[Pulmonary intralobar sequestration in adults: Evolution of surgical treatment]. / Séquestrations pulmonaires intralobaires de l'adulte : évolution du traitement chirurgical.

BACKGROUND: Until now, the traditional procedure to treat intralobar pulmonary sequestration (ILS) in adults has been a lobectomy performed by open thoracotomy. We have reviewed our data to observe if the surgical management of these lesions has evolved over the last years. METHODS: We retrospectively reviewed the records of the patients who were operated for an ILS either by posterolateral thoracotomy (PLT group), or by thoracoscopy (TS group) between 2000 and 2016. RESULTS: Eighteen patients were operated for a SIL during this period. Prior to 2011, all resections were performed by thoracotomy (n=6) and after 2011 the surgical approach was either a thoracotomy (n=5) or a thoracoscopy (n=7). There was one conversion because of dense pleural adhesions and this patient was integrated in the PLT group for further analysis. ILS were more frequently encountered on the left side (n=12, 66.6 %) than on the right one (n=6, 33.3 %) and exclusively in the lower lobes. All patients of the PLT group underwent a lobectomy. In the TS group, 5 patients underwent a sublobar resection (2 segmentectomiesS9+10, 1 basilar segmentectomy and 2 atypical resections). There was no mortality. In the PLT group, 5 patients (45 %) had complications versus one patient (14 %) in the TS group. The mean hospital stay was 7.4 days in the PLT group versus 5.4 days in the TS group. CONCLUSIONS: These data confirm that ILS can be safely treated by a sublobar resection that should be performed, whenever possible, thoracoscopically.

[Surgical treatment of early stage non-small cell lung cancer by thoracoscopic segmental resection]. / Traitement chirurgical des cancers bronchiques non à petites cellules (CBNPC) de stade précoce par segmentectomie à thorax fermé : résultats préliminaires.

The rate of segmental resection for early stage non-small cell lung carcinoma (NSCLC) is increasing. However, the indications remain controversial. The aim of this study is to analyze the preliminary results of thoracoscopic segmental resection in early stage NSCLC in terms of morbidity, oncological validity and survival. We report the preliminary results of a consecutive series of 226 thoracoscopic segmentectomies for suspicion of early stage NSCLC. PATIENTS AND METHODS: Between 2007 and 2016, we performed 322 thoracoscopic anatomical sublobar resections (ASLR). Two hundred and twenty six of these were for suspicion of early stage NSCLC in 222 patients. Data were recorded prospectively and analysed retrospectively on an intent-to-treat basis. Overall and disease-free survivals were estimated on a Kaplan-Meier curve and differences were calculated by a log-rank test. RESULTS: Twenty-two patients were upstaged (10.4%), in 10 cases to T3 or T4, in 6 cases to N1 and in 6 others to N2 for metastasis. Out of the 6 N1 cases, 3 were discovered at frozen section and resulted in a switch from segmentectomy to lobectomy. There were 10 conversions to thoracotomy (3.9%). Seventeen patients had a more extensive resection than initially planned (7.5%), most often for oncological reasons: invasion of intersegmental lymph nodes (n=3) or insufficient resection margin at frozen section (n=7). Morbidity and mortality were 25.7% and 1.3 % respectively. For pT1aN0 carcinomas, overall and disease-free survivals were 87.1% and 80.6%, respectively. For pT1bN0 carcinomas, overall and disease-free survivals were 88.8 %, and 75.3% respectively. CONCLUSION: For early stage NSCLC, thoracoscopic ASLR allows reduced perioperative morbidity while offering satisfactory survival. However, a rigorous technique must be applied to reduce the rates of conversion to thoracotomy and extension to lobectomy when required for oncological reasons.

Identification of CD245 as myosin 18A, a receptor for surfactant A: A novel pathway for activating human NK lymphocytes.

