massive bleeding and the need for blood transfusion, the operation was performed through a left-sided mini-thoracotomy, and the fistula was freed easily from neighboring tissue, such as the esophagus, lung, and left lower pulmonary vein, and divided by GIA without freeing the adhesion of the right thorax. The post-operative course has been satisfactory, with no recurrence of cough, hemoptysis, or pneumonia since the operation.
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Toshiteru Tokunaga, Hidenori Kunou, Daisuke Ishida, Takashi Kanou, Jir ...
2015 Volume 29 Issue 1 Pages
51-55
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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A 43-year-old woman had suffered from cough and hemosputum for a year, and was hospitalized because of dyspnea. Chest computed tomography showed a tumor shadow in the trachea. Bronchoscopic examination revealed a peduncular tumor at the same site. It was diagnosed as a fibroepithelial polyp based on transbronchial biopsy findings. She was referred to our hospital for treatment. Brochoscopic resection using Nd:YAG laser was performed, and the postoperative course was uneventful. Her respiratory symptoms resolved postoperatively.
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Hirotsugu Notsuda, Akira Sakurada, Hiromichi Niikawa, Chiaki Endo, Yos ...
2015 Volume 29 Issue 1 Pages
56-61
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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A 62-year old woman underwent liver transplantation for hepatocellular carcinoma secondary to hepatitis C virus cirrhosis. Five years after the operation, chest computed tomography showed a small nodule in a right middle lobe of the lung, and she was followed up. Two years later, the nodule developed to 37 mm in diameter. Transbronchial lung biopsy of the tumor revealed lung adenocarcinoma. The clinical stage was estimated as IB (cT2aN0M0). After another 2 months, right middle lobectomy and systemic nodal dissection were performed. Pathologically, there was metastasis in the same lobe of the lung, and pleural lavage cytology was also positive. Therefore, the pathological stage was IIIA (pT3N2M0). Postoperative combination chemotherapy of Cisplatin and Vinorelbine was performed. However, one year after the initial operation, recurrence and metastasis occurred. After 4
th-line chemotherapy, palliative care was chosen. The incidence of
de novo malignancy after organ transplantation has been reported to be 3-4 times higher than that in the general population. Careful follow-up for early detection and treatment is important for transplant patients.
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Toshiki Takemoto, Hiroshi Mizuuchi, Katsuaki Sato, Kenichi Suda, Takuy ...
2015 Volume 29 Issue 1 Pages
62-66
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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A 71-year-old woman presented with an abnormal chest shadow on routine chest radiograph. Contrast enhanced chest computed tomography (CT) showed a heterogeneous mass in the anterior mediastinum with invasion to the right lung, pericardium, and superior vena cava (SVC). Positron emission tomography-CT showed high FDG accumulation (SUVmax: 13.51). Under a diagnosis of invasive thymoma or thymic carcinoma, the patient underwent tumor resection with combined resection of the right upper lobe of the lung, pericardium, phrenic nerve, and SVC. The tumor was white and solid at the cut surface. Histopathologically, the tumor was diagnosed as large-cell neuroendocrine carcinoma of the thymus. Twelve months later, mediastinal lymph node and multiple liver metastases developed. The patient was treated with combination chemotherapy consisting of carboplatin and etoposide for 4 cycles, leading to a partial response. However, multiple bone metastases were newly diagnosed.
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Hiroki Ebana, Masatoshi Kurihara, Hideyuki Kataoka, Teruaki Mizobuchi
2015 Volume 29 Issue 1 Pages
67-72
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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The patient was a 63-year-old male. He was diagnosed with Langerhans cell histiocytosis (LCH) on CT examination in 2000. He underwent video assisted thoracoscopic surgery (VATS) for right pneumothorax in 2003. The pathological diagnosis was malignant melanoma of the lung. There was no other malignant melanoma noted on whole-body examinations, and so he was diagnosed with primary malignant melanoma of the lung. He thoracoscopically underwent both partial resection and pleural covering method with a regenerated oxidized cellulose mesh for left intractable pneumothorax in 2004. Regarding histopathological findings, the malignant melanoma cells invaded a thickened visceral pleura created by the covering. However, the malignant cells in the other covered areas had been contained below the thickened pleura. The pleural covering method was effective for pneumothorax due to invasive malignant cells. However, he subsequently died of brain metastasis in 2007.
