Olivier Toubas

Tracheobronchial Involvement of Rosai-Dorfman Disease: Case Report and Review of the Literature.

AbstractRosai–Dorfman Disease (RDD) is a rare non-neoplastic entity, also known as sinus histiocytosis with massive lymphadenopathy (SHML), characterized by a benign proliferation of histiocytes in lymph nodes. Localized forms of RDD involving the tracheobronchial tree are very rare. There is no consensus regarding the management of central airway forms and recurrence is frequent.We report the case of an 81-year-old Caucasian woman admitted in 2014 for chronic cough. Her main medical past history included a diagnosis of sinonasal RDD in 1996 with recurrent obstructive rhinosinusitis requiring repeated sinonasal surgery, and a diagnosis of tracheal RDD in 2010 with 2 asymptomatic smooth lesions (5 and 7 mm) on the anterior tracheal wall. Physical examination was normal in 2014. Pulmonary function tests showed an obstructive pattern. Computed tomographic scan revealed a mass arising from the anterior wall of the trachea that projects into the tracheal lumen. Fiberoptic bronchoscopy showed a hypervascular multilobular lesion (2 cm) arising from the anterior tracheal wall and causing 50% obstruction of the tracheal lumen. Mechanical resection with electrocoagulation of the tracheal mass was performed by rigid bronchoscopy with no complication. Histological examination demonstrated tracheal RDD. One year after endotracheal resection, the patient presented no recurrence of cough and the obstructive pattern had resolved.Reports on tracheobronchial involvement are scarce. Symptomatic tracheobronchial obstruction requires mechanical resection by rigid bronchoscopy or surgery. Recurrence is frequent, justifying long-term follow-up.

Purpura rhumatoïde révélateur d’un carcinome épidermoïde bronchique

Schoenlein-Henoch purpura is a systemic vasculitis involving the small vessels. In adults it is rare and is sometimes associated with malignancies such as bronchial carcinoma. We report the case of a 74-year-old male ex smoker who was admitted with necrotic skin lesions associated with a nephrotic syndrome, and was found to have a right upper lobe squamous cell bronchial carcinoma. The renal biopsy led to a diagnosis of IgA nephropathy related to Schoenlein-Henoch purpura. Curative surgical resection of the bronchial carcinoma (ypT2N0M0) was associated with remission of the purpura. The synchronous diagnosis of bronchial carcinoma and Schoenlein-Henoch purpura suggests a potential relationship between these two pathologies. Our observation and other published data strongly suggest a direct link on account of: the synchronous diagnosis, the clinical and biological remission of the Schoenlein-Henoch purpura after curative treatment of the bronchial carcinoma. It is important to recognise both the therapeutic and prognostic significance of this connection.

Thrombose in situ du moignon artériel pulmonaire après pneumonectomie.

Resume Introduction La pneumonectomie laisse en place un moignon d’artere pulmonaire plus long a droite qu’a gauche. Le cul-de-sac vasculaire ainsi forme peut etre le siege de la constitution, souvent tardive, d’un thrombus. La prevalence, les facteurs de risque et les consequences de ces thrombus sur moignon demeurent meconnus. Observations Nous rapportons trois cas de thrombose arterielle pulmonaire survenue apres pneumonectomie droite pour cancer bronchique. Le diagnostic a ete etabli par une tomodensitometrie thoracique realisee dans le cadre de la surveillance evolutive de la maladie neoplasique. Aucune complication embolique n’a ete observee malgre l’absence de traitement anticoagulant. Discussion La prevalence de cette complication est estimee a 12 %. La decouverte est souvent fortuite a l’occasion d’un scanner thoracique realise a titre systematique. Le thrombus prend l’aspect d’une lacune hypodense, a bord proximal net, convexe ou concave, moule par le produit de contraste et comblant le moignon. Une seule migration embolique est rapportee dans la litterature recente. L’evolution habituellement benigne n’incite pas a proposer d’anticoagulation systematique.

Micronodular pattern of organizing pneumonia: Case report and systematic literature review.

Rationale: Organizing pneumonia (OP) is a clinicopathological entity characterized by granulation tissue plugs in the lumen of small airways, alveolar ducts, and alveoli. OP can be cryptogenic (primary) (COP) or secondary to various lung injuries. Patient concerns: We report the case of a 38-year-old male smoker with COP presenting in the form of diffuse micronodules on computed tomography (CT) scan and describe the clinical, radiological, and functional characteristics of micronodular pattern of organizing pneumonia (MNOP) based on a review of the literature including 14 cases. Patients were younger (36.3 ± 15.5 years) than those with the classical form of OP. The clinical presentation was subacute in all cases with a mean duration of symptoms before admission of 14.5 ± 13.2 days. The radiological pattern was characterized by centrilobular nodules and “bud-in-tree” sign in 86.7% of patients. The diagnosis was based on histological examination of transbronchial (28.6%) or surgical biopsies (71.4%). Diagnosis: An associated condition was identified in 65% of cases and included illicit substance abuse (44.5%), myeloproliferative disease (33.5%), and infections (22%). Outcomes: Steroid therapy was effective in all patients with improvement of symptoms and documented radiologic resolution. No relapse was recorded. Lessons: MNOP should be recognized and distinguished from other diagnoses, mainly infectious bronchiolitis and disseminated tumor, as it requires early specific steroid therapy.

Sarcoïdose médiastinopulmonaire associée à une hémorragie intra-alvéolaire

Introduction La sarcoidose est une granulomatose systemique d’etiologie inconnue. Les formes associees a une hemorragie intra-alveolaire sont exceptionnelles. Observation Les auteurs rapportent un cas de sarcoidose aigue chez un homme jeune, caucasien, ayant une exposition a la fumee de tabac et de cannabis. Le scanner thoracique revele des adenopathies mediastinales associees a des masses alveolaires predominant dans les regions superieures des deux champs pulmonaires. L’aspect macroscopique du lavage bronchiolo-alveolaire et la formule cytologique sont compatibles avec une hemorragie intra- alveolaire. En raison de la survenue d’une insuffisance respiratoire aigue, un traitement par corticoides par voie intraveineuse a ete debute entrainant une rapide amelioration clinique et gazometrique. La mediastinoscopie a permis d’etablir le diagnostic de sarcoidose sur la presence de nombreux granulomes epitheloides et gigantocellulaires. Conclusion Cette observation est l’occasion d’une revue de la litterature sur les formes de sarcoidose associees a la survenue d’une hemorragie intra-alveolaire.