CD245 is a human surface antigen expressed on peripheral blood lymphocytes, initially delineated by two monoclonal antibodies DY12 and DY35. Until now, CD245 molecular and functional characteristics remained largely unknown. We combined immunological and proteomic approaches and identified CD245 as the unconventional myosin 18A, a highly conserved motor enzyme reported as a receptor for the surfactant protein A (SP-A), that plays a critical role in cytoskeleton organization and Golgi budding. We report that the recruitment of CD245 strongly enhanced NK cell cytotoxicity. Further, we show that the enhancement of the NK lymphocytes killing ability toward CD137-ligand expressing target cells could result from the induction of CD137 expression following CD245 engagement. The SP-A receptor could therefore represent a novel and promising target in cancer immunotherapy.

[Intrapulmonary bronchogenic cysts]. / Kystes bronchogéniques intrapulmonaires.

INTRODUCTION: Bronchogenic cysts are congenital malformations that are usually located in the mediastinum. Intrapulmonary location is rare. OBSERVATION: Four cases of intrapulmonary bronchogenic cysts are reported in order to discuss their clinical and radiological presentation and their treatment. CONCLUSION: Intrapulmonary bronchogenic cysts diagnostic is often missed. This condition must however be known so as to foresee a resection in order to prevent a potential complication.

[Cystic mediastinal schwannoma appended to the vagus nerve]. / Schwannomes kystiques du médiastin développés au dépend du nerf vague.

INTRODUCTION: Schwannomas are a form of rare tumor, arising from neural tissue and representing 2 % of mediastinal tumors. They are usually located in the posterior mediastinum, most often in the paravertebral gutters and typically appended to intercostal nerves. CASE REPORTS: We report two cases of unusual mediastinal schwannomas, appended to the vagus nerve. The schwannoma was located in the subcarinal region in the first case and in the right para-tracheal region in the second case. The lesions were thought to be bronchogenic cysts preoperatively in both cases because of a cystic appearance on preoperative CT scan and endobronchial ultrasonography. A surgical approach was adopted to remove the tumors. Video-assisted thoracoscopy was used in one case and robotic-assisted surgery in the second case, without any complication, allowing for complete resection and to establish a certain pathological diagnosis. CONCLUSION: Despite this location and cystic presentation being unusual, schwannoma should be considered as a possible cause of cystic lesions in the mediastinum. Minimally invasive surgery allows for complete resection and definitive pathological diagnosis.

[Double bronchogenic cyst]. / Double localisation d'un kyste bronchogénique.

Bronchogenic cysts are rare congenital malformations of the tracheobronchial tree and are mostly found in an intrathoracic location. We report a very rare case of a double location - cervical and mediastinal - in a young female patient.

[Spontaneous regression of epithelial thymic tumours]. / Tumeurs épithéliales thymiques de régression spontanée.

INTRODUCTION: Spontaneous regression of an epithelial thymic tumour has been reported but seems extremely rare. Its mechanism is unknown. CASE REPORT: We report two cases of epithelial thymic tumour, either histologically proven or highly suspected on imaging, that regressed spontaneously (partially in one patient and totally in the other). CONCLUSION: Spontaneous regression of an epithelial thymic tumour is very rare but this possibility could lead to clinical and radiological monitoring rather than surgery in selected patients.

Visceral lesions occurring during follow-up of melanoma patients: a true place for other diagnosis than melanoma metastasis.

BACKGROUND: Diagnosis of melanoma metastasis is often based on a combination of clinical and radiological examinations in patients with a past history of melanoma. Chemotherapeutic treatment is often proposed without histological proof of the metastatic status. OBJECTIVE: The aim of this study was to investigate a cohort of melanoma patients with invasive diagnostic procedures (IDPs) for pathological confirmation of metastasis in case of suspicious visceral lesions. METHODS: A total of 109 melanoma patients with IDPs for suspicious visceral lesion(s) were included. Data about primary melanoma, IDPs characteristics, pathological result and therapeutic consequence were collected. Patients with AJCC Stage I-III melanoma at the time of the IDP were statistically analysed for various characteristics according to the final diagnosis yielded by the IDP. RESULTS: A total of 64 diagnostic surgical resections, 38 CT-guided core-needle biopsies, 15 ultrasound-guided core-needle biopsies, 6 surgical biopsies and 6 per-endoscopic biopsies were performed. Main target organs were the lungs (43.5%), breasts (8.5%) and liver (8%). IDPs were well tolerated and provided adequate samples for reliable diagnoses. Among the 105 IDPs in stage I-III patients, 56 melanoma metastases (53%), 25 benign lesions (24%) and 23 other cancers (22%) were found. One IDP was not informative. Multivariate analysis showed that nodular type of the primary melanoma, time-lag between primary melanoma and IDP over 12 months and the presence of suspicious lesions outside the organ biopsied were significantly associated with melanoma metastasis diagnosis. CONCLUSION: Suspected melanoma metastasis was ruled out for benign lesion or second cancer in nearly half of the stage I-III patients having undergone an IDP, therefore modifying the medical treatment.

