[Acanthosis nigricans over the face revealing primitive bronchial adenocarcinoma: about a case]. / Acanthosis nigricans du visage révélant un adénocarcinome bronchique primitif: à propos d'un cas.

We here report a case of bronchial cancer revealed by acanthosis nigrigans affecting the face. This rare mode of revelation may precede diagnosis of underlying neoplasia by several months . This study highlights the importance of suspecting primary lung cancer in patients with acanthosis nigrigans.

Prevalence and risk factors for latent tuberculosis infection among healthcare workers in Morocco.

Increased prevalence of latent tuberculosis infection (LTBI) has been observed among high-risk populations such as healthcare workers (HCWs). The results may depend on the method of LTBI assessment, interferon-gamma release assay (IGRA) and/or tuberculin skin test (TST). Here, we investigated the prevalence and risk factors for LTBI assessed by both IGRAs and TST in HCWs living in Morocco, a country with intermediate tuberculosis (TB) endemicity and high BCG vaccination coverage. HCWs were recruited in two Moroccan hospitals, Rabat and Meknes. All the participants underwent testing for LTBI by both IGRA (QuantiFERON-TB Gold In-Tube, QFT-GIT) and TST. Different combinations of IGRA and TST results defined the LTBI status. Risk factors associated with LTBI were investigated using a mixed-effect logistic regression model. The prevalence of LTBI among 631 HCWs (age range 18-60 years) varied from 40.7% (95%CI 36.9-44.5%) with QFT-GIT to 52% (95%CI 48.2-56.0%) with TST using a 10 mm cut-off. The highest agreement between QFT-GIT and TST (κ = 0.50; 95%CI 0.43-0.56) was observed with the 10 mm cut-off for a positive TST. For a definition of LTBI status using a double positive result for both QFT-GIT and TST, significant associations were found with the following risk factors: being male (OR = 2.21; 95%CI 1.40-3.49; p = 0.0007), belonging to age groups 35-44 years (OR = 2.43; 95%CI 1.45-4.06; p = 0.0007) and even more 45-60 years (OR = 4.81; 95%CI 2.72-8.52; p = 7.10-8), having a family history of TB (OR = 6.62; 95%CI 2.59-16.94; p = 8.10-5), and working at a pulmonology unit (OR = 3.64; 95%CI 1.44-9.23; p = 0.006). Smoking was associated with LTBI status when defined by a positive QFT-GIT result (OR = 1.89; 95%CI 1.12-3.21; p = 0.02). A high prevalence of LTBI was observed among HCWs in two Moroccan hospitals. Male gender, increased age, family history of TB, and working at a pulmonology unit were consistent risk factors associated with LTBI.

Unusual mode of presentation of intrathoracic bronchogenic cyst: A double location.

A 63 year old woman presenting chronic back pain and neuralgia had abnormal shadow on chest radiograph. She has a history of pulmonary tuberculosis treated in 1977. The chest-CT scan showed a soft tissue mass in the lower lobe of the right lung and a cystic mass in the paravertebral region. The patient had right lower lobectomy and complete excision of a paraoesophageal cyst. Both masses were bronchogenic cysts at histology. The patient had an uneventful discharge the seventh postoperative day. After 4 years and 7 months of follow-up with CT-scann, the patient was free of symptoms with no evidence of recurrent disease.

Malignant melanoma of the lung: a case report.

Primary melanoma of the lung is an extremely rare pathological entity and sparsely reported in the literature. A 68-year-old man was admitted with 3 months history of cough, sputum production, dyspnea, hemoptysis and chest pain. The chest radiography demonstrated bilateral mass lesion and thoracal computerized (CT) showed a bilateral tissu mass with left parietal invasion. Bronchoscopy revealed a large polypoidal tumor arising from the left lower lobe bronchus, histology at bronchial biopsy revealed a malignant melanoma. Surgical biopsy of the left parietal mass was confirmed by invasive malignant melanoma. Primary melanoma of the lung represents a rare pathological entity; careful interpretation of histopathological information in correlation with all other findings from clinical studies can establish a diagnosis.

Intrathoracic extrapulmonary hydatid cysts.

