Recurrence of Cervical Squamous Cell Carcinoma After More Than 4 Years in the Lung: A Rare Case Report.

Cervical squamous cell carcinoma (CSCC) is a common gynecological malignancy, typically affecting women of reproductive age. Although the occurrence of late metastatic recurrence in the lung is relatively rare, we present the case of a 52-year-old woman, previously diagnosed and treated for CSCC. After 4 years of disease-free intervals, she presented with respiratory symptoms, including cough, dyspnea, and hemoptysis, with marked asthenia. A computed tomography (CT) scan of the chest revealed a lung mass. Histopathological examination of the lung biopsy confirmed the recurrence of CSCC, specifically in the lung. Immunohistochemistry further supported the origin of the tumor as cervical. The management of such cases necessitates a multidisciplinary approach, considering treatment options such as surgery and chemoradiation. Long-term follow-up and surveillance are vital for the early detection of late recurrences, as they can present several years after the initial diagnosis. This case report highlights the importance of recognizing and appropriately managing cases of late metastatic recurrence of CSCC in the lung. Further studies are needed to deepen our understanding of the underlying mechanisms, refine diagnostic approaches, and optimize treatment strategies for such rare occurrences.

Functional characterization of small and large alveolar macrophages in sarcoidosis and idiopathic pulmonary fibrosis compared with non-fibrosis interstitial lung diseases.

BACKGROUND: Sarcoidosis is a granulomatous disease that mostly affects the lungs. Advanced tissue injury caused by this disease can progress to pulmonary fibrosis with similar characteristics shared with idiopathic pulmonary fibrosis (IPF). The initial presentations of both sarcoidosis and IPF may be shared with other interstitial lung diseases (ILDs). Two populations of macrophages have been described in the alveolar space: small alveolar macrophages (AMs) and large alveolar macrophages. Despite their protective function, these cells may also play a role in the initiation and maintenance of inflammation leading to fibrosis. OBJECTIVE: The aim of this study was the functional characterization of small and large AM subpopulations in sarcoidosis and IPF as a pathology with respectively mild and advanced tissue injury causing fibrosis, in comparison with non-fibrosis ILDs. METHODS: Activation and adhesion surface markers as well as functions of small and large AMs isolated from bronchoalveolar lavage (BAL) were assessed by Flow Cytometry within patients with confirmed sarcoidosis (n= 14), IPF (n= 6), and non-fibrosis ILDs (n= 9). RESULTS: Our results showed that small AMs are immunologically more active, which may be important for airway inflammation. They are also proportionally more abundant in IPF, and therefore they may be more involved in a fibrosis process associated with the down-regulation of HLA-DR, LeuCAM, and CD62L expression. In Sarcoidosis, the inflammatory process appears to be associated with up-regulation of CD38 expression and oxidative burst activity. CONCLUSION: A relevant potential of the activation and adhesion markers as well as oxidative burst activity expressed on small and large AMs, in the perspective of differential diagnosis of sarcoidosis and IPF.

Assessment of the Association of Chlamydia e pneumoniae Infection with Lung Cancer in a Moroccan Patients' Cohort.

BACKGROUND: Chlamydia pneumoniae (C. pneumoniae) is a respiratory pathogen associated with chronic inflammatory and its detection in human lung cancer suggests its involvement in cancerogenesis. Our study aimed to evaluate the association between C. pneumoniae  infection and Lung Cancer disease in Moroccans patients and control cohorts, through a molecular investigation. METHODS: The study comprised 42 lung cancer patients and 43 healthy controls. All participants provided demographics, Clinical, and Toxic behaviors datas, and a peripheral blood sample for testing, a Nested Polymerase Chain Reaction (PCR) was performed for C. pneumoniae Deoxyribonucleic acid (DNA) detection. Statistical analysis was performed using IBM®SPSS®software. RESULTS: Positive Nested PCR results for cases and controls were respectively 33.3% and 4.7%, there by  significant difference between cases and controls   infection was identified (p <0.05). Data analysis also showed that tobacco could act synergically with C. pneumoniae infection as a risk factor of lung cancer. In fact a significant difference between patients and controls was shown for tobacco and alcohol use (p < 0.05). CONCLUSION: C. pneumoniae infection is potentially associated with primary Lung cancer in the Moroccan population and has combined effects with Tabaco consumption.