Fully endoscopic major pulmonary resection for stage I bronchial carcinoma: initial results.

INTRODUCTION: Several case-series studies of major pulmonary resection (MPR) by video-assisted thoracic surgery (VATS) for non-small-cell lung cancer (NSCLC) have been published, but fully endoscopic MPR is still very rarely performed. Our objective here was to report the outcomes in 71 patients recently managed using fully endoscopic MPR for NSCLC. METHODS: From 2007 to 2009, 635 patients with NSCLC underwent MPR (pneumonectomy, lobectomy or segmentectomy). Among them, 71 (11%) had features strongly suggesting clinical stage I NSCLC and were managed by fully endoscopic MPR, with no utility incision. Lobectomy was performed in 63 patients and segmentectomy in eight patients. Conversion to thoracotomy was required in two (2.8%) patients, because of a fused fissure in one and tight pleural adhesions in the other. Radical lymphadenectomy was performed in all patients. RESULTS: Of the 69 patients managed endoscopically, none died and none experienced intraoperative complications. Mean operating time was 226±38 minutes (range, 137-307 minutes) and mean intraoperative blood loss was 111±93mL (range, 0-450mL). The final histological examination showed stage I NSCLC in 52 patients, NSCLC with node involvement in nine patients (pN1 in 6 and pN2 in 3) and other types of malignancies in eight patients. Mean number of nodes removed was 21±8 after right-sided lymphadenectomy and 23±8 after left-sided lymphadenectomy and the mean number of dissected node sites was 3 (range, 2-5). The postoperative morbidity rate was 23%. Mean postoperative hospital stay length was 6.9±2 days (range, 3-12). CONCLUSION: Fully endoscopic MPR is safe and meets the criteria for oncological surgery.

[Congenital bronchial atresia in adults]. / Atrésie bronchique congénitale de l'adulte.

Congenital bronchial atresia is a rare congenital obliteration of a segmental or lobar bronchus resulting in distension of the corresponding parenchyma. It is seldom diagnosed in the adult. It may lead to infectious complications and, in the long term, to damage to the adjacent lung parenchyma. A surgical resection is necessary and it can be achieved by thoracoscopy. We report a recent series of six patients.

[Pleuropulmonary involvement leading to bilateral pneumothorax in a patient being treated for rheumatoid arthritis]. / Atteinte pleuropulmonaire conduisant à un pneumothorax bilatéral chez une patiente traitée pour une polyarthrite rhumatoïde.

INTRODUCTION: Rheumatoid arthritis (RA) is a systemic illness where the development of pulmonary nodule has been described in from 4 to 20% of patients. Symptomatic pleural manifestations occur in 3 to 5% of cases. Rarely, pulmonary nodules become necrotic and lead to pleural complications. Bilateral pneumothorax has only rarely been described. CASE REPORT: We report the case of a 64-year-old woman, who had been treated for RA for several years and presented with bilateral pneumothorax secondary to necrobiosis of one or several pulmonary rheumatoid nodules. The management of the pneumothorax was very prolonged and difficult, and despite surgical pleurodesis, the lung did not reexpand fully. Pathological examination of the pleura revealed a noncaseating granulomatous pattern. The diagnosis of a sarcoidosis like disease, possibly induced by anti-TNFα, or of pleural tuberculosis were suggested, but we concluded that the final diagnosis was of pleural rheumatoid involvement. CONCLUSION: Bilateral pneumothorax secondary to rheumatoid nodule is a rare entity. The management of such a complication is difficult, particularly in patients who receive an immunosuppressant regimen. A granulomatous pattern has been described rarely in the pleural tissue of these patients. Specific RA pleural involvement has to be taken in consideration when other diagnoses are eliminated, especially tuberculosis or sarcoidosis-like disease.

