N. Chaouch

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.

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.

Insuffisance respiratoire aiguë isolée révélant une malformation d’Arnold-Chiari: À propos de deux observations

Arnold-Chiari malformation is an occipitocervical malformation where the cerebellar amygdales descend below the occipital foramen. Acute respiratory failure is an exceptional inaugural sign. We report two cases disclosed by alveolar hypoventilation associated with type I Arnold-Chiari malformation. The two patients age 51 and 52 years had an uneventful past history and presented with hypercapnic encephalopathy with acute respiratory failure requiring ventilatory assistance. Respiratory function tests, helicoidal thoracic computed tomographic angiography, electromyogram, cardiac echography, and thyroid and immunological tests were normal. Blood gases and polysomnography were in favor of central hypoventilation without sleep apnea. Magnetic resonance imaging demonstrated type I Arnold-Chiari malformation. The course was complicated by recurrent respiratory failure in both patients. Surgical decompression performed for the first patient provided no improvement. This patient died two months after surgery subsequent to aspiration pneumonia. The second patient was treated with continuous positive pressure noninvasive ventilatory assistance and had a good outcome at 25 months. These two cases illustrate the absence of any neurological sign, acute respiratory failure being the only sign of Arnold-Chiari malformation.

Pseudotumeur inflammatoire pulmonaire invasive

Inflammatory pseudotumor of the lung is an uncommon nonneoplastic tumor of unknown origin. It can mimic lung carcinoma. We report a 65-year-old man who presented with productive cough, weight loss, and a heterogeneous right apical lung condensation. This clinical and radiographic presentation suggested a malignant lung tumor. Surgery was performed and the histological examination of the surgical specimen concluded to an inflammatory pseudotumor. A pneumonectomy was performed because of the tumor extension towards the lower lobe and the mediastinum. No recurrence was observed after a 2-year follow-up. Surgery is essential to confirm the diagnosis of inflammatory pseudotumor. Complete resection is the only guarantee to prevent recurrence.

Hémoptysie révélatrice d’une amylose trachéobronchique

The authors report the case of a 68-year-old man complaining of haemoptysis and breathlessness. Bronchoscopy revealed a budding formation in tracheal bifurcation. Multiple biopsies were performed and concluded as to AL type amyloidosis. Tracheobronchial amyloidosis is an uncommon localised form of amyloidosis that can simulate lung cancer.

ImageDes infections pulmonaires récidivantesRecurrent lung infections

Un homme âgé de 19 ans, non tabagique, avait comme antéédents des bronchopneumopathies récidivantes. Il signalait une ronchorrhée purulente depuis trois ans qui contenait parfois es débris alimentaires. L’examen physique notait un retard stauropondéral, une déformation thoracique avec à l’auscultation ulmonaire des râles ronflants diffus aux deux champs pulmoaires. La radiographie du thorax retrouvait des images alvéolaires t kystiques prédominantes au niveau du lobe supérieur droit vocatrices de dilatations de bronches. Biologiquement, la CRP tait à 179 mg/l avec une hyperleucocytose à 17 000 par millimètre ube. La fibroscopie bronchique montrait des sécrétions purulentes bondantes provenant de l’arbre bronchique droit. Le test de la ueur était normal. Le scanner thoracique retrouvait des bronchecasies prédominantes au niveau du lobe supérieur droit. Un transit sogastroduodénal à la baryte était fait (Fig. 1).

Des infections pulmonaires récidivantes

Un homme âgé de 19 ans, non tabagique, avait comme antéédents des bronchopneumopathies récidivantes. Il signalait une ronchorrhée purulente depuis trois ans qui contenait parfois es débris alimentaires. L’examen physique notait un retard stauropondéral, une déformation thoracique avec à l’auscultation ulmonaire des râles ronflants diffus aux deux champs pulmoaires. La radiographie du thorax retrouvait des images alvéolaires t kystiques prédominantes au niveau du lobe supérieur droit vocatrices de dilatations de bronches. Biologiquement, la CRP tait à 179 mg/l avec une hyperleucocytose à 17 000 par millimètre ube. La fibroscopie bronchique montrait des sécrétions purulentes bondantes provenant de l’arbre bronchique droit. Le test de la ueur était normal. Le scanner thoracique retrouvait des bronchecasies prédominantes au niveau du lobe supérieur droit. Un transit sogastroduodénal à la baryte était fait (Fig. 1).