Mammary sarcoidosis: A rare case report.

Introduction: Sarcoidosis is an inflammatory, systemic, idiopathic disease characterized by multisystem involvement, of which mediastinal and pulmonary involvement is the most frequent. Mammary sarcoidosis is exceptional. Case presentation: We report the case of a 50-year-old, diagnosed with mediastinal and mammary sarcoidosis. Therapeutic abstention with clinical and radiological surveillance was recommended. The evolution was marked by a clear improvement (clinical and radiological). Discussion: Mammary sarcoidosis is a rare anatomical and clinical entity which poses a problem of differential diagnosis with other granulomatous diseases and especially with breast carcinoma. The coexistence of systemic manifestations should lead to the discussion of sarcoidosis. Conclusion: Mammary sarcoidosis involvement is rare and is manifested by a mass with a smooth or spiculated border, requiring the exclusion of malignancy.

Unexplained Pleural Effusion Leads to the Revelation of a Malignant Mesothelioma: A Case Report.

Malignant mesothelioma is a rare and aggressive cancer that usually affects subjects with prior asbestos exposure, a major risk factor that has been widely known as carcinogenic, and its use is now controlled if not banned in many areas of the world. Malignant mesothelioma originates from mesothelial surface cells covering the serous cavities, and the pleura is its most common site. Malignant pleural mesothelioma (MPM) typically presents with pleural effusion and chest wall pain with wide pleural thickening at radiological investigation. Although the histological examination along with immunohistochemistry helps yield the diagnosis, clinicians and experts face many challenges in diagnosing malignant mesothelioma not only due to the rarity of the disease but also due to the similarities that the disease share with other malignancies. Here, we report a case of a 55-year-old male patient with a history of chronic asbestos work exposure for 12 years who initially presented with unexplained pleural effusion and chest wall pain and was lost to follow-up but came back later with a worsening clinical state. This case is specially presented to raise awareness against cases of unexplained pleural effusion and chest pain.

Exceptional association of hepatic and pancreatic tuberculosis mimicking metastatic pancreatic neoplasia: A case report and review of the literature.

Introduction: Despite the high prevalence of tuberculosis in the world and especially in endemic areas such as Morocco, isolated hepatic and pancreatic tuberculosis and pancreatic tuberculosis remain rare and pose a real diagnostic problem. Case presentation: We report a case illustrating an exceptional association of pancreatic tuberculosis with hepatic tuberculosis in a 44-year-old immunocompetent woman, in whom the presence of a pancreatic mass on imaging suggested a neoplastic origin. The diagnosis was rectified after bacteriological and pathological study of the CT-guided percutaneous biopsy specimens. Discussion: The symptomatology of pancreatic and hepatic tuberculosis is unspecific and polymorphic and can mimic any intra-abdominal pathology. Abdominal ultrasound is often the first imaging modality used. The diagnosis of certainty is bacteriological.The treatment of pancreatic and hepatic tuberculosis is identical to the other extrapulmonary tuberculosis. the anti-bacillary drugs are the gold standard. Surgery is reserved for complicated forms. Conclusion: The diagnosis of hepatic and pancreatic tuberculosis is a challenge for the clinician. The treatment is usually medical and based on antituberculosis treatment; surgery may be necessary in case of complications.

Macrophagic activation syndrome revealing disseminated multifocal tuberculosis: A case report of a rare clinical situation.

Introduction: Macrophage activation syndrome (MAS) is a rare but serious entity, sometimes triggered by an infectious agent, in particular by certain viruses or mycobacteria. Forms of tuberculosis complicated by MAS frequently occur in immunocompromised subjects. The disease is often disseminated, severe, and has a poor prognosis. Case presentation: We report a case of MAS complicating disseminated tuberculosis and revealing HIV in a previously healthy young patient. Discussion & conclusion: The management of macrophage activation syndrome related to tuberculosis is complex and not codified. On the one hand, the immunosuppressive treatment allows to slow down the macrophage activation syndrome and obtain a correction of cytopenia. On the other hand, there is a risk of aggravating tuberculosis by increasing the patient's immunodepression.

