[A rare pulmonary lesion association]. / Une association lésionnelle pulmonaire rare.

INTRODUCTION: Pulmonary amyloidoma or nodular amyloidosis is a localized form of amyloidosis, which can mimic a bronchopulmonary carcinoma. This form of amyloidosis may be associated to an infectious, a systemic disease or a lymphoma. OBSERVATION: We describe the case of a 36-year-old patient whose past medical history was consistent for a diabetes mellitus and a hypothyroidism treated by medical treatment. The patient presented a Gougerot-Sjögren syndrome and was explored for non-specific respiratory symptoms. Physical examination was normal. Laboratory tests revealed a monoclonal pic of immunoglobulin. Radiologic findings showed bilateral pulmonary nodules associated to mediastinal lymph nodes. A pulmonary biopsy was performed. Histologic examination revealed a tumoral nodule containing an abundant eosinophilic material, which was acellular and surrounded by a dense lymphomatous infiltrate destroying the pulmonary parenchyma. Histochemical and immunohistochemical study revealed an association of a nodular pulmonary amyloidosis with a MAT pulmonary lymphoma complicating a Gougerot-Sjögren syndrome. CONCLUSION: The association of MALT pulmonary lymphoma and localized amyloidosis is rarely observed in case of Gougerot-Sjögren syndrome. The pathogenesis of this association remains unknown and the management non-consensual because of the rarity of the cases reported. Whereas, it appears that localized amyloidosis associated to a MALT lymphoma seems to have a better prognosis than a disseminated amyloidosis.

[Pain and primary lung cancer in the elderly]. / Douleur et cancer bronchopulmonaire primitif du sujet âgé

The study of pain in elderly patients with a primary lung cancer (PLC) deserves special attention particularly because this symptom is frequently associated with the condition and influences the management and prognosis. To study the characteristics of pain due to PLC in the elderly, we prospectively evaluated pain in all patients aged over 65 years admitted for PLC. Thirty-nine elderly patients were enrolled in 15 months (62% of all PLC). The average age was 72 years. The cancer was advanced NSCLC in most cases. Pain was present in 74.3%. It was significantly less common among those over 75 years (50% versus 85.1%; P<0.05). The pain, mild in most cases, worsened during follow-up in 55.5%. The last mean visual analogue scale score was significantly lower than the first (1.3 versus 3.6; P=0.001). The pain treatment required was based on level I in 20.6%, level II in 48.2% and level III in 31% of cases. Pain management in the elderly should be early, adequate and continued in order to preserve to a maximum the quality of life of these patients with PLC.

[Clinical characteristics of resected bronchial hamartoma. Study of seven cases]. / Particularités anatomocliniques des hamartochondromes endobronchiques opérés. Étude de sept cas.

INTRODUCTION: Endobronchial hamartoma is a benign tumour derived from peribronchial mesenchymal tissue. It is a form of intrapulmonary hamartoma and can cause irreversible pulmonary destruction due to bronchial obstruction. Early diagnosis and treatment is very important and endoscopic treatment is usually the first choice. In cases in which prolonged bronchial obstruction has produced irreversible lung destruction surgical, resection of the tumour is necessary. The aim of this study is to describe the clinicopathological characteristics of resected endobronchial hamartoma. PATIENTS AND METHODS: Seven cases of endobronchial hamartoma, diagnosed in our institution between January 1995 and December 2009, were reviewed retrospectively. RESULTS: The patient population consisted of four males and three females with mean age of 53.7 years (41-68 years). The most frequent clinical presentation was obstructive pneumonia. Endoscopy and imaging showed an endobronchial mass in most cases. Surgical treatment consisted of atypical resection in one case, lobectomy in five cases and pneumonectomy in one case. Tumour size ranged between 0.5 and 3.5 cm. The diagnosis was confirmed in all cases by histological examination. The outcome was favorable in all cases. CONCLUSION: Endoscopic techniques are effective for the diagnosis and treatment of endobronchial hamartochondroma. Treatment should be prompt to prevent irreversible lung damage due to chronic obstruction and suppuration, in which case, pulmonary resection may be necessary.

