I. Ridene

Imaging of thoracic textiloma

OBJECTIVE Intrathoracic textiloma or gossypiboma, a retained surgical sponge in the thoracic cavity, is an exceptional but serious complication following thoracic or abdominal surgery. The purpose of this work is to highlight the topographic features of thoracic textiloma and to describe imaging aspects, and, particularly, computed tomography (CT) features. METHODS Eight patients have been operated in our thoracic surgery department for thoracic gossypiboma. In the past, three patients had undergone hepatic surgery and the five others had a history of thoracic surgery. All the patients had a chest radiograph, five of them had a thoracic ultrasonography, all had a chest CT, and one patient had a chest magnetic resonance imaging (MRI). RESULTS In patients with a history of abdominal surgery, the foreign body was located in the parenchyma of the right lower lobe. In the other patients, the foreign body was either intrapleural or mediastinal. Ultrasonography suggested the diagnosis of textiloma in three of the five patients by demonstrating a non-calcified hyperechoic mass with acoustic shadow. At CT, the gossypiboma was a low-attenuating mass containing trapped gas lucencies in six patients and it was a high-attenuating mass in two patients. MRI showed a diaphragmatic defect in one patient with an intrapulmonary gossypiboma that migrated from the abdomen. CONCLUSIONS The CT aspect of thoracic gossypiboma may be different according to pleural or parenchymal location. The spongiform appearance, characteristic in abdominal gossypiboma, is not the only CT presentation of thoracic gossypiboma. The confrontation of the surgical history with the CT signs helps to have a preoperative diagnosis.

Desmoid-type chest wall fibromatosis. A six cases series.

PURPOSE OF THE STUDY Desmoid-type fibromatosis is a fibroblastic proliferation that develops in the deep soft tissues and is characterized by infiltrative growth and a tendency towards local recurrence but does not metastasize. Fibromatosis of the chest wall is rare, representing only 10 to 20% of all deep fibromatoses. CASE REPORT We report a six cases series of fibromatosis of the chest wall treated at our institution between 1996 and 2009. There were five men and one woman with a mean age of 42.2. Swelling of the chest wall was the most frequent symptom. Imaging showed an expansive homogeneous mass, invading the rib (four cases) or the sternum (two cases). Surgical resection was performed in all cases. The outcome was favorable (five cases) or marked by local recurrence (one case). DISCUSSION Although it is considered to be a benign lesion, this tumor can be locally very aggressive, and has a high local recurrence rate depending upon the efficacy of surgical resection.

Les sarcomes primitifs du médiastin

INTRODUCTION Primary sarcomas of the mediastinum are rare and account for 2 to 8% of malignant mediastinal tumours. The aim of this study is to describe their clinical and pathological characteristics. PATIENTS AND METHODS Fifteen cases of primary mediastinal sarcoma, diagnosed between 1993 and 2009, were reviewed retrospectively, noting the clinical, radiological and pathological findings, and the treatment given. RESULTS The patient population consisted of eight females and seven males with mean age of 40 years (14 to 73 years). The symptomatology was predominately respiratory. Imaging showed a mediastinal mass invading adjacent organs in nine cases. The diagnosis was made in all cases by histological examination. These 15 mediastinal sarcoma comprised 12 malignant peripheral nerve tumours, two liposarcomas and one angiosarcoma. Three were grade III, six grade II and six grade I. Ten were treated surgically, of which seven had radical resections. Associated treatments were neoadjuvant (one case) or adjuvant (one case) chemotherapy and postoperative radiotherapy (five cases). Radiotherapy was undertaken alone in three inoperable tumours. Eight patients (53%) had died. CONCLUSION Management of primary mediastinal sarcoma needs a multidisciplinary approach, and is based mainly on radical resection. The prognosis is poor and depends mainly on surgical excision and histological grade.

Imagerie des tumeurs myofibroblastiques inflammatoires du poumon

Inflammatory myofibroblastic tumors of the lung: Imaging features Inflammatory myofibroblstic tumors are ubiquitous but most frequently affect the lung. The imaging features are non-specific but the diagnosis may be suggested in the presence of solitary pulmonary nodule or mass in children or young adults. The tumor may appear locally and regionally aggressive suggesting malignancy. Diagnostic confirmation is obtained from histological evaluation of the surgical specimen. Treatment is surgical with oncologic surgical resection.

Article originalLes sarcomes primitifs du médiastinPrimary mediastinal sarcomas

INTRODUCTION Primary sarcomas of the mediastinum are rare and account for 2 to 8% of malignant mediastinal tumours. The aim of this study is to describe their clinical and pathological characteristics. PATIENTS AND METHODS Fifteen cases of primary mediastinal sarcoma, diagnosed between 1993 and 2009, were reviewed retrospectively, noting the clinical, radiological and pathological findings, and the treatment given. RESULTS The patient population consisted of eight females and seven males with mean age of 40 years (14 to 73 years). The symptomatology was predominately respiratory. Imaging showed a mediastinal mass invading adjacent organs in nine cases. The diagnosis was made in all cases by histological examination. These 15 mediastinal sarcoma comprised 12 malignant peripheral nerve tumours, two liposarcomas and one angiosarcoma. Three were grade III, six grade II and six grade I. Ten were treated surgically, of which seven had radical resections. Associated treatments were neoadjuvant (one case) or adjuvant (one case) chemotherapy and postoperative radiotherapy (five cases). Radiotherapy was undertaken alone in three inoperable tumours. Eight patients (53%) had died. CONCLUSION Management of primary mediastinal sarcoma needs a multidisciplinary approach, and is based mainly on radical resection. The prognosis is poor and depends mainly on surgical excision and histological grade.

