Bilateral pleural metastases of a primary central nervous system neuroblastoma in an adult: First case in the world.

Primary central nervous system neuroblastoma (PCNS-NBL) is a rare and aggressive malignant tumour. Pleural metastases of PCNS-NBL have not been documented before. We report a case of a 30-year-old male patient, with a history of PCNS-NBL treated with surgery, radiation and chemotherapy. Three years later, he presented an aggravated dyspnoea with impaired general condition. The different investigations confirmed that his PCNS-NBL has relapsed with bone, lymph nodes and bilateral pleural metastases. Because of the disseminated disease and the poor general condition of the patient, only symptomatic treatment measures were preconized. The patient died 3 months later following cardiorespiratory arrest. To the best of our knowledge, this is the first case reporting bilateral pleural metastases of a PCNS-NBL in a young adult.

Inflammatory myofibroblastic tumor of the lung: A rare entity.

Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor usually seen within the first and second decade. They are extremely rare in adults, constituting less than 1% of adult lung tumors. It's usually benign, but it had a tendency for local recurrence. We report a case of asymptomatic inflammatory myofibroblastic tumor of lung in a 46-year-old non-smoker woman.

A Rare Case of Haemoptysis Revealing Aortic Coarctation in an Adult.

Haemoptysis is a frequently occurring but sometimes life-threatening condition. Congenital cardiovascular abnormalities are rare causes of haemoptysis. We report a case of a 33-year-old man without any past medical history complaining of haemoptysis with no other associated clinical manifestations. A contrast-enhanced chest computed tomography scan revealed aortic coarctation with dilation of the internal mammary, intercostal and bronchial arteries. He underwent stent placement after balloon angioplasty with favourable outcomes. LEARNING POINTS: Adult patients with congenital cardiovascular abnormalities such as aortic coarctation may rarely, due to the high pressure and dilation in the bronchial arteries, present with recurrent haemoptysis as the sole clinical sign.A multidetector computed tomography scan contributes significantly to the aetiological diagnosis of haemoptysis in cases of congenital cardiovascular abnormalities.Interventional procedures such as stenting are currently the preferred approach for the treatment of aortic coarctation in adults, with good outcomes.

Mounier-Kuhn syndrome: A variable course disease.

Mounier-Kuhn syndrome or tracheobronchomegaly is a rare disease characterized by marked dilation of the trachea and proximal bronchi with recurrent lower tract respiratory infections. Computed tomography and bronchoscopy are the key tools to accomplish the diagnosis. This is a condition with a clinical polymorphism, symptoms vary from minor with preserved respiratory function, to very severe with life threatening exacerbations leading to respiratory failure and premature death. The treatment is mainly symptomatic, stenting or surgery are reserved to extreme cases.Herein, we report two cases of the same condition with different clinical signs and diverse outcome.

Pleural effusion revealing a ruptured mediastinal mesothelial cyst.

Mesothelial cysts are uncommon benign cysts of the mediastinum. Rarely, they are discovered after complications or unusual presentations. This report describes a rare case of pleural effusion revealing a ruptured mediastinal mesothelial cyst in a 28-year-old man. The diagnosis of this complicated mesothelial cyst relied on intraoperative and anatomopathological findings. He underwent videothoracoscopy with resection of the cyst. Outcomes were favourable.

Transudative chylothorax in liver cirrhosis; an underappreciated entity.

Chylothorax is a rare pathology with potentially severe consequences. Transudative chylothorax remain an extremely rare entity. Cirrhosis is often an underappreciated cause. We report a case of transudative chylothorax in 62-year-old woman with cirrhosis due to hepatitis C.

Thyroid metastasis revealing a lung adenocarcinoma.

Thyroid metastasis revealing a primary lung cancer is an extremely rare condition. Only few cases have been reported in the literature. A multidisciplinary approach is essential for the diagnosis. The prognosis is generally poor. We report a case of a 50-year-old man presented with cervical nodules corresponding to a thyroid nodule and lymph nodes. The ultrasonography-guided fine-needle aspiration cytology of the thyroid nodule and a cervical lymphadenopathy concluded to a poorly differentiated adenocarcinoma. Cervical lymphadenopathy biopsy with immunohistochemistry and additional imaging explorations contributed to the diagnosis of a lung adenocarcinoma stage IVB. He died few days after the diagnosis.

[Survival and prognostic factors of non-small-cell lung cancer among young people in central Tunisia]. / Survie et facteurs pronostiques du cancer bronchique non à petites cellules chez le sujet jeune au centre tunisien.

