Faouzi El Mezni

Pulmonary and mediastinal bronchogenic cysts: a clinicopathologic study of 33 cases.

Bronchogenic cysts are uncommon congenital anomalies of foregut origin and usually located within the mediastinum and the lung. A retrospective study of 33 thoracic bronchogenic cysts was undertaken to detail their clinicopathologic and radiologic features. There were 18 male and 15 female patients between 12 and 77 years of age with a mean age of 41 years. Thirty-one patients (94%) were symptomatic at the time of diagnosis and the chief complaint was chest pain (48.5%). Most of the cysts presented as homogeneous water-density shadows on standard chest radiographs. The location was intrapulmonary in 25 cases and mediastinal in 8 cases. Based on radiologic investigations, preoperative diagnosis of bronchogenic cyst was made in only 11 cases (33.34%). Surgical excision of the cyst was approached via thoracotomy in 32 cases and thoracoscopy in one case. Total excision of the cyst was performed in 31 cases and subtotal resection in 2 cases. Pathologic findings were consistent with bronchogenic cyst in all cases. During the follow-up period, which ranged between 1 month and 51 months, all patients were symptom-free with no evidence of recurrence. Complete surgical resection is recommended for all bronchogenic cysts to establish diagnosis, alleviate symptoms, and prevent complications.

Benign myoepithelioma of the lung - a case report and review of the literature

IntroductionBenign myoepithelioma is extremely rare in the lung, to the best of our knowledge; only five cases have been reported in the literature.Case ReportAn 18-years woman complained from tiredness and fever during four months. Laboratory findings and fibroscopies were normal. CT of the thorax demonstrated a nodule in the left segment of the Fowler. Left inferior lobectomy was performed comporting a firm nodule of 25 mm, lifting the bronchial mucous membrane. Histologically, there was a proliferation of small cells of a plasmocytoid-type, with a predominantly whorled pattern. No mitotic activity or necrosis was seen in the tumor. Immuhistochemically, the tumor cells positive for smooth muscle actin, vimentine, and S100 protein. They were negatives for cytokeratine, chromogranine and HMB45. The diagnosis of benign myoepithelioma of the lung is so confirmed. The patient recovered well at 6 months follow-up.ConclusionBenign myoepithelioma is a rare pulmonary neoplasm distinct from pleomorphic adenoma, which should be considered in the differential diagnosis of lung nodules.

Cardiac cavernous haemangioma.

BACKGROUND Cardiac haemangioma was first described in 1893. It is an infrequent and benign neoplasm which accounts for about 2.8% of all benign primary cardiac tumours, arising from the cardiac ventricles, valves, atria and rarely the epicardium. METHODS AND RESULTS We report the case of a 24-year-old woman with a cardiac haemangioma detected by transthoracic echocardiography, computed tomography, and magnetic resonance imaging. The coronary CT showed a mass located in the pericardial cavity with close relationship to the myocardium. The mass surrounded completely the segments 2 and 3 of the left anterior descending coronary artery. At operation, the tumour was incompletely resected, leaving a remnant in the left anterior descending coronary artery contact, one diagonal branch has been sacrificed. Pathologic study diagnosed a cavernous haemangioma. Transthoracic echocardiography eight months later showed a remnant of haemangioma with a left ventricular ejection fraction estimated to 69%. The coronary CT 10 months after surgery showed the remnant of the tumour with normal cardiac cavities and absence of visualisation of the diagonal artery. The patient is currently asymptomatic and doing well 14 months after surgery. CONCLUSIONS Cardiac haemangioma is a rare cardiac tumour with an unknown aetiology. The diagnosis is aided by imaging techniques. The coronary CT may be useful when more precise evaluation of the tumour extent is required. It allows specifying the relationship of the mass with the coronary vessels. Successful treatment usually requires timely surgery. However, periodic examinations and echocardiography are recommended.

Carcinomes sarcomatoïdes du poumon : étude rétrospective de 28 cas

INTRODUCTION Sarcomatoid carcinoma (SC) of the lung is defined by the World Health Organization as poorly differentiated non-small cell carcinoma that contains a component of sarcoma or sarcoma-like elements. It represents an overall continuum of epithelial and mesenchymal differentiation. Five subtypes are recognized: pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, carcinosarcoma, and pulmonary blastoma. The diagnosis is pathological and requires a good sampling of the tumor. PATIENTS AND METHODS Twenty-eight cases of primary sarcomatoid carcinoma, diagnosed between 1993 and 2010, were reviewed retrospectively, noting the clinicopathological characteristics. RESULTS The patient population consisted of 25 males and 3 females with mean age of 62.9 years (48-75 years). The symptomatology was dominated by respiratory symptoms. Imaging features showed a pulmonary mass invading pleura or thoracic wall in 5 cases. The diagnosis was made in all cases on histological examination. These 28 tumors were divided as below: into 19 pleomorphic carcinomas, 4 giant cell carcinomas, 1 spindle cell carcinoma and 4 carcinosarcomas. Twenty-seven tumors were treated surgically. Associated treatments were neoadjuvant (3 cases) or adjuvant chemotherapy (1 case) and preoperative radiotherapy (5 cases). Deaths occurred in 7 patients. Twenty-two patients were lost to follow up. CONCLUSION These tumors are frequently symptomatic, are locally advanced, and have higher rates of recurrence. Its prognosis is worse than that of other non-small cell lung cancer.

Lymphomatoid granulomatosis mimicking interstitial lung disease.

