[Endobronchial presentation of an inflammatory myofibroblastic tumor]. / Présentation endobronchique d'une tumeur myofibroblastique inflammatoire.

INTRODUCTION: Inflammatory myofibroblastic tumors are a rare cause of primary lung tumors, most often solitary and in more than 50% of cases detected in individuals under 40 years of age. OBSERVATION: A 17-year-old patient consulted in pneumology for development of hemoptysis over a period of two weeks. Thoracic computed tomography revealed a left lower lobe cavity 24mm in diameter with bronchial fistulation and hydro-aeric level. Bronchial fibroscopy by mini-endoscope highlighted an endobronchial lesion in a subdivision of the sub-segmental posterior aspect of the left lower lobe. Paraclinical assessment highlighted a probable inflammatory myofibroblastic tumour. A surgical intervention was indicated and a lower left lobectomy performed. Histological analysis confirmed the presence of the tumour, which was resected in healthy margins by left lower lobectomy.

[Pulmonary nodules and arachnophobia]. / Nodules pulmonaires et arachnophobie.

Pulmonary nodules are a common reason for consultation and their investigation must always exclude a possible neoplastic cause. This means that, in addition to a thorough history, investigations may be necessary which are sometimes invasive and therefore potentially a cause of iatrogenic harm. The toxic aetiologies for pulmonary nodules are rare. We report a case of a patient with pulmonary nodules occurring predominantly in the right lung, about 1cm in diameter, non-cavitating without calcification, and sometimes surrounded by a peripheral halo. The nodules were a chance finding during preoperative evaluation. After a comprehensive review, a reaction to an inhaled irritant was the preferred hypothesis, specifically overuse of a compound insecticide containing, in addition to the propellant gas and solvent type hydrocarbon - a mixture of piperonyl butoxide, of esbiothrine and permethrin. Removal of this led to the complete disappearance of nodules. Pathological examination identified bronchiolitis obliterans with organising pneumonia accompanied by non-necrotizing granulomas and lipid vacuoles.

[Obliterative bronchiolitis with organising pneumonia following FOLFOX 4 chemotherapy]. / Bronchiolite oblitérante avec pneumonie organisée après chimiothérapie de type FOLFOX 4.

INTRODUCTION: FOLFOX 4 chemotherapy (5-fluorouracil, leucovorin and oxaliplatin) is the standard adjuvant treatment for stage III colon cancer. The principal secondary effects described are haematological, gastro-intestinal or neurological. A single case of obliterative bronchiolitis with organising pneumonia has been described recently. CASE REPORT: We report the case of a female patient aged 74 years who, after 12 courses of FOLFOX 4 chemotherapy, developed acute onset of severe shortness of breath and a dry cough but remained afebrile. A thoracic CT-scan showed symmetrical bilateral interstitial infiltration that was reticular in appearance, and predominantly basal and peripheral in distribution. Broncho-alveolar lavage revealed an alveolitis with 9% eosinophils and 4% neutrophils. Transbronchial biopsies showed the appearances of obliterative bronchiolitis with organising pneumonia. Systemic corticosteroid treatment led to a remarkable clinical and functional improvement. CONCLUSION: To our knowledge, this is the second case of obliterative bronchiolitis with organising pneumonia that has been described following adjuvant treatment based on FOLFOX 4.

Mesenteric liposarcoma or lipodystrophy: an elusive diagnosis.

Mass lesions of the mesentery may be fortuitously encountered on computerized tomographic (CT) scans, posing a diagnostic challenge. Despite CT, magnetic resonance (MR) imaging and a surgical biopsy, a patient with mesenteric lipodystrophy was misdiagnosed as having a low-grade mesenteric liposarcoma. Spontaneous regression of the mass on control CT scan and review of the pathological material prompted us to reconsider the diagnosis of malignancy. Because a wide variety of tumors and pseudotumors produce alterations in the density and volume of mesenteric fat on CT scan, a surgical biopsy is usually necessary to obtain a tissue-specific diagnosis, but even then pathological findings may be equivocal. As final resort the natural evolution assessed by radiological follow-up can be of help in determining the nature of the disease.