J.-M. Vergnon

Endobronchial Metastases from Colorectal Cancers: Natural History and Role of Interventional Bronchoscopy

Background: Endobronchial metastases are rare. The most frequent primary tumors associated with endobronchial involvement are breast, colon and renal cell carcinomas. Metastases from colorectal cancers can be treated either surgically or with chemotherapy in order to improve survival. Objectives: This paper aims to report the potential role of interventional bronchoscopy in patients with endobronchial metastases from colorectal cancer. Methods: This retrospective study included 24 patients who underwent an interventional bronchoscopy procedure between 1988 and 2006. All patients had verified tracheobronchial metastases and were treated to relieve their obstruction. Assessment of the natural history of metastatic colorectal carcinoma, therapeutic options and survival associated with endobronchial metastases are reported. Results: Endobronchial metastases occurred at a median of 53 months (range 18–144) following the diagnosis of the primary tumor. Fifty-seven percent of patients had other proven metastases when the endobronchial involvement was diagnosed. All patients had known synchronous pulmonary metastases upon the discovery of tracheobronchial secondary lesions. The most frequently observed symptoms were dyspnea, cough and hemoptysis. Atelectasis was a common radiological finding. In 67% of patients, an interventional bronchoscopy was possible with the primary intent of relieving the obstruction. An endoscopic intervention provided symptomatic relief and an improvement in forced expiratory volume in 1 s. The median overall survival was 70 months (range 23–245) and 14 months once the endobronchial metastase(s) had been diagnosed. Conclusion: Endobronchial metastases occur relatively late in patients with a metastatic colorectal neoplasm. Palliative treatment with interventional bronchoscopy to prevent asphyxia is a safe and effective method that may improve the quality of life in these patients.

Invasive Thymoma: A Clinical Study of 23 Cases

Background: Invasive thymoma is a rare mediastinal tumor. Clinicopathological characteristics that influence survival of patients with this tumor are under debate. Treatment is based on tumor resection. The benefice of therapies, such as radiation therapy (RT) and/or chemotherapy (CT) as adjuvant treatments to surgery, or palliative therapy to unresectable or recurrent thymoma are discussed. Objectives: The aim of this study was to assess patients with invasive thymoma, with specific emphasis on factors predicting survival. Methods: We studied retrospectively 23 patients with invasive thymoma. Parameters assessed were age, presenting symptoms, histological features, stage at diagnosis, treatment modalities and survival. All patients received primary therapy: 11 patients (48%) had tumor resection associated with CT and/or RT, while 12 patients had palliative therapy including RT and/or CT. Regimens for CT were based on cisplatin. Results: Patients’ mean age was 58 years. Three patients had stage II disease at diagnosis (13%), 8 patients had stage III (35%) and 12 patients had stage IV (52%). Median overall survival was 20 months (range: 4–160) and five-year survival rate was 43.5% (10 patients). Surgical resection had a significant impact on survival (p < 0.0001). Survival was also related to stage of the disease at diagnosis (p = 0.006), but not to histology of the tumor (p = 0.12). Salvage treatment was of clinical importance: 5 out of 15 patients (33.3%) who relapsed during a 5-year follow-up responded to a multimodality therapeutic approach that affected survival (p = 0.019). Conclusion: Factors determining the outcome of these tumors are the stage of the disease at diagnosis, and the adequacy of surgical removal. Salvage treatment of recurrent thymoma may give a moderate response rate and improve survival.

Présentation nodulaire d’une pneumopathie organisée cryptogénique

INTRODUCTIONnCryptogenic organizing pneumonia is inflammatory and proliferative pulmonary diseases whose specific radiologic feature are bilateral and migrant opacities.nnnOBSERVATIONnAn isolated peripheral nodule of the left lower lobe was discovered on chest X-ray of a man who presented with isolated chronic cough. As this nodule has a positive FDG positron emission tomography uptake (PET) but with inconclusive fiberoptic bronchoscopy, the patient was sent to surgeon and a wedge-resection was processed because intraoperative analysis did not show any tumour. Histopathological study was in favour of organizing pneumonia. Search for potential cause remained negative and the diagnosis of cryptogenic organizing pneumonia was retained.nnnCONCLUSIONnCryptogenic organizing pneumonia may mimic lung cancer, presenting as an isolated peripheral nodule with positive PET. Histopathological study remains absolutely necessary to retain the diagnosis because of dramatic differences in prognosis and therapy.

Infection pulmonaire à Mycobacterium malmoense, traitement médico-chirurgical

Resume Cas clinique Nous rapportons l’observation d’un patient ayant une broncho-pneumopathie chronique obstructive post-tabagique, porteur d’une infection pulmonaire liee a Mycobacterium malmoense decouverte de facon inattendue. Une exerese chirurgicale a ete realisee a titre diagnostique et therapeutique. Conclusion La culture du prelevement a permis secondairement l’identification de cette mycobacterie non tuberculeuse. La chirurgie a ete suivie d’un traitement antibiotique probabiliste associant rifampicine et pyrazinamide durant deux mois et demi. Cette bi therapie a ensuite ete completee par de la clarithromycine, portant la duree totale de traitement a sept mois et demi. L’originalite de cette observation repose sur sa prise en charge medico-chirurgicale, permettant de discuter des aspects therapeutiques d’une telle infection.

Pulmonary distension restrains pulmonary blood flow during exercise in COPD patients

Introduction Recruitment of pulmonary blood flow has been poorly investigated in COPD patients during exercise. It may be impaired, especially in patients with pulmonary distension. Methods We measured simultaneously pulmonary capillary blood flow (Qs, uptake of acetylene) and Transfer Capacity of CO (TLCO), at rest and during three stages of a submaximal exercise in 19 COPD patients (FEV1=51±18%pred) and 9 controls. Twelve patients had a Residual Volume >150%pred and formed the hyperinflated subgroup (HI). Results Patients had lower values of Qs and TL than controls, both at rest and at each phase of the exercise. Qs and TLCO increases were respectively 81±49% and 25±12% for the last exercise phase in HI and 191±48% and 47±12% in controls (p Conclusions We found a reduced capability to recruit functional capillaries and so increase TL in hyperinflated COPD patients. The impact of treatments to reduce hyperinflation should now be evaluated using this methodology.