Apical parietal pleural holes: what are they?

We report the incidental discovery of an apical pleural abnormality characterized by the presence of pleural holes during video-thoracoscopic surgery for upper limb hyperhidrosis. Patients were 4 males and one female with a median age of 24 years. These pleural anomalies were left sided in all cases with a maximum diameter of 5 mm. One of the defects was double. There was neither air leakage nor water leakage after irrigation. Our hypothesis is that the revealed pleural defect is a precursor of cervical lung hernia.

[Accessory spleens after splenectomy in a patient with common variable immunodeficiency]. / Rates accessoires après splénectomie pour thrombopénie immunologique chez un patient ayant un déficit immunitaire commun variable.

INTRODUCTION: Blood cells are mainly destroyed in the spleen during autoimmune cytopenia. Amongst the various therapeutic strategies, splenectomy is sometimes necessary during the disease course. However, splenosis or accessory spleens can account for autoimmune cytopenia relapse after initial splenectomy in these patients. CASE REPORT: We report an 18-year-old male with common variable immunodeficiency who presented with immunological thrombocytopenia. Splenectomy allowed remission of cytopenia, but a relapse was attributed to splenosis, because Jolly bodies were absent on blood smear. Laparoscopic splenectomy of accessory spleens induced long term remission. A literature review is performed. CONCLUSION: Fifteen to 20% of relapses of autoimmune cytopenia treated by splenectomy are related to accessory spleens. Ablation of accessory spleens can cure again the patients, including patients with accompanying common variable immunodeficiency.

[Totally endoscopic major pulmonary resection for stage I bronchial carcinoma: initial results]. / Résections pulmonaires majeures par voie totalement endoscopique pour carcinome bronchique de stade I: résultats initiaux.

INTRODUCTION: Several series of video-assisted (VATS) major pulmonary resection (MPR) for non small cell bronchial carcinoma (NSCBC) have been published recently. However, totally endoscopic MPR is still very uncommon. We report the initial results of a recent series of 71 patients. METHODS: From 2007 to 2009, 635 patients had a major pulmonary resection (pneumonectomy, lobectomy or segmentectomy) for NSCBC. Seventy-one out of these patients (11%) in whom a clinical stage I NSCBC was strongly suspected were operated on via a totally endoscopic approach, without mini-thoracotomy or utility incision. Sixty-three had a lobectomy and 8 a segmentectomy. There were 2 conversions to thoracotomy (2.8%), for a fused fissure (1 patient) and for tight pleural adhesions (1 patient). The resection was completed by a radical lymphadenectomy in all patients. RESULTS: For the 69 patients who had a totally endoscopic procedure, there was no mortality. No intraoperative complications occurred. The mean duration of operation was 226 minutes + or - 38 (range: 137-307 minutes). The mean intraoperative blood loss was 111 cc + or - 93 (range: 0-450 cc). Final pathological examination confirmed stage I NSCBC in 52 patients while 9 NSCBC were upstaged pN1 (n = 6) or pN2 (n = 3). In 8 cases, another type of malignant tumour was found. The mean number of lymph nodes collected was 21 + or - 8 after right-side lymphadenectomy and 23 + or - 8 after left-side lymphadenectomy and the mean number of dissected lymph node stations was 3 (range:2-5). Postoperative morbidity was 23%. The mean postoperative stay was 6.9 days + or - 2 (range: 3-12 days). CONCLUSIONS: MPR via a totally endoscopic approach is safe and fulfils the criteria for an oncological resection.

[Atmospheric air pollution and lung cancer: epidemiologic data]. / Pollution atmosphérique et cancer bronchique: données épidémiologiques.