Hydatid disease caused by echinococcus granulosus is still a serious problem in both underdeveloped and developing countries. Clinical signs of the disease are not specific. Most patients have a few symptoms when a hydatid cyst is discovered. Symptoms depend on its location, size and complications. Parasite can settle in every organ and tissue in the human body. We report two cases with intrathoracic extrapulmonary hydatid cyst with multiple cysts. Pathophysiology of the mode of dissemination, and surgery are discussed.

Diffuse large B-cell lymphoma presenting as large anterior chest wall mass involving pleura and lung: A possible result of post-traumatic chronic inflammation.

A 67 year-old-man was hospitalized due to chronic pain and a large mass on the anterior chest wall. His medical history showed chest trauma in 1970, the reconstitution of the scenario revealed there was blunt trauma with swelling and rib fracture on the same side. Physical examination revealed an isolated large anterior chest wall mass. Chest radiography showed two bilateral irregular masses, chest computed tomography showed a large right chest wall tumor with pleural effusion, nodules of the right upper lobe and tumor of the left lower lobe without mediastinal lymphadenopathy. Whole body exploration showed only the chest disease. Transthoracic biopsy showed inflammatory reaction. Surgical biopsy by anterior thoracotomy of the right mass was performed under general anesthesia. Histological and immunohistological analysis revealed lymphoid diffuse large cell proliferation with positive staining of CD 20, BCL-6 and MUM1, confirming the diagnosis of diffuse large B-cell malignant lymphoma. Chemotherapy based on CHOP-21 (cyclophosphamide, doxorubicin, vincristine, and prednisolone) was administered with good response after three cycles. The patient was discharged under surveillance in good condition after the end of chemotherapy. We report an infrequent neoplasm with an unusual and subtle clinical presentation.

A well-differentiated fetal adenocarcinoma of the lung with early local recurrence after limited resection.

A 42-year-old man was found to have an abnormal shadow during a systematic physical examination. Computed tomography of the chest revealed a mass in the lateral segment of the left lower lobe with parietal contact without pleural effusion or mediastinal lymphadenopathy. Bronchoscopy showed inflammation at the pyramid basal bronchus without visualization of hydatid materials or bud tumor. The hydatid serology, testing for myobacterium tuberculosis in sputum and the histological finding of bronchial biopsy, were negative. Initial surgery of a posterolateral thoracotomy showed a mass with soft consistency adherent to the parietal pleura on the seventh and eighth intercostal space. Because of the technical difficulties of extemporaneous examination, a limited resection was performed. The histopathological exam showed a well-differentiated fetal adenocarcinoma. The patient was re-operated on for complete resection 1 month and 20 days later, she was staged cT2N0M0. At exploration we discovered local recurrence with a 1.5 cm nodule in the same segment. An extended lower lobectomy to the seventh and the eighth rib was performed with lymphadenectomy. The patient was staged as Ib (pT2N0M0) with clear resected margins (R0). She was discharged in good condition from hospital 11 days postoperatively. Review at 2, 6 and 11 weeks showed no complications and chest radiograph revealed no anomaly. No adjuvant therapy was conducted and the patient is under surveillance.

Desmoplastic small round cell tumor of the pleura.

In July 2006 a 19-year-old woman presented with a history of few months of back ache. Routine chest radiograph and computed tomography (CT) examination revealed a thickening of the parietal pleura with a collapsed right lung. The abdominal pelvic CT scan was normal. Thoracotomy was performed with decortication lung, parietal pleurectomy and pleural biopsy. The histological examination and immunohistochemical coexpression of cytokeratin AE1-AE3, vimentin and desmin confirmed the diagnosis of desmoplastic small round cell tumor of the pleura. After resection, the patient received radiotherapy and chemotherapy with doxorubicin, ifosfamide, etoposide and cisplatin in six cycles which resulted in complete remission. The patient was seen regularly in consultation; the last examination was in December 2010 and clinically and radiologically showed a stable condition. The whole follow-up period was 53 months. We thought this case to be worth presentation because of the unusually long survival, which is probably due to the aggressive complex anticancer treatment.