[Small-cell lung carcinoma: CT imaging features]. / Aspects tomodensitométriques du carcinome bronchique à petites cellules.

Small cell lung carcinoma (SCLC) typically is central in location. It is a very aggressive tumor characterized by its propensity for invasion of mediastinal structures, frequently, the ipsilateral pulmonary artery, multifocal nodal metastases and high frequency of distant metastases at initial presentation. CT is very sensitive and effective for local and regional staging. Combined with other diagnostic modalities, especially PET imaging, it allows whole body imaging for accurate staging, which is mandatory for therapeutic management. The different CT imaging features of SCLC and its more specific imaging characteristics will be reviewed in this article.

[Diagnostic difficulty in bronchopulmonary tuberculous pseudotumor]. / Difficulté diagnostique de la tuberculose bronchopulmonaire pseudotumorale.

Pseudotumour is a rare presentation of bronchopulmonary tuberculosis, occurring in immunocompetent patients, which simulates lung cancer and may thus cause diagnostic difficulty. To assess the frequency and clinical features of tuberculous pseudotumour in immunocompetent patients, we analyzed all cases of pulmonary tuberculosis hospitalized in our department. Tuberculous pseudotumour was defined by the presence of a bronchial or pulmonary lesion suggestive of lung cancer. Over a period of 11 years, 12 cases of tuberculous pseudotumour were collected among 341 cases of pulmonary tuberculosis (3.5%). Mean age was 45 years. All patients were smokers. Symptoms were not specific and were dominated by cough and chest pain. Radiological investigations showed consolidation in five cases and a mass lesion in five cases. Fibreoptic bronchoscopy visualized a tumour in four cases and stenosing bronchial wall infiltration in one case. Mean delay to diagnosis was 47 days. The confirmation of tuberculosis was bacteriologic in only three cases but histological in the others (four bronchial biopsies, two transbronchial biopsies, one pleural biopsy, four surgical specimen). The positive diagnosis of tuberculous pseudotumour is difficult because the clinical and radiological presentation may closely mimic lung cancer, especially as the cases are usually smear negative, leading to a very late diagnosis.

[Primary mediastinal sarcomas]. / Les sarcomes primitifs du médiastin.

INTRODUCTION: Primary sarcomas of the mediastinum are rare and account for 2 to 8% of malignant mediastinal tumours. The aim of this study is to describe their clinical and pathological characteristics. PATIENTS AND METHODS: Fifteen cases of primary mediastinal sarcoma, diagnosed between 1993 and 2009, were reviewed retrospectively, noting the clinical, radiological and pathological findings, and the treatment given. RESULTS: The patient population consisted of eight females and seven males with mean age of 40 years (14 to 73 years). The symptomatology was predominately respiratory. Imaging showed a mediastinal mass invading adjacent organs in nine cases. The diagnosis was made in all cases by histological examination. These 15 mediastinal sarcoma comprised 12 malignant peripheral nerve tumours, two liposarcomas and one angiosarcoma. Three were grade III, six grade II and six grade I. Ten were treated surgically, of which seven had radical resections. Associated treatments were neoadjuvant (one case) or adjuvant (one case) chemotherapy and postoperative radiotherapy (five cases). Radiotherapy was undertaken alone in three inoperable tumours. Eight patients (53%) had died. CONCLUSION: Management of primary mediastinal sarcoma needs a multidisciplinary approach, and is based mainly on radical resection. The prognosis is poor and depends mainly on surgical excision and histological grade.

Desmoid-type chest wall fibromatosis. A six cases series.

PURPOSE OF THE STUDY: Desmoid-type fibromatosis is a fibroblastic proliferation that develops in the deep soft tissues and is characterized by infiltrative growth and a tendency towards local recurrence but does not metastasize. Fibromatosis of the chest wall is rare, representing only 10 to 20% of all deep fibromatoses. CASE REPORT: We report a six cases series of fibromatosis of the chest wall treated at our institution between 1996 and 2009. There were five men and one woman with a mean age of 42.2. Swelling of the chest wall was the most frequent symptom. Imaging showed an expansive homogeneous mass, invading the rib (four cases) or the sternum (two cases). Surgical resection was performed in all cases. The outcome was favorable (five cases) or marked by local recurrence (one case). DISCUSSION: Although it is considered to be a benign lesion, this tumor can be locally very aggressive, and has a high local recurrence rate depending upon the efficacy of surgical resection.

