A. Ayoub

Métastase ovarienne d’un carcinome bronchique

INTRODUCTION The ovary, being a richly vascular organ, may receive metastases from numerous tissues, particularly of gynecologic origin. Extragenital cancers are dominated by gastro-intestinal and breast tumors. The lung is exceptionally described as a primary site of ovarian metastasis. CASE REPORT We report a 28-year-old woman who was found to have a right perihilar opacity. The diagnosis of small cell bronchial carcinoma was made by bronchial biopsy. A right-sided uterine mass was also identified. This was resected and histopathology identified it as an ovarian metastasis from the pulmonary tumor. CONCLUSION We report, through this case, and present a review of the literature on ovarian metastasis originating from bronchopulmonary neoplasms.

Carcinome à petites cellules du poumon et syndrome néphrotique d’évolution rapidement fatale

Nephrotic syndrome due to membranous glomerulonephritis is observed in 1 to 3% of patients with lung cancer. The nephrotic syndrome usually precedes the discovery of the causal tumor, but diagnosis can be concomitant or during the disease course. We describe a case of small-cell carcinoma of the lung without metastases revealed by a paraneoplastic nephrotic syndrome. Complete remission of the tumor was achieved with chemotherapy and radiotherapy with resolution of the nephrotic syndrome, but tumor progression occurred together with rapidly fatal renal failure. In this case, and the review of the literature, illustrate the association between paraneoplastic nephrotic syndrome and lung cancer, as well as the disease course and prognosis of the lung cancer and the accompanying glomerulopathy.Nephrotic syndrome due to membranous glomerulonephritis is observed in 1 to 3% of patients with lung cancer. The nephrotic syndrome usually precedes the discovery of the causal tumor, but diagnosis can be concomitant or during the disease course. We describe a case of small-cell carcinoma of the lung without metastases revealed by a paraneoplastic nephrotic syndrome. Complete remission of the tumor was achieved with chemotherapy and radiotherapy with resolution of the nephrotic syndrome, but tumor progression occurred together with rapidly fatal renal failure. In this case, and the review of the literature, illustrate the association between paraneoplastic nephrotic syndrome and lung cancer, as well as the disease course and prognosis of the lung cancer and the accompanying glomerulopathy.

Une fibrose pulmonaire révélant une granulomatose de Wegener

Resume Introduction La presence d’une fibrose pulmonaire satellite aux vascularites associees aux anticorps anticytoplasme des polynucleaires neutrophiles est rarement observee. La plupart des cas decrits sont survenus avec la polyangeite microscopique. Observation Nous rapportons l’observation d’un patient âge de 82 ans se presentant pour fibrose pulmonaire avec a la tomodensitometrie thoracique des images en rayon de miel et des bronchectasies de traction a predominance peripherique et basale. Le diagnostic de granulomatose de Wegener a ete etabli devant la positivite des anticorps anticytoplasme des polynucleaires neutrophiles, les anomalies du sediment urinaire et les donnees de la biopsie renale. Conclusion Nous insistons, a travers cette observation, sur la rarete de la fibrose interstitielle comme manifestation pulmonaire de vascularite et nous discutons la pathogenie de cette association.

Une localisation rare de plasmocytome solitaire

INTRODUCTION Solitary bone plasmocytoma is rare, characterized by malignant plasmocyte proliferation, derived from a sole B lymphocyte clone located on a bony segment without medullar invasion. It, above all, affects the thoracolumbar spine. Costal involvement is rarely described. CASE REPORT The authors report the case of a 60-year-old man who complained of dyspnea, dry cough, and thoracic pain four months before admission. Thoracic imaging revealed a left apical tissue mass with osteolysis of the first rib. A transparietal biopsy of the mass was not helpful. Surgical biopsy concluded as to the diagnosis of costal plasmocytoma. All of the examinations carried out to search for other localizations were negative confirming the solitary nature of the tumor. The treatment consisted of complementary radiotherapy at a dose of 45Gy. The patient was in remission after eight months. CONCLUSION Solitary costal plasmocytoma should be called to mind when confronted with a lytic tumor of the rib. The treatment is based on surgery and radiotherapy. The prognosis is dominated by the risk of progression to multiple myeloma.