Vascular thromboses with retroperitoneal fibrosis: a case report.

BACKGROUND: Granulomatosis with polyangiitis is a systemic inflammatory disease characterized by necrotizing vasculitis that affects small- and medium-sized blood vessels. Granulomatous inflammation affects the lungs, ears, nose, and throat, and commonly affects the kidneys, although the retroperitoneal tissue is rarely affected. Several studies have reported an increased risk of venous thromboembolism. Early diagnosis and treatment are of vital importance due to the rapid progression of the disease. CASE PRESENTATION: We present the case of a 66-year-old Moroccan man followed for bilateral jugular thrombosis. Cavitary pulmonary nodules and retroperitoneal fibrosis with thrombosis involving several vascular territories were detected on thoracoabdominopelvic computerized tomography scan. Laboratory analyses revealed that the patient was positive for cytoplasmic antineutrophilic antibodies. The diagnosis of granulomatosis with polyangiitis was retained. Treatment with glucocorticoids and immunosuppressive agents resulted in significant clinical and radiological improvement over the following months. CONCLUSIONS: We describe the diagnostic steps and the difficulty of managing this patient. Rare manifestations, such as retroperitoneal fibrosis, have been reported in the literature in association with granulomatosis with polyangiitis, and should not delay the diagnosis and treatment of granulomatosis with polyangiitis owing to its severity.

Painful testicular swelling: an unusual localization of sarcoidosis.

Sarcoidosis is a systemic inflammatory disease characterized by non-caseating epitheloid granulomas; whereas it usually involves the lungs and lymph nodes. Testicular sarcoidosis is extremely rare, having been reported to occur in 0.2% of all sarcoidosis patients. We describe a very unusual form of sarcoidosis of the testis, mimicking malignancy at initial presentation.

Simultaneous Association of Pulmonary Tuberculosis and Kaposi's Sarcoma in an Immunocompetent Subject: A Case Report and Literature Review.

Kaposi's Sarcoma (KS) occurs as a pathological entity that may be classified into four different types: classic, endemic, epidemic, and iatrogenic. It can arise among HIV-positive subjects or within immunosuppression, yet exceptionally of tuberculous origin. We describe a new case report of an HIV-negative patient, manifesting Kaposi's disease in the course of tuberculosis, with the aim to assess this uncommon disorder and to outline this rare atypical association.

Contribution of Imaging in Diagnosis of Primitive Cyst Hydatid in Unusual Localization: Pleura-A Report of Two Cases.

Hydatic disease has always been the most common in countries where large amount of sheep and cattle is raised, but increased travel and immigration have made this condition a serious worldwide public problem. Cyst hydatid may affect all parts of the human body like the heart, the bone marrow, the eye, the brain, the kidney, and the spermatic cord. Humans can become infested by accidentally ingesting the eggs that are passed in the feces from definitive hosts (usually a canid, such as a wolf, fox, or dog). Even in endemic countries, the primitive pleural hydatid cyst is exceptional, and it is very difficult to distinguish from other pleural and parietal cystic masses especially that in majority of cases the immunologic tests are negative. We report two cases of pleural hydatid cyst discovered in two young patients, with a nonspecific clinical presentation. The interest of this paper is to raise the primordial role of imaging in the positive diagnosis of primary pleural hydatid cyst.

Primary Pleuropulmonary Synovial Sarcoma: A Case.