Development and validation of a prognostic index for survival in non-small cell lung cancer: Results from a Tunisian cohort study

INTRODUCTION Despite the continuous efforts made with the TNM system, the issue of heterogeneity of prognosis within the stages of non-small cell lung cancer (NSCLC) could not be resolved. Our aim was to identify prognostic factors and develop an index to predict NSCLC survival with greater accuracy. METHODS We conducted a survival study over 5 years on patients with NSCLC. Kaplan-Meier analysis followed by Cox regression modelling were used. Prognostic indices were derived, using either an additive or a multiplicative pattern, and were compared by their receiver operating characteristics (ROC) curves. We then proceeded to a risk stratification and validation of the index on the derivation cohort. RESULTS Two hundred and sixty-two NSCLC patients were included. Two models were constructed, using the following nine variables as prognostic factors: age, performance status, haemoglobin level, leucocyte count, calcium, lactate dehydrogenase, alkaline phosphatase levels, histological type and TNM stage. Four prognostic indices were derived, and the best one was picked and validated on a population of five risk groups. The higher the risk group, the shorter the survival. CONCLUSIONS This novel and simple prognostic tool could predict survival more accurately in patients with NSCLC.

Réaction paradoxale à la fin du traitement antituberculeux chez le sujet immunocompétent.

INTRODUCTION The features of paradoxical reactions (PR) that occurred in non-HIV infected patients are rare and not well known. CASE REPORT The authors reported the case of a 21years old, non-immunocompromised, and HIV negative patient treated for disseminated tuberculosis. PR occurred after 8months after initiation of antituberculous treatment. PR presented as left cervical lymphadenopathy, pulmonary, pleural, costal and spinal location of the tuberculosis. The antituberculous drugs were prolonged. Patients clinical symptoms improved initially. However, left inguinal lymphadenopathy appeared after 20months of antituberculous therapy. Inguinal lymph node biopsy revealed tuberculous lymphadenitis. The patient has a good compliance to the treatment. The patient was continued on same antituberculous treatment for a total of 28months. The cervical and inguinal lymphadenopathy disappeared and CT scan showed regression of thoracic, abdominal, costal and spinal lesions. CONCLUSION PR during antituberculous treatment must be considered after exclusion of other causes. No consensus on the therapeutic management of this entity has been developed to date.

Article originalLa tumeur fibreuse solitaire pleurale : à propos de cinq observationsSolitary fibrous tumour of the pleura: About five cases

BACKGROUND Pleural solitary fibrous tumour (PSFT) is a rare, usually benign tumour, with unpredictable behaviour. PATIENTS AND METHODS Five cases of PSFT were diagnosed in our department over a 12-year period from January 1999 to December 2010. Clinical, radiological, histological, therapeutic and follow-up information were provided in all cases. RESULTS Our series comprised four men and one woman. The mean age of the patients at presentation was 55 years. All patients were symptomatic. Radiologic investigations showed a pleural lesion with a mean size of 10.6cm ranging from 3 to 17cm. Histologic diagnosis was made from resected parietal pleura in three cases and visceral pleura in two cases. The histologic features were suggestive of malignancy in two cases and benign in three cases. Immunohistochemical study showed that the tumour cells expressed vimentin, CD34, CD99 and Bcl2. Complete resection was obtained in all patients. The evolution was marked in the two patients with malignant PSFT by the recurrence of the tumour after 6 and 21 months respectively. Both died from the condition. The three patients with a benign form are disease-free after 3, 11 and 2 and half years of follow-up. CONCLUSIONS PSFT is rare tumour, the diagnosis of which is based on histologic investigations. These tumours require long-term monitoring due to the possibility of local recurrence and malignant transformation.