INTRODUCTION: Non-small cell lung cancer (NSCLC) is a public health problem that usually affects the elderly. Currently and for some years now, this disease is increasingly affecting the young population. The purpose of this study was to analyze the features of NSCLC in young subjects and to assess survival as well as the various prognostic factors. METHODS: We conducted a retrospective study of all patients under the age of 50 years treated in the Department of Pneumology at the Fattouma Bourguiba University Hospital, Monastir for NSCLC. Survival and prognostic factors have been analyzed according to Kaplan Meier method. RESULTS: The average age of patients was 43.8 ± 5.29 years. The most common histological type was lung adenocarcinoma (66.1%). NSCLC was discovered at an advanced or metastatic stage in 79.7% of cases. The median overall survival was 8 ± 0.72 months. Univariate analysis showed that survival was significantly influenced by patients' general status, assessed according to the "Performance Status (PS)" index of the World Health Organization on admission, tumor stage and CRP concentrations. Multivariate analysis was performed, which enabled us to use PS index ≥ 2 and high CRP concentrations as factors of poor prognosis. CONCLUSION: Despite the therapeutic progress, prognosis in young subjects with NSCLC is poor. Early diagnosis and management can improve survival in these patients.

Rare case of vascular ring with Kommerell diverticulum mimicking uncontrolled asthma.

Anomalies of the aortic arch associated with Kommerell diverticulum (KD) are rare congenital malformations. Symptomatic thoracic vascular rings presenting in adults are rare. We report a case of a 39-year-old woman who was diagnosed with uncontrolled asthma. She was complaining of worsening respiratory symptoms with dysphagia. Imaging studies and preoperative findings concluded to type II congenital anomaly of the aortic arch or Neuhauser's anomaly: a right-sided aortic arch with aberrant left subclavian artery, tracheoesophageal compression by KD and ligamentum arteriosum (LA). This compression was relieved by the resection of the LA and KD.

Choroidal metastasis as the initial presentation of lung adenocarcinoma: A case report.

Clinical reports of symptomatic choroidal metastasis as the initial presentation of lung cancer are rare. Here, we report such a presentation in a female patient of non small cell lung cancer. She presented with loss of vision in her left eye. On further analyses, the patient was diagnosed with a lung adenocarcinoma.

Rare case of cavernous hemangioma of the thymus.

Cavernous hemangioma (CH) of the thymus is an extremely rare congenital venous malformation. Related symptoms are non-specific and patients are often asymptomatic. The diagnosis is difficult to make either by non-invasive or mini-invasive procedures. Surgical resection is usually required for diagnosis and treatment. We report a case of a 46-year-old men with an incidental finding of an anterior mediastinal tissue mass on chest computed tomography scan. A complete surgical resection of the mass was performed. Histopathological examination concluded to a thymic CH.

Rare case of primary extranodal marginal zone lymphoma of the thorax.

Primary lymphoma presenting a solitary lesion of the chest wall is extremely rare, as the majority of chest-wall tumors arise from metastasis. We report a case of a 64-year-old man with no history of HIV infection or pyothorax who presented with dry cough, right pleuritic pain and dyspnea. A computed tomography scan revealed an irregular pleural mass invading his right chest wall with pleural effusion. CT-guided needle biopsy revealed extranodal marginal zone B-cell lymphoma. The patient was treated with chemotherapy and radiotherapy. The patient has 9 years of follow up with 2 relapse's episodes.

Predictive factors of severe asthma in women.

INTRODUCTION: Severe asthma is an uncontrolled asthma despite an optimal treatment. The aim of this study was to determine predictive factors of severe asthma in Tunisian asthmatic women. METHODS: A retrospective study including 910 women followed for asthma at pneumology department during a period of 10 years. We compared 2 groups: Patients with severe asthma and asthmatic patients without severe asthma. This comparison was based on demographic, clinic and functional criteria. A multivariate logistic regression study enabled to identify predictive factors of severe asthma in women. RESULTS: In univariate analysis, significant predictive factors of severe asthma were: Late age of asthma diagnosis, advanced age of asthma onset, obesity, aspirin intolerance, gastro esophageal reflux (GERD) symptoms and ventilator disorder at spirometry. The main predictive factors of severe asthma in a logistic regression analysis were GERD symptoms (p=0, 02) and ventilatory deficit: Lower forced expiratory volume in 1 second (FEV) (p=0,002) and reduced FEV/CVF (forced vital capacity) (p<10-3). CONCLUSION: Knowledge of the predictors of severe asthma in women enables optimization of patients care and help to prevent this form of asthma.