Primary pleuropulmonary synovial sarcoma is extremely rare. The diagnosis can only be made after having eliminated an extrapleuropulmonary localization in the past and at the time of diagnosis. Our presentation is about a 40-year-old woman having a cough and dyspnea since three weeks ago; imaging had showed a left pleurisy with pleuropulmonary process. Histological study of the biopsy confirmed the diagnosis of pleuropulmonary synovial sarcoma. PET-SCAN had not identified any extrathoracic localization. This tumor is known for its aggressive nature and high risk of metastasis. Its primitive character is retained following a diagnostic procedure of exclusion. Surgical treatment remains the best therapeutic tool when it is technically feasible; otherwise the prognosis is often unfortunate. In this paper, we report a case of primary pleuropulmonary synovial sarcoma. Through this case, we present a rare disease that is often difficult to diagnose.

[Spontaneous hemothorax: a rare complication of neurofibromatosis type 1]. / Hémothorax spontané: complication rare de la neurofibromatose type 1.

Neurofibromatosis type 1 (NF1), also known as Von Recklinghausen's disease is an autosomal dominant genetic disorder. It is the most common of phacomatoses. Pulmonary complications have been rarely described in the literature. Vascular complications have been reported in 3.6% of patients. We here report the case of a 38-year old female patient, followed-up for neurofibromatosis type 1, admitted to the Emergency Department with hemorrhagic shock. Clinical examination showed several coffee-with-milk colored spots, many plexiform neurofibromas, left-sided pleural effusion syndrome. Pleural puncture objectified coagulable haemorrhagic fluid. The patient received transfusion and emergency chest drainage. Patient's assessment was completed by angioscanner which showed no pulmonary embolism or other associated lesions. Spontaneous hemothorax is a rare and severe complication of neurofibromatosis. It is probably due to vascular injury caused by this disease.

[Pulmonary nocardiosis in immunocompetent patients: about 2 cases]. / Nocardiose pulmonaire sur un terrain immunocompétent: à propos de 2 cas.

Nocardiosis is a rare but severe infection caused by bacteria of the genus nocardia, which belong to the order actinomycetales. If they can affect immunocompetent adult, nocardioses are pathologies affecting the individuals with weakened immune system. Pulmonary involvement is the most common manifestation, its correct management is based on diagnosis, which is often delayed due to non-specific symptoms and inconclusive specimens. We here report two cases of nocardiosis in immunocompetent patients. The first case concerns a 24-year old man with a history of smoking and alcoholism, hospitalized for chest pain and hemoptysis of low abundance evolving for two months, associated with the occurrence of dorsal subcutaneous fistulized abscess. Radiological assessment showed right mediastino-pulmonary tissue mass associated with adjacent costal lysis and dissemination in rights paravertebral tissues. Bacteriological sampling remained negative motivating ultrasound-guided biopsy of the lesion, which confirmed the diagnosis of nocardia infection. The second case concerns a 22-year old man with a history of pleural tuberculosis treated 8 years ago and of relapse of tuberculosis in 2011 (mediastinal abscess). He was admitted to hospital due to suspicion of relapse of tuberculosis based on chronic cough with alteration of general state and hepatosplenomegaly. Chest CT scan showed alveolar condensations with pleurisy. During his hospitalization, purulent subcutaneous swellings occurred. Bacteriological analysis of the pus confirmed the diagnosis of nocardiosis. Nocardia strains were resistant to all antibiotics except for colistin and bactrim. This study aims to highlight the clinical and radiological aspects of pulmonary nocardiosis, focusing on diagnostic and therapeutic difficulties especially in a country with a high prevalence of tuberculosis and a very low incidence of nocardiosis.

[Initial manifestation and atypical site for metastatic synovial sarcoma in an immunocompetent adult patient: about a case and literature review]. / Mode révélateur original et localisation métastatique particulière d'un synovialo-sarcome chez un adulte immunocompétent: à propos d'un cas avec revue de la littérature.