[Imaging features of primary pulmonary lymphomas]. / Imagerie des lymphomes pulmonaires primitifs.

INTRODUCTION: Primitive pulmonary lymphomas (PPL) are rare tumors, often misdiagnosed by radiologists. METHODS: In order to illustrate the various radiological presentations of PPL, we report a retrospective series of nine cases of PPL collected in our service over a period of four years. A mucosa-associated lymphoid tissue (MALT) lymphoma was found in six patients, a diffuse large B-cell lymphoma in two patients and lymphomatoid granulomatosis in one patient. All diagnoses were proven histologically by bronchial or surgical biopsies. RESULTS: Among the six cases of MALT lymphoma, computed tomography (CT) demonstrated one or more areas of alveolar consolidation in four patients, progressing with a chronic course over 2 years in two patients. Other CT features were nodular opacities associated with a mass or consolidation and diffuse "ground glass" opacities. In the two cases of diffuse large B-cell lymphoma, CT showed one or more masses spreading locally, mimicking primary bronchial carcinoma. In lymphomatoid granulomatosis the CT showed diffuse interstitial disease with fibrosis. CONCLUSION: The imaging features of PPL are very polymorphic. The diagnosis of MALT lymphoma is often difficult because its radiological appearance is often falsely reassuring.

[Pseudotumoral mediastinal amyloidosis]. / Amylose ganglionnaire médiastinale pseudotumorale.

PURPOSE: Amyloidosis involvement of mediastinal nodes is rare. Isolated pseudotumoral involvement without extra-thoracic disease is a diagnostic challenge and typically raises concern for underlying malignancy. We present 3 cases of pseudotumoral mediastinal amyloidosis. METHODS: We report the cases of 3 patients presenting with recent onset of respiratory symptoms. Bronchoscopy showed mucosal infiltration suspicious for lymphangitic spread of tumor. The patients underwent chest radiography complemented by CT of the chest and abdomen, and laboratory and immunological work-up. A diagnosis of pseudotumoral mediastinal amyloidosis was confirmed by mediastinoscopic biopsy in all cases. RESULTS: CT showed a pulmonary and mediastinal tumor process in 2 cases and pericarinal tumor in 1 case. Diffuse bronchial wall thickening was present in all cases. Review of biopsy material showed tracheobronchial amyloidosis in 1 case. Patient work-up showed no evidence of extra-thoracic amyloidosis. Rapid progression of bronchial obstruction was observed in 1 case. CONCLUSION: The imaging features of mediastinal amyloidosis are non-specific. Pseudotumoral involvement of mediastinal nodes associated with pulmonary amyloidosis accelerates the degree of airway obstruction.

[Complicated hydatid cysts of the lung]. / Kystes hydatiques compliqués du poumon.

BACKGROUND: Hydatid disease which is caused by the parasite Echinococcus granulosis is one of the most important helminthic diseases. The parasitic infection is endemic in many areas worldwide, including the Mediterranean region. The lung is the second most common involved organ. In the present study, we review cases of complicated pulmonary hydatidosis, discussing pathophysiological mechanisms and the clinical, radiological features, as well as natural history and therapeutic options. METHODS: A retrospective study was conducted in the adult pulmonary department of The Tunis Chest Diseases and Surgery Training Hospital, a tertiary referral hospital for pulmonary diseases in Tunisia. RESULTS: 52 cases (mean age=34.6 years) were evaluated between 1998 and 2008. Rupture of the hydatid cyst occurred into the bronchi in the majority of cases (86.5%) and into the pleura in 9.6%. Extrathoracic involvement was found in 17.3% of the cases. Diagnosis of pulmonary hydatidosis was based on a consistent clinical and radiological presentation. Recourse to CT scan of the chest was helpful for diagnosis in 28% of the patients. Fibre-optic bronchoscopy (performed in 64.5