Une tumeur primitive rare du médiastin : le liposarcome pléomorphe

Resume Le liposarcome mediastinal constitue une tumeur rare, comportant plusieurs types histologiques. Il est souvent source de difficultes diagnostiques et therapeutiques. Nous rapportons un cas de liposarcome pleomorphe du mediastin, revele par des douleurs thoraciques et une alteration de l’etat general, chez un homme de 37 ans. La tomodensitometrie thoracique, qui a revele un processus expansif mediastinal anterieur, n’a pas permis d’evoquer le diagnostic en l’absence de densite graisseuse. Le diagnostic histologique a ete etabli par biopsie transthoracique sous controle scanographique. Une premiere cure de chimiotherapie a base de cisplatine et gemcitabine n’a pu empecher la progression tumorale rapide, qui a abouti au deces du patient 3 mois plus tard. Le liposarcome mediastinal pleomorphe constitue une tumeur exceptionnelle, touchant habituellement l’adulte d’âge moyen. Cette tumeur, souvent volumineuse, est habituellement symptomatique par compression des structures mediastinales. La chirurgie en constitue le traitement de choix, alors que la place des traitements associes reste controversee. Le pronostic depend essentiellement du grade de malignite et de la qualite de l’exerese.

Métastase musculaire révélatrice d'un adénocarcinome bronchique

INTRODUCTION The diagnosis of nonsmall cell lung cancer is made at a metastatic stage in 25% of cases. The most frequent sites are the lung, liver, bone, the adrenal glands and the central nervous system. Skeletal muscle metastases are uncommon and are rarely the first manifestation of a neoplastic process. CASE REPORT We report the case of 55 years old man presenting with a hard painless swelling of the left arm. A scan guided biopsy revealed infiltration of the muscle by a thyroid transcription factor 1 (TTF1) positive adenocarcinoma. A CT scan of the chest showed a partially necrotic tissue mass with moderate uptake of contrast. The patient was treated by chemotherapy with gemcitabine and carboplatine. The progress was unfavourable with the appearance of a second muscular metastasis in the thigh and the patient died 3 months after diagnosis. CONCLUSION Skeletal muscle metastases are rarely described in lung cancer and they are an exceptional presentation of the tumour. Their symptoms can be misleading and delay diagnosis.

Un nouveau cas de carcinome à petites cellules primitif de la plèvre

Small cell carcinoma (SCC) is commonly of pulmonary origin. Pleural small cell carcinoma is a very uncommon feature. We report here a case of small cell carcinoma of the pleura in a 36 year old man. The diagnosis of primary disease SCC of the pleura was established by transparietal pleural biopsy in absence of any mediastino-pulmonary or extrathoracic other lesions that could be the primary tumor. The treatment was based on chemotherapy with cisplatin and etoposide. The patient died four months in spite of cytotoxic chemotherapy. Extrapulmonary small cell carcinoma is a rare entity. Immunohistochemistry study is very useful for the diagnosis. The prognosis seems to be worse than the small cell lung cancer.

Atteinte trachéale révélatrice d’une maladie de Hodgkin: A propos d’un cas

Inaugural tracheobronchitis is a rare but known manifestation of Hodgkins disease. Clinical signs are often misleading, retarding diagnosis and treatment. We report a case of Hodgkins disease revealed by wheezing with minimal hemoptysis. Histology of the endoscopic biopsies demonstrated Hodgkin type infiltration of the trachea with mixed cellularity. The patient was given chemotherapy and mediastinal radiotherapy and achieved complete remission.

Tamponnade péricardique en postpartum révélatrice d’un lupus érythémateux systémique

Pericarditis is the most common manifestation of systemic lupus erythematosus and is clinically found in 62% of the autopsies. Cardiac tamponade is a deadly but rare complication found in less than 1% of all lupus cases. It is highly revealing. The authors report the case of a 29-year old woman presenting postpartum cardiac tamponade. The diagnosis of systemic lupus erythematosus was based on the association of haematological disorders (anaemia and leukopenia), pericarditis, pleurisy and positive anti-nuclear and anti-native DNA antibodies. The patient was treated with pericardiac drainage and cortisone therapy. The evolution was favourable after 22 months. Using this case study, the authors note the rarity of cardiac tamponade as a manifestation inaugurating lupus and discuss the relationship between pregnancy and lupus disease.

Une pneumopathie récidivante bilatérale et fébrile

Resume La polyangeite microscopique (PAM) est une affection rare, se traduisant habituellement par un syndrome pneumo-renal. Nous rapportons l’observation d’un jeune de 35 ans, qui s’est presente pour hemoptysie recidivante avec, a la tomodensitometrie thoracique, des opacites alveolo-interstitielles bilaterales en mosaique et a predominance apicale. Le lavage broncho-alveolaire a permis de confirmer le diagnostic d’hemorragie intra-alveolaire. La biopsie renale, realisee devant une proteinurie, a mis en evidence des lesions de glomerulonephrite extra-capillaire. Devant l’association d’hemorragie intra-alveolaire, d’atteinte renale et de positivite des p-ANCA, le diagnostic de polyangeite microscopique a ete retenu. Un traitement a base de corticoides et d’immunosuppresseurs a permis une remission de la maladie. Les auteurs discutent, a travers cette observation, la diversite des presentations radio-cliniques de la polyangeite microscopique, qui peut etre parfois source de difficultes diagnostiques.