Lymphoid granulomatosis is a rare form of pulmonary angiitis. This case report presents a patient with lymphoid granulomatosis in whom the clinical presentation, radiological features and the partial response to corticosteroid therapy mimicked interstitial lung disease. Lymphoid granulomatosis was only diagnosed at post‐mortem examination. The range of reported clinical presentations, diagnostic approaches and outcomes are described.

Le fibrome desmoplastique de la côte : À propos de deux observations

Resume Le fibrome desmoplastique est une tumeur primitive tres rare de l’os, equivalente a la tumeur desmoide des parties molles. Bien qu’elle soit consideree comme une lesion benigne, elle peut etre tres agressive localement avec un haut risque de recidives locales apres exerese chirurgicale. En l’absence de specificite radiologique, elle peut simuler un osteosarcome, une dysplasie fibreuse ou un fibrosarcome. L’atteinte costale par un fibrome desmoplastique est extremement rare. Nous rapportons deux cas illustrant cette localisation exceptionnelle avec lyse costale et extension endothoracique. L’examen anatomo-pathologique apres exerese chirurgicale montrait une proliferation tumorale peu dense de petites cellules fusiformes s’entremelant a des faisceaux collagenes et resorbant les travees osseuses. Il n’a pas ete observe d’atypies ni de mitoses ni de necrose. Nous discuterons les aspects radiologiques, cliniques et morphologiques ainsi que les diagnostics differentiels de cette tumeur dont la reconnaissance est importante afin d’assurer un traitement chirurgical adapte.Desmoplastic fibroma is a very rare primary tumor of bone, closely related to aggressive fibromatosis of soft tissue. Although considered a benign lesion, it can be very aggressive locally and has a high rate of local recurrence after incomplete surgical excision. Radiologically, the lesion shows no distinctive features, often simulating osteosarcoma, fibrous dysplasia, or fibrosarcoma. Rib involvement by desmoplastic fibroma is extremely rare. We present two cases of desmoplastic fibroma involving this unusual location with lytic costal lesion and chest wall extension. Histological examination after surgical resection revealed that the tumor consisted of spindle cells with small, elongated nuclei in a background of numerous collagen fibers and infiltrating lamellar bone. There was no evidence of nuclear atypia, mitotic activity, or necrosis. We also discuss histological differential diagnosis as well as clinical features and the radiological and pathologic findings of this rare disease. Recognition of this entity is important to ensure proper surgical treatment.

Castleman's Disease: An Intrapulmonary Form with Intrafissural Development

Castlemans disease (CD) is an uncommon, mainly benign, lymphoproliferative disorder of unknown etiology, mostly involving the mediastinum. Parenchymal lung involvement of the disease is exceedingly rare. We describe a case of CD in a 23-year-old woman with a 4-year history of recurring dyspnea and nonproductive cough, whose chest X-ray showed an abnormal shadow of the right hilum. Chest computed tomography confirmed the presence of a tissue-density mass of the right lower lobe, demonstrating poor contrast enhancement, associated with multiple laterotracheal and mediastinal lymphadenopathies. The patient underwent curative surgery, revealing a right hilar compressive mass, with an intrafissural development between the superior and middle lobes. Pneumonectomy was performed due to profuse bleeding. This case of CD is particular because of its unusual intrapulmonary location and its intrafissural development. Poor contrast enhancement is atypical in CD.

Malignant glomus tumor of trachea: a case report with literature review

Glomus tumors of the trachea are extremely rare and generally benign, with very few cases of malignant transformation reported in literature. We present the case of a 74-year-old man explored for cough and dyspnea. Bronchoscopy showed a polypoid mass arising from the posterolateral tracheal wall. Computed tomography demonstrated a mid-tracheal tissular mass obliterating the tracheal lumen. Resection and anastomosis of the trachea were performed. The histological and immunohistochemical findings were consistent with malignant glomus tumor.

Pulmonary carcinosarcoma with heterologous component: report of two cases with literature review

Carcinosarcoma is an uncommon malignant biphasic tumor that accounts for less than 1% of all lung cancers. It is defined by coexisting histologic elements of carcinomatous and sarcomatous components. We report two cases of carcinosarcoma in a 68-year-old patient and a 78-year-old patient explored for lung masses. Macroscopically, the resected tumors were 7 and 10 cm in diameter. Histologically, they consisted in adenosquamous carcinoma with osteosarcoma in one case and adenocarcinoma with chondrosarcoma in the other case.

Pulmonary blastomycosis: a case from Africa.

Pulmonary blastomycosis is an uncommon pathologic condition that is quite rare in Africa compared to endemic regions of Canada and the upper Midwest of the U.S. We describe a 45-year-old patient who complained of productive cough, hemoptysis, and dorsal rachiodynia. Chest imaging revealed a necrotic tissue-density pulmonary mass involving both the upper and lower right lobes. Chest MRI showed signal abnormality of the third thoracic vertebral body and the greater trochanter, consistent with metastatic lesions. Clinical and radiological findings were strongly suggestive of lung cancer. Diagnosis of pulmonary blastomycosis was made by visualization of yeast in bronchial biopsies and further confirmed by culture of bronchoalveolar lavage specimens. The patient was treated with itraconazole and his clinical condition improved markedly. Pulmonary blastomycosis is unusual in Africa and that fact caused a considerable delay in diagnosis. We suggest that this disease may be more common in Africa than has been previously suspected.