INTRODUCTION: Much has been written about the short term effects of air pollution on health. In contrast, long term effects, which may be highly significant such as lung cancer, have been addressed in only a few cohort studies. STATE OF THE ART: Long term effects of air pollution on mortality have been evaluated in three American and three European prospective cohort studies. These studies consistently demonstrate associations between ambient fine particulate air pollution and elevated risks of both cardiopulmonary and lung cancer mortality. They indicate that diesel exhaust especially contributes to the human lung cancer burden. PERSPECTIVES AND CONCLUSIONS: Although long-term health effects of air pollution are of relatively small magnitude at the individual level when compared to that of tobacco smoking, their consequences are considerable in terms of public health.

[Benign schwannoma with high uptake of 18 fluorodeoxglucose (PET-Scan)]. / Un cas de schwannome bénin avec hypermétabolisme sur la tomoscintigraphie TEP au 18fluorodésoxyglucose.

INTRODUCTION: In patients with a previous history of malignancy, the occurrence of a mediastinal mass with significant uptake of 18 Fluorodeoxyglucose on a PET-scan may lead to biopsy or resection. CASE REPORT: We report the case of a posterior mediastinal mass, with significant uptake of 18 Fluorodeoxyglucose on PET- scan, in a patient with a previous history of testicular seminoma. The lesion was actually a benign schwannoma. CONCLUSIONS: In the case of a mediastinal mass with conventional imaging being in favour of a neurogenic tumour a PET scan cannot confirm benignity or malignancy.

[Full thoracoscopic lobectomy and segmentectomy for benign or metastatic conditions]. / Lobectomies et segmentectomies par thoracoscopie exclusive pour pathologie bénigne ou métastatique.

INTRODUCTION: Several techniques for video-assisted pulmonary lobectomy have been reported. However full thoracoscopic lobectomy, i.e., without the help of a utility incision has seldom been performed. We report our results based on a series of resections for benign or metastatic conditions where mediastinal lymphadenectomy is not indicated. PATIENTS AND METHODS: Fifty-six patients (29 males and 27 females) with a mean age of 46 years (range: 8-82 years) had an attempted major pulmonary resection (54 lobectomies and 2 segmentectomies) via thoracoscopy alone for either a benign lesion (30 cases) or a metastasis (26 cases). RESULTS: There was no operative mortality. Six patients required conversion to thoracotomy (11%). In the 50 remaining patients who underwent an exclusively thoracoscopic operation, there was 1 intra-operative complication that was managed thoracoscopically. The duration of the procedure ranged from 65 to 230 minutes (mean: 157 minutes). Intra-operative blood loss was 55 cc (range: 0 to 200 cc) in the "metastasis group" and 109 cc (range: 0 to 280 cc) in the "benign lesion group". There were 5 postoperative complications (10%). Postoperative duration of stay ranged from 3 to 15 days (Mean: 6.7 days). All patients were seen at the first postoperative month and no clinical or radiological complication was noticed. CONCLUSION: Full thoracoscopic lobectomies are feasible and safe provided appropriate equipment is used and the surgical team is experienced in endoscopic surgery.

[Pleural diffusion of amoxicillin 1 and vancomycin in patients treated for post-surgical empyema]. / Empyème après chirurgie d'exérèse pulmonaire: étude de la diffusion pleurale de l'amoxicilline et de la vancomycine.

INTRODUCTION: Treatment of post surgical thoracic empyema consists of chest tube drainage, antibiotic administration, and in some cases surgical lavage of infected spaces. Data in human on the diffusion of antibiotics in pleural cavity after post surgical empyema are lacking. METHODS: We studied on 9 patients with post surgical thoracic empyema (including 6 pneumonectomy) the diffusion of 2 antibiotics commonly used in this situation: amoxicillin (for 7 patients) and vancomycin (for 2 patients). Antibiotics concentrations were measured after at least 3 days of treatment (3-12 days), in order to reach a plateau concentration in the pleural space. RESULTS: The ratio pleural/plasma antibiotic concentration was 1.96 (range: 0.6-4.9). The pleural infection was cured for 8 on 9 patients. The last patients required thoracostomy, and the outcome was favorable after this procedure. CONCLUSION: That the penetration of amoxicillin and vancomycin in pleural space after post surgical empyema is good. Pleural antibiotics concentrations are in the majority of cases higher than plasmatic concentrations.