Synovial sarcoma (SS) is a rare tumor. It is characterized by various sites of occurrence but rarely involves the chest. The tumor may be wrongly diagnosed as benign due to its slow growth. Less than 10% of patients present with metastatic cancer. Endobronchial metastases are exceptional. Immunohistochemical examination and cytogenetic analysis allow to distinguish it from other mesenchymal tumors. The presence of SYT-SSX fusion transcript allows the diagnosis. Surgery is used for localized tumors that can be treated with radiation therapy while chemiotherapy is used for metastatic tumors. The average rate of locoregional or metastatic recurrence two years after SS is 50%. We report the case of a 28-year old patient with metastatic SS characterized by its uncommon metastatic site. He presented with endobronchial metastasis revealing his disease, that had evolved for more than 2 years. The SS is life-threatening due to its slow and insidious growth. Prognosis is guarded. This study aimed to emphasize this atypical site for metastatic synovial sarcoma as well as to insist on the role of early diagnosis and treatment.

[The tree that hides the forest: aspergillosis associated with bronchial carcinoma (about two cases)]. / L'arbre qui cachait la forêt: aspergillose sur carcinome bronchique (à propos de deux cas).

Endobronchial aspergilloma and intracavitary pulmonary aspergilloma may clinically and radiologically mimic a bronchial neoplasia, hence the importance of systematically searching for an association. A confirmed association completely changes the prognosis as well as the therapeutic approach. We here report two cases with two different forms of pulmonary aspergilloma associated with bronchial carcinoma.

[Myocardial tuberculoma: unusual location of tuberculosis: a new observation and review of the literature]. / Tuberculome myocardique: localisation inhabituelle de la tuberculoseà propos d'une nouvelle observation avec une revue de la littérature.

We report the case of a 50-year old patient with a left ventricular tumor whose evolution was marked by impaired general condition and fever. This mass was objectified by echocardiography performed to explore a radiological cardiomegaly. The imaging (MRI) appearance was suggestive of an intra-myocardial tuberculoma Based on our observations, we propose a review of the literature on this unusual location of tuberculosis.

[Endobronchial aspergilloma revealing a bronchial carcinoma]. / Aspergillome endo-bronchique révélant un carcinome bronchique.

Endobronchial aspergillosis is a rare presentation of pulmonary aspergillosis in immunocompetent patients; this raises questions about structural changes inducing airflow stasis in order to colonize the bronchial lumen. We present the case of a patient diagnosed with endobronchial aspergilloma covering a bronchial adenocarcinoma.

First line anti-tuberculosis induced hepatotoxicity: incidence and risk factors.

In our days, tuberculosis, whet ever its localization, became a curable disease. The cornerstone is a 6 month course of isoniazid, rifampicine and pyrazinamide. All of the three first line antituberculosis drugs may induce hepatic damage which may have negative consequences for treatment outcome. Several risk factors were associated with the development of antituberculosis- drug-induced hepatotoxicity (ATDH). A retrospective study was conducted from July 2014 to March 2015 regarding all therapeutic drug-monitoring requests sent to the Laboratory of Poison Control and Pharmacovigilance Centre of Morocco. 142 patients diagnosed with active tuberculosis were included in study. Plasma peak levels of isoniazid, rifampicin and pyrazinamide were analyzed in plasma samples after 2 to 3 hours of administration of anti-tuberculosis treatment. Logistic regression was used to identify the ATDH risk factors. The incidence of ATDH was found 24.6% (35 patients out of 142). Intergroup differences in the plasma levels were statistically significant for isoniazid (p=0.036). ATDH was found to be associated with combined form of anti-TB drugs (p=0.002, COR=13.1, AOR= 13.5) and plasma concentration of INH superior to 2mg/l (p=0.045, COR=1.3, AOR= 1.4).age, gender, alcohol intake and smoking status were not significantly associated with ATDH. The finding of 24.6% incidence of hepatotoxicity is extremely high. Many factors can be associated with the development of ATDH such as genetic factors, combined forms of treatment and plasma peak levels.

A leech at the aerodigestive crossroads.

We report a case of hemoptysis observed in a 32-year-old man with an uneventful past history. Flexible bronchoscopy demonstrated presence of a leech attached to the laryngeal orifice. This condition is common in endemic areas but is underdiagnosed. The association of hemoptysis, voice alterations, and difficult respiration are suggestive signs. Extraction should be achieved rapidly to avoid death from asphyxiation or acute respiratory failure.