Une association lésionnelle pulmonaire rare

INTRODUCTION Pulmonary amyloidoma or nodular amyloidosis is a localized form of amyloidosis, which can mimic a bronchopulmonary carcinoma. This form of amyloidosis may be associated to an infectious, a systemic disease or a lymphoma. OBSERVATION We describe the case of a 36-year-old patient whose past medical history was consistent for a diabetes mellitus and a hypothyroidism treated by medical treatment. The patient presented a Gougerot-Sjögren syndrome and was explored for non-specific respiratory symptoms. Physical examination was normal. Laboratory tests revealed a monoclonal pic of immunoglobulin. Radiologic findings showed bilateral pulmonary nodules associated to mediastinal lymph nodes. A pulmonary biopsy was performed. Histologic examination revealed a tumoral nodule containing an abundant eosinophilic material, which was acellular and surrounded by a dense lymphomatous infiltrate destroying the pulmonary parenchyma. Histochemical and immunohistochemical study revealed an association of a nodular pulmonary amyloidosis with a MAT pulmonary lymphoma complicating a Gougerot-Sjögren syndrome. CONCLUSION The association of MALT pulmonary lymphoma and localized amyloidosis is rarely observed in case of Gougerot-Sjögren syndrome. The pathogenesis of this association remains unknown and the management non-consensual because of the rarity of the cases reported. Whereas, it appears that localized amyloidosis associated to a MALT lymphoma seems to have a better prognosis than a disseminated amyloidosis.

Aspects tomodensitométriques du carcinome bronchique à petites cellules

Small cell lung carcinoma (SCLC) typically is central in location. It is a very aggressive tumor characterized by its propensity for invasion of mediastinal structures, frequently, the ipsilateral pulmonary artery, multifocal nodal metastases and high frequency of distant metastases at initial presentation. CT is very sensitive and effective for local and regional staging. Combined with other diagnostic modalities, especially PET imaging, it allows whole body imaging for accurate staging, which is mandatory for therapeutic management. The different CT imaging features of SCLC and its more specific imaging characteristics will be reviewed in this article.

Amylose ganglionnaire médiastinale pseudotumorale

Pseudotumoral mediastinal amyloidosis Purpose Amyloidosis involvement of mediastinal nodes is rare. Isolated pseudotumoral involvement without extra-thoracic disease is a diagnostic challenge and typically raises concern for underlying malignancy. We present 3 cases of pseudotumoral mediastinal amyloidosis. Methods We report the cases of 3 patients presenting with recent onset of respiratory symptoms. Bronchoscopy showed mucosal infiltration suspicious for lymphangitic spread of tumor. The patients underwent chest radiography complemented by CT of the chest and abdomen, and laboratory and immunological work-up. A diagnosis of pseudotumoral mediastinal amyloidosis was confirmed by mediastinoscopic biopsy in all cases. Results CT showed a pulmonary and mediastinal tumor process in 2 cases and pericarinal tumor in 1 case. Diffuse bronchial wall thickening was present in all cases. Review of biopsy material showed tracheobronchial amyloidosis in 1 case. Patient work-up showed no evidence of extra-thoracic amyloidosis. Rapid progression of bronchial obstruction was observed in 1 case. Conclusion The imaging features of mediastinal amyloidosis are non-specific. Pseudotumoral involvement of mediastinal nodes associated with pulmonary amyloidosis accelerates the degree of airway obstruction.

THO-WS-29 Rentabilite diagnostique des biopsies trans-thoraciques en fonction du type d’aiguille

Objectifs L’objectif de ce travail est de comparer la rentabilite diagnostique des aiguilles a guillotine a celle des aiguilles a fragment cylindrique dans les biopsies des masses mediastinales et pulmonaires. Materiels et methodes Sur une periode de 20 mois allant de juin 2007 a fevrier 2009, nous avons realise 106 biopsies transparietales sous guidage tomodensitometrique chez 100 patients, 8 porteurs d’une masse mediastinale et 92 d’une masse pulmonaire ou parietale. Nous avons realise 84 biopsies avec des aiguilles de calibre 18 Gauge (G), 48 biopsies a l’aide d’aiguilles a guillotine et 36 a l’aide d’aiguilles a fragment cylindrique. Pour les 22 biopsies restantes, 13 etaient realisees avec des aiguilles a guillotine 16G et 9 avec des aiguilles a guillotine 20G. Un a deux passages trans-parietaux ont ete juge necessaires. Resultats Les aiguilles a guillotine ont permis un diagnostic histologique precis dans 77% des cas (54 sur 70). Cette precision diagnostique pour les aiguilles de calibre 18 G etait de 79% (38 sur 48) pour les aiguilles a guillotine contre 92% (33 sur 36) pour les aiguilles a fragment cylindrique. Pour le diagnostic de carcinome, l’efficacite des aiguilles a guillotine 18G etait de 81% (34 sur 42) alors qu’elle etait de 94% (31 sur 33) pour les aiguilles a fragment cylindrique. Le geste etait complique de pneumothorax de faible abondance dans 4 cas et d’une hemoptysie de faible abondance dans 5 cas. Conclusion Les aiguilles de biopsie transparietale thoracique a fragment cylindrique presentent une meilleure precision diagnostique que les aiguilles a guillotine notamment pour le diagnostic de carcinome bronchopulmonaire.