ABSTRACT
We report the case of a 79-year-old man for whom investigations of superior vena cava syndrome have revealed extramedullary plasmocytoma. Extramedullary plasmocytoma (EMP) is the less frequent form of plasma cell neoplasms. The mediastinal location of EMP is rare, and its compressive nature is exceptional. Another particular feature we observed is that the EMP was associated with an authentic kappa light chain multiple myeloma.
Subject(s)
Mediastinal Neoplasms/complications , Plasmacytoma/complications , Superior Vena Cava Syndrome/etiology , Aged , Humans , Immunoglobulin kappa-Chains/metabolism , Male , Mediastinal Neoplasms/diagnosis , Multiple Myeloma/complications , Multiple Myeloma/diagnosis , Multiple Myeloma/immunology , Multiple Myeloma/metabolism , Plasmacytoma/diagnosis , Radiography, Thoracic , Superior Vena Cava Syndrome/diagnosisABSTRACT
Whereas synchronous lung cancer is rare, synchronous small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) are exceptional. The authors report the case of a 61-year-old man with synchronous unilateral adenocarcinoma and small cell lung cancer, raising the question as to the need for the histology of all of the lesions in the same lobe or same lung as well as the treatment. The medical history, biology, CT and (18)F-FDG TEP-CT did not support a diagnosis of synchronous lung cancer. The prognosis was poor and only surgery could improve the prognosis. This is a rare case and illustrates the difficulty in the diagnosis of multiple lung cancer and the difficulty in treating synchronous lung cancer with different histologies (SCLC and NSCLC).
Subject(s)
Adenocarcinoma/pathology , Carcinoma, Small Cell/pathology , Lung Neoplasms/pathology , Neoplasms, Multiple Primary/pathology , Biomarkers, Tumor/analysis , Biopsy , Bronchoscopy , Diagnosis, Differential , Fluorodeoxyglucose F18 , Humans , Image Processing, Computer-Assisted , Lung/pathology , Lymphatic Metastasis/pathology , Male , Middle Aged , Neoplasm Staging , Positron-Emission Tomography , Tomography, X-Ray ComputedABSTRACT
Primary pulmonary malignant melanoma is rare (0.01% of pulmonary cancers); only 25 cases are published in the literature. The diagnosis of primary pulmonary malignant melanoma is controversial, the pathogenesis is unknown and a pulmonary metastasis from a mucocutaneous melanoma is the main differential diagnosis. The diagnosis is based on the strict application of the Jensen criteria published in 1967. We report the case of an asymptomatic 82-year-old man presenting with a fortuitously discovered primary pulmonary malignant melanoma according to the Jensen criteria and treated by lobectomy (cT1N0M0). Surgery seems to be the gold standard treatment on account of the poor sensitivity of melanoma to chemotherapy and radiotherapy. Surgical resection and the absence of nodal involvement suggest a good prognosis even though the small number of cases does not produce useful statistical data. This observation raises the question of (18)FDG CT-PET in this situation, particularly of the whole body, by extrapolation from the recommendations in mucocutaneous melanoma. The lack of increased uptake on (18)FDG CT-PET could be a new paraclinical diagnostic criterion to add to the clinical criteria of Jensen. This report is the first, which shows the results of (18)FDG CT-PET (standard and whole-body) under this situation.
Subject(s)
Lung Neoplasms/pathology , Lung Neoplasms/secondary , Melanoma/pathology , Melanoma/secondary , Skin Neoplasms/pathology , Aged, 80 and over , Diagnosis, Differential , Fluorodeoxyglucose F18 , Humans , Image Processing, Computer-Assisted , Lung/pathology , Lung Neoplasms/diagnostic imaging , Lymph Nodes/pathology , Male , Melanoma/diagnostic imaging , Positron-Emission Tomography , Skin Neoplasms/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
We report a 27-year-old man who presented with a Lemierre's syndrome associated with two uncommon complications: a septic sternoclavicular joint arthritis and a cavitating pneumonia.