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Tsugumasa Kamata, Hiroyuki Sakurai, Kazuo Nakagawa, Shun-ichi Watanabe ...
2015 Volume 29 Issue 1 Pages
73-77
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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Case 1: A 53-year-old male had undergone colectomy for descending colon cancer and subsequently received systemic chemotherapy for multiple liver metastases. The patient was found to have bilateral pulmonary nodules during follow-up. Spherical nodules were found in the right upper lobe and left upper lobe on CT, and they were suspected to be metastatic lung tumors. He underwent partial resection of the right upper lobe, and the nodule was revealed to be an intrapulmonary hematoma. He had a past history of chronic atrial fibrillation, and received the administration of Warfarin. Case 2: A 67-year-old male was referred to our hospital for the evaluation of an abnormal shadow on a regular check-up. He had a past history of valve replacement, and received the administration of Warfarin. A spherical mass was found in the left lower lobe on CT, and it was suspected to be a benign lung tumor or metastatic lung tumor. A CT-guided needle biopsy of the lesion showed intrapulmonary hematoma. Chest radiograph performed 4 months later showed obscuration of the mass. Intrapulmonary hematoma in patients lacking a history of chest trauma is very rare.
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Takatoshi Fujishita, Kenichi Suda, Mikihiro Kono, Tsukihisa Yoshida, T ...
2015 Volume 29 Issue 1 Pages
78-83
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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A 62-year-old woman was diagnosed with right lung adenocarcinoma. In addition, CT revealed 22 - and 9 -mm nodules in the anterior mediastinum and suprasternal fossa, respectively. The mediastinal tumor had a high SUV-max value, and the signal pattern on MRI suggested that the tumor originated from the thymus. All tumor markers were within normal limits, including soluble IL2-R. Right upper lobectomy and mediastinal tumor resection were performed. The final pathological examination revealed that both the mediastinal tumor and a nodule in the suprasternal fossa were diffuse large B-cell lymphoma. Malignant lymphoma cannot be ruled out irrespective of the signal pattern on MRI.
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Toshio Nishikawa, Masahiko Takahashi, Masanobu Mori, Yasuaki Kamikawa, ...
2015 Volume 29 Issue 1 Pages
84-88
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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A 71-year-old woman with a previous history of bronchiectasis and nontuberculous mycobacteriosis consulted for fever and left chest pain in June 2013. We diagnosed her with pneumothorax with a severe inflammatory reaction. Chest CT after drainage showed a shadow, considered to be a bronchial fistula of a collapsed nodule, in the left S6 that had been identified previously. She showed no improvement, and so we performed surgery. The air leakage caused by the nodule in the left S6 was detected, and we performed left S6 segmentectomy. The specimen showed a nodule with a fistula of 2.5×1.7 cm. Microscopic findings showed nodules with central necrosis surrounded by epithelioid cells and Langhans giant cells.
Mycobacterium abscessus was detected in the culture of the pre- and intraoperative effusion. Surgery is an important treatment method for secondary pneumothorax due to pulmonary nontuberculous mycobacteriosis.
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Kentaro Fukuta, Koichi Tanaka, Toshiro Tanioka, Hideki Yamagami
2015 Volume 29 Issue 1 Pages
89-94
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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The patient was a 52-year-old woman previously diagnosed with rectal carcinoma. In June 2001, she underwent low anterior resection and partial resection of the liver simultaneously at another hospital. In September 2004, she received rectal amputation due to local recurrence in the pelvis. In 2008, an abnormal shadow in the left pulmonary artery (A
1+2c) was identified on chest computed tomography. Since this was considered to be a benign vascular lesion, no further examination was conducted, and she had been conservatively followed-up. However, the size of the lesion continued to increase gradually. In April 2013, the lesion was still confined inside the pulmonary artery, but its size had increased to 4.5 cm. As a result, she consulted our department. We reviewed the patient's previous chest computed tomography findings at the previous hospital, and found that the small shadow had been present since October 2005. We then performed positron emission tomography, and the lesion showed the accumulation of FDG (SUV max=17.1). Since the lesion was suspected to be malignant, we performed left upper lobectomy in June 2013. Histopathological examination revealed that the intravascular lesion was a metastasis from rectal carcinoma. The tumor tissue was found to exist only inside the pulmonary artery, and the vascular wall had been partially invaded.
