Narjes Khalfallah

[Hypercalcemia related to PTH-rP revealing malignant hepatic epithelioid hemangioendothelioma].

Hypercalcemia caused by tumor production of PTH-rp occurs most often in cases of squamous cell carcinoma of the lung, aerodigestive tract cancer, gynecological cancer and lymphoma. We report an exceptional case of PTH-rp related to a hepatic hemangioendothelioma. A 70 years-old male admitted for deterioration of the general state. The laboratory investigations revealed hypercalcemia, related to tumor production of PTH-rp. Imaging revealed tumoral hepatic lesions. Histopathological study and immunohistochemistry showed diffuse response for CD31 marker, CK20 (+) with CK7 (-) and hepatocyt antigen (-). The diagnosis of PTH-rp related to hepatic hemangioendothelioma was make. The patient died with recurrence of fatal hypercalcemia. Management of patients presenting with humoral hypercalcemia includes a vigorous search for tumor lesions. Elevated PTH-rp can be a bad prognostic factor. In front of tumoral liver lesions, a hepatic epithelioid hemangioendothelioma must be considered. Immunohistochemistry is necessary to make diagnosis.

Unicentric Mixed Variant Castleman Disease Associated with Brachiocephalic Vein Thrombosis: A Rare Presentation

Castleman disease (CD) is an uncommon lymphoproliferative disorder occurring mostly in patients presenting with mediastinal lymphadenopathy. Predominant phenotypes are categorized as localized hyaline vascular or multicentric plasma cell variants. Localized form of CD is usually asymptomatic and rarely associated with deep venous thrombosis. We report an exceptional case of mediastinal CD, which presented as retrosternal chest pain, in a 42-year old man. Imaging and pathological examination showed an atypical, mixed and localized form of CD. Thoracic CT scan revealed brachiocephalic vein thrombosis. Investigations didn’t reveal other risk factors for deep venous thrombosis. Deep venous thrombosis is an exceptional complication of localized variants of CD. Therefore, it seems worth looking carefully for this last type of benign lymphopathy when an unusual thrombosis is found.