[Infectious pneumonia favored by paraneoplastic Cushing syndrome in a pulmonary carcinoid tumor]. / Pneumopathie infectieuse favorisée par un syndrome de Cushing paranéoplasique d'une tumeur carcinoïde pulmonaire.

INTRODUCTION: Ectopic Cushing's syndrome (CS) is a rare condition nevertheless well-known to endocrinologists. The pneumologist may be called upon to treat CS not only because bronchial carcinoid tumors are the most frequent source of ectopic ACTH secretion, but also due to the fact that the immunosuppression induced by hypercorticism favors lower respiratory tract infections. CASE REPORT: We report the case of a female patient presenting with acute respiratory failure secondary to Enterobacter cloacae pneumonia exacerbated by SC. Further investigations confirmed ectopic ACTH secretion and revealed a right upper lobe pulmonary nodule. After appropriate antibiotic therapy, the patient received preoperative adrenolytic treatment. Management by right upper lobectomy resulted in the extraction of a 12mm tumor. Pathological analysis was consistent with the diagnosis of a typical carcinoid tumor. Immunohistochemistry confirmed ACTH secretion by the tumor. Even though the postoperative course showed CS regression, the patient developed adrenal insufficiency. CONCLUSION: Ectopic CS induces immunosuppression, which aggravates lower respiratory tract infections. Search for a pulmonary neuroendocrine tumor should be systematic. Following control of the secretory syndrome by adrenolytic treatment, and if the diagnosis of carcinoid tumor is confirmed, surgical treatment is the preferred option.

[Face to a bilateral pneumothorax, just scratch your head!] / Devant un pneumothorax bilatéral, il faut bien se gratter la tête !

Head and neck skin angiosarcoma is a rare and aggressive tumor (1 % of head and neck tumors). Prognosis remains poor, with a 5-year survival rate ranging from 10 to 54%, depending on the initial stage. Metastatic disease markedly worsens the prognosis. Metastatic lung involvement is classic and can take on several forms. The cystic form is responsible for numerous complications, particularly pneumothorax. In this case, an 83-year-old patient was diagnosed with bilateral pneumothorax complicating cystic interstitial lung disease, which was revealed by hemoptoic sputum. Skin examination revealed two large necrotic lesions of the calvaria. Anatomo-pathological examination confirmed cutaneous angiosarcoma on both skin biopsy and lung resection. At a metastatic stage, only systemic treatment with paclitaxel can be proposed. The clinical course was unfavorable, leading to death before any specific treatment. This observation highlights the importance of a complete clinical skin examination in the assessment of pulmonary cystic lesions.

Cytokeratin-like proteins in the sheep oocyte.

In immunoblotting analysis of fully grown oocyte proteins separated by sodium dodecyl sulfate polyacrylamide (SDS-PAGE) gel electrophoresis, four polypeptides reacted specifically with cytokeratin antibodies: Mr 66,000, IEP 5.6; Mr 64,000, IEP 5.4; Mr 59,000, IEP 5.3; Mr 55,00, IEP 5.2. These proteins remained insoluble after extraction in high salt buffer and Triton X-100. In oocytes isolated from small antral follicles, only two polypeptides of Mr 66,000 and Mr 55,000 were detected. Immunofluorescence microscopy revealed a bright granular staining throughout the oocyte with an accumulation of granules in the perinuclear and cortical regions. Using electron microscopy and immunogold staining after treatment with cytokeratin antibody, gold particles were found on discrete amorphous material distributed throughout the cell. In the subcortical region of the oocyte, dense aggregates, whose diameters ranged from 3 to 8 microns, were also covered with gold particles. From these results it appears that cytokeratin-like proteins are present in sheep oocytes in a non-fibrillar form.