Subject(s)
Arthritis, Infectious/microbiology , Fusobacterium Infections/complications , Fusobacterium Infections/diagnosis , Fusobacterium necrophorum/isolation & purification , Jugular Veins , Pneumonia/microbiology , Sternoclavicular Joint , Upper Extremity Deep Vein Thrombosis/microbiology , Adult , Anti-Bacterial Agents/therapeutic use , Clarithromycin/therapeutic use , Fusobacterium Infections/drug therapy , Humans , Male , Pneumonia/pathology , Rare Diseases , Severity of Illness Index , Syndrome , Treatment OutcomeABSTRACT
Emmonsia crescens is a saprophytic fungus that is distributed worldwide, causing diseases mostly in rodents. It has also been described, though rarely, as an etiologic agent of pulmonary pathology in humans, potentially leading to death. A case of pulmonary adiaspiromycosis is reported in a 30-year-old immunocompetent man. The patient presented with a history of several weeks of weakness, cough, fever, and weight loss of 10 kg. Clinical and radiographic findings showed pulmonary lesions consistent with tuberculosis or histoplasmosis, but no pathogen was found with classical microbiological procedures. The diagnosis of adiaspiromycosis due to Emmonsia crescens was initially made using molecular biology techniques. Histological observations subsequently confirmed the presence of adiaspores in granulomas. To our knowledge, this is the first case of adiaspiromycosis diagnosed by PCR and sequencing. The patient was treated with itraconazole and was seen at 1 month with symptomatic improvement. Here we will discuss this rare fungal infection and its difficult treatment and diagnosis. As represented in this case, molecular biology is a powerful method to optimize diagnostic tests and therefore improve the care of the infected patient.
Subject(s)
Chrysosporium/isolation & purification , Lung Diseases, Fungal/diagnosis , Adult , Animals , Antifungal Agents/therapeutic use , Chrysosporium/genetics , DNA, Fungal/chemistry , DNA, Fungal/genetics , France , Humans , Itraconazole/therapeutic use , Lung/pathology , Lung Diseases, Fungal/microbiology , Lung Diseases, Fungal/pathology , Lung Diseases, Fungal/physiopathology , Male , Molecular Sequence Data , Radiography, Thoracic , Sequence Analysis, DNAABSTRACT
Mycobacterium kansasii is one of the main mycobacterial species. Among the numerous subtypes, I and II subtypes are the only pathogens ones. A 56 years old woman has been under observation during her hospitalization for a cervical adenitis check-up; these one having been evolving for 2 months, without inflammatory syndrome. The failures of various antibiotics treatments lead one to withdraw some cervical ganglions whose histopathologic aspect reminds tuberculosis. These adenitis being isolated. An INH, rifampin, and ethambutol associated treatment is set up. After 2 weeks, the different cultures enable to isolated numerous photochromogenic colonies; a positive result is obtained with M. kansasii probe (Accuprobe). The identification is confirmed in 24 hours time with another molecular hybridation test (INNO-LiPA V2); the various specific probes of the different M. kansasii subtypes show it's not a I or II subtype (subtype IV by sequence analysis). This observation underlines the advantage and rapidity of the new diagnosis methods for nontuberculous mycobacterial diseases.
Subject(s)
Cervix Uteri/microbiology , Lymphadenitis/microbiology , Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium kansasii , Uterine Cervical Diseases/microbiology , Diagnosis, Differential , Female , Genetic Markers , Humans , Mycobacterium Infections, Nontuberculous/genetics , Reagent Kits, DiagnosticABSTRACT
Technological progress and numerous published studies allow to estimate the best place of the 18F-fluorodeoxyglucose positron emission tomography, a real functional metabolic imagery, in the clinical and therapeutic strategy of non small cell lung cancers.
Subject(s)
Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Fluorodeoxyglucose F18 , Lung Neoplasms/diagnostic imaging , Positron-Emission Tomography , Radiopharmaceuticals , Carcinoma, Non-Small-Cell Lung/secondary , Humans , Neoplasm Staging , Patient Care PlanningABSTRACT
18FDG-PET scanning enables the imaging of metabolic activity giving an assessment of the local extent of thoracic malignancies as well as an indication of the presence of nodal or metastatic spread. This enables more accurate staging and has revolutionised the management of lung cancer. National and international guidelines describe the role of this technique.
Subject(s)
Lung Neoplasms/diagnostic imaging , Positron-Emission Tomography , HumansABSTRACT
"Whole body" FDG-PET usually covers the body from the base of the skull to the upper third of the thighs, arms in abduction. Thus, the upper part of the head and the lower limbs are not included in the acquisition field. We report the cases of three patients with non-small-cell lung cancer who developed secondary distal localizations beyond the acquisition field of "whole body" FDG-PET. Lung cancer is known to favor hematogenic dissemination, raising the possibility of early distal metastasis. A pretherapeutic PET scan which includes the extremities can be useful to search for distal extension. These true whole body scans are time consuming and can thus limit machine availability. Furthermore, the diagnostic yield of this type of examination may be low since it can be estimated that about 1% of patients will develop isolated distal metastases (3 out of 293 patients in our series initially treated for non-metastatic non-small-cell lung cancer). In the current context of technical availability, systematic inclusion of the lower limbs in the PET scan acquisition field would not appear warranted for the initial work-up of patients with non-small-cell lung cancer. However, clinicians must be aware that distal metastases (brain, lower limbs) may not be detected.