[Primitive metastasizing bronchial carcinoid with long survival]. / Carcinoïde bronchique d'emblée multimétastatique et survie prolongée. Une entité anatomo-clinique peu connue: place de l'imagerie fonctionnelle.

BACKGROUND: Metastatic bronchial carcinoid tumours are rare but some patients have a prolonged survival. A new functional imagery now makes it possible to supplement the assessment of the extent of disease. OBSERVATION: A 57 year old patient was referred for dyspnoea on exertion revealing an upper left lobar tumour, with carcinoid syndrome. The assessment enabled to find out a bronchial carcinoid tumour with liver and bone metastases, highlighted by positron-emission tomography and pentetreotide SPECT. A chemotherapy proved to be ineffective and upper left lobectomy was carried out because of the risk of pulmonary atelectasis. The patient was treated by somatostatin analogues then underwent liver transcatheter arterial chemo-embolization. The patient was alive 44 months after diagnosis (56 months after first computed tomography). CONCLUSION: Metastatic bronchial carcinoid tumours are rare. They keep a metastatic potential, the histological type remaining the major prognosis factor. Carcinoid syndrome is suggestive. The assessment of extra-thoracic disease extent benefits by contribution of new functional imagery techniques such as the pentetreotide SPECT and positron-emission tomography. The management is essentially symptomatic since there is no effective chemotherapy. However survival can be prolonged, even in multimetastatic patients.

Elevated plasma level of lipotropin revealing an occult carcinoid tumor with normal plasma adrenocorticotropin.

The increases in the level of plasma lipotropin (LPH) and in the LPH/ACTH ratio are considered diagnostic tools in ectopic ACTH syndrome. However, plasma ACTH is also elevated in this syndrome. We report a case of a small carcinoid tumor with an increase in both ACTH and LPH in plasma before surgery. Eight months after the tumoral resection, plasma LPH alone was increased again, whereas plasma ACTH and plasma and urinary cortisol remained normal in this apparently cured patient. This repeated abnormality was the only available feature that allowed successful removal of the occult tumoral residue.

[Costal chondroma and chondrosarcoma]. / Chondromes et chondrosarcomes costaux.

The aim of this study was to report two cases of chondrosarcoma located on the chest wall, in order to emphasize the difficulty encountered by the pathologist to differentiate a chondrosarcoma from a chondroma and the importance, in our opinion, of performing a large resection with wide margins in all cases.

Bronchial stump aspergillosis.

Two cases of bronchial stump aspergillosis were diagnosed 5 and 6 years after pneumonectomy for lung cancer. In each case, the fungal mass was endoscopically removed using standard forceps. A recurrence of the fungal mass persisted until all visible protruding nylon threads in the airway lumen were destroyed with a Nd:YAG laser. Removal of the visible suture is necessary for eliminating the infection. No additional local or systemic antifungal therapy is needed.

Andrews thoracoplasty as a treatment of post-pneumonectomy empyema: experience in 23 cases.

BACKGROUND: Andrew's thoracopleuroplasty has been described for treating tuberculous empyemas with bronchopleural fistulas. We report on its utilization for treating postpneumonectomy empyemas. METHODS: During a 25 year period, 23 patients underwent thoracopleuroplasty for treating postpneumonectomy empyemas, after a period of drainage-irrigation of the cavity. Seven patients presented with persistent bronchial fistula at operation. After resection of the costal arches surrounding the infected cavity, the cavity was cleaned, and the external parietal plane was sutured to the mediastinal plane. Only drainage of the subscapular space was left in place. RESULTS: Postoperative mortality was 4.3%. Postoperative recovery was simple in 17 cases, whereas a superficial abscess was evacuated in 3 cases. The procedure failed in 3 cases, which were treated by open thoracostomy (2), and by reenlargment of the thoracopleuroplasty (1). The sequelae were mainly a diminution of the shoulder mobility, especially when the first rib was resected. CONCLUSIONS: Thoracopleuroplasty may safely treat postpneumonectomy empyemas, even those with bronchial fistulas. Most patients are definitively and rapidly cured with limited sequelae.

Scimitar syndrome with pulmonary arteriovenous fistulas.

Right abnormal pulmonary venous return into the inferior vena cava associated with abnormal fissure, dextrocardia, and systemic arterial supply of a variable degree, are the characteristics of the scimitar syndrome. We report on a patient in whom this rare syndrome was associated with pulmonary arteriovenous fistulas within the involved lung.

Desmoid fibromatosis of the shoulder and of the upper chest wall following a clavicular fracture.

A desmoid tumor of the shoulder girdle infiltrating the upper chest wall and weighing 1500 g was almost completely removed in an 18-year-old man, 27 months after a bifocal fracture of the clavicule. Thirteen years later, the patient was free of recurrence. The interval time between trauma and diagnosis, as the particular characteristics of aggressive fibromatosis, strongly support a major causal role of the clavicular fracture in the occurrence of this tumor.

[Pleural mesotheliomas. Current knowledge]. / Les mésothéliomes pleuraux. Revue d'actualité.

Pleural mesotheliomas are rare primary tumors of the pleura. Three groups are classified under the term mesothelioma: 1) benign pleural mesothelioma for which complete surgical treatment is curative with a good prognosis; 2) localized malignant mesothelioma which is a fibrosarcoma, best treated by wide en-bloc resection; 3) diffuse malignant mesothelioma which is mainly of epithelial type. The prognosis is poor in spite of all therapeutic approaches using irradiation, chemotherapy and surgery, alone or in combination, and long-term survivals are uncommon. Two surgical approaches are currently available for patients with diffuse mesothelioma: radical extrapleural pneumonectomy and pleurectomy/decortication. Rigorous combinations of multimodality therapy are needed to improve local control and survival.

[Pleural fibromas: a review based on 12 cases]. / Les fibromes pleuraux: mise au point à partir de douze observations.

The authors report 12 cases of pleural fibroma, which is a rare benign tumor, usually discovered incidentally. However, these tumors are sometimes associated with a paraneoplastic syndrome, or may lead to compressive symptoms related to their large size. Radical resection is mandatory because recurrence may occur, sometimes several years later with a malignant behavior. Long-term follow-up is therefore necessary to detect any recurrence, particularly when certain prognostic factors are initially present.

[Cystic lymphangioma of the mediastinum. Apropos of 3 cases, review of the literature]. / Les lymphangiomes kystiques du médiastin. A propos de trois cas, revue de la littérature.

Cystic hygromas are benign cysts frequently discovered incidentally on chest X ray films. Although CT scan provides helpful information about the size, density, and site of the cysts, it cannot establish a precise diagnosis concerning its nature. Complete removal of the cyst is the treatment of choice, and allows precise diagnosis on histological examination. However, surgical excision is sometimes difficult, due to the size and extension of the cysts, infiltrating mediastinal planes, enveloping great vessels, displacing mediastinal organs without invasion. The difficulty of completely eradicating certain cysts explains cases of insidious progression with compressive recurrence.