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Shinsuke Uchida, Kazuya Takamochi, Yoshitaka Kitamura, Tomoaki Kinno, ...
2015 Volume 29 Issue 1 Pages
95-100
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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The patient was a 23-year-old man. An abnormal chest shadow was detected in the mediastinum on radiograph. Contrast-enhanced chest computed tomography showed a large mass of approximately 8 cm in diameter in the middle mediastinum. The hypervascular mass compressed the bilateral main pulmonary arteries, pulmonary veins, and bilateral main bronchi. Transbronchial and surgical biopsy of the tumor revealed no findings of malignancy. Therefore, the patient underwent surgery for a definite diagnosis and treatment. Preoperative embolization of the bronchial artery was performed on the day before surgery because bleeding from the tumor during the initial surgical biopsy was difficult to control. We performed the operation through a left thoracotomy. Firstly, we dissected severe adhesions between the tumor and left main pulmonary artery and main bronchus. Thereafter, we performed complete resection of the tumor by dissecting the remaining adhesions between the tumor and surrounding organs. Preoperative embolization resulted in reduction of the amount of bleeding during surgery. The final histological diagnosis was Castleman disease (hyaline vascular type).
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Kumiko Yoshida, Eisuke Matsuda, Toshiki Tanaka, Hiroyuki Tao, Tatsuro ...
2015 Volume 29 Issue 1 Pages
101-105
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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We report 2 cases of idiopathic azygos vein aneurysm resected by thoracoscopic surgery. In case 1, a man in his 50s without any symptom, the enlargement of a right hilar mass was pointed out in a chest radiograph. Contrast-enhanced computed tomography (CT) and three-dimensional CT showed aneurysmal change of the azygos vein in the azygos arch, without a thrombus. Thoracoscopic resection of the aneurysm was performed using an endostapler. In case 2, a woman in her 70s with lung cancer, an azygos vein aneurysm was revealed during thoracoscopic lobectomy and mediastinal lymph node dissection. The aneurysm, located in the azygos arch, was resected using an endostapler. No postoperative complication was observed in either case. Idiopathic azygos vein aneurysm is rare. Although there is no unified treatment, surgical resection is generally selected to prevent thrombosis and rupture of the aneurysm. Three-dimensional CT is useful to confirm the location, shape, and relation of the surrounding structures, which easily facilitate decision-making regarding the operative procedure. Thoracoscopic resection is possible if the aneurysm is located in the azygos arch and sufficiently distant from the superior vena cava.
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Masahiko Takahashi, Kenji Takahashi, Yuuji Hirami, Toshio Nishikawa, M ...
2015 Volume 29 Issue 1 Pages
106-111
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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Background. The incidence of true pulmonary carcinosarcoma is about 0.1~0.3% of all malignant lung tumors, and it has a tendency to occur in heavy smokers and elderly men. Preoperative diagnosis is very difficult, and there is no established method of treatment. The tumor sizes of true pulmonary carcinosarcoma are generally large and the prognosis is poor. Case. A 54-year-old man was admitted to our hospital because of hemoptysis. Chest radiograph and CT showed a mass of 9.5 cm in diameter in the left lower lobe. A transbronchial lung biopsy did not lead to a definitive diagnosis. However, because the tumor was growing rapidly, we performed surgery. The postoperative pathologic diagnosis was pulmonary carcinosarcoma with adenocarcinoma and chondrosarcoma. Now, at 7 years postoperatively, he is alive without recurrence. Conclusion. We treated a patient with true pulmonary carcinosarcoma, who achieved long-term survival.
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Takuya Fukazawa, Ichiro Morita, Niro Okimoto, Hiromichi Yamane, Yasuma ...
2015 Volume 29 Issue 1 Pages
112-117
Published: January 15, 2015
Released on J-STAGE: January 30, 2015
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A 29-year old man consulted his primary care physician because of cough and fever, and was referred to our hospital for further investigation of an abnormal chest shadow. He was suspected of having aspergillosis in his right S10 segment. Anti-microbial agents were not effective, and right lower lobectomy was performed. Fungi of
Aspergillus were found in the bronchus in pulmonary segment S9 of the right lower lobe, and the patient was pathologically diagnosed with chronic necrotizing aspergillosis. We present a resected case of chronic necrotizing aspergillosis with a clinical course of repeated spontaneous recovery and relapse, with a review of the literature.
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