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━━ Background. In pulmonary cryptococcosis, solitary nodular shadows are sometimes noted in the lung, making it difficult to distinguish from lung cancer. We herein report our recent experience with two cases of pulmonary cryptococcosis in patients in whom a solitary nodular shadow in the lung was observed on a chest Xray film. Cases. In Case 1, an abnormal shadow was detected during a health checkup. In Case 2, a shadow was detected on a chest X-ray film that was taken during an outpatient visit for hypertension. In both cases, chest computed tomography showed no daughter shadows, and the shadows with spiculation and pleural indentation tended to increase in size. Although lung cancer was suspected, the diagnosis was not confirmed by bronchoscopy. Surgical resection was thus performed, and a diagnosis of pulmonary cryptococcosis was established. The patients were treated with azole antifungal drugs for three months after surgery, and no recurrence has been observed to date. Conclusion.We experienced two cases of pulmonary cryptococcosis in which lung cancer was suspected. Surgical resection is considered to be useful for the diagnosis and treatment of cryptococcosis when lung cancer cannot be ruled out based on imaging and bronchoscopic findings. (JJLC. 2015;55:1075-1079) KEY WORDS━━ Pulmonary cryptococcosis, Serum cryptococcal antigen, Lung cancer, Surgical resection Reprints: Masanobu Hayakawa, Department of Thoracic Surgery, Higashiosaka Municipal Hospital, 3-4-5 Nishiiwata, Higashiosakashi, Osaka 578-8588, Japan. Received June 6, 2015; accepted September 14, 2015. 要旨━━背景.肺クリプトコッカス症は肺内に単発の 結節影を呈することがあり,しばしば肺癌との鑑別が問 題になる.最近,孤立性肺結節影を呈した肺クリプトコッ カス症の 2例を経験したので報告する.症例.症例 1は 検診で胸部異常陰影を指摘され,症例 2は高血圧で通院 中に撮影した胸部X線にて指摘された. 胸部CTでは, ともに散布影を認めず,spiculation と胸膜陥入を伴うと ともに増大傾向を示した.肺癌が疑われたが,気管支鏡 検査で診断がつかず,外科的切除を施行し,肺クリプト コッカス症の診断がついた.術後 3か月間アゾール系真 菌薬で治療し,再発を認めていない.結論.肺癌が疑わ れた肺クリプトコッカス症の 2例を経験した.肺クリプ トコッカス症は,肺癌との画像所見上の鑑別が困難なこ とが多い.肺癌が否定できない症例では,診断と治療を 兼ねた外科的切除が有用であると考える. 索引用語━━肺クリプトコッカス症,血清クリプトコッ カス抗原,肺癌,外科的切除

Two Cases of Pulmonary Cryptococcosis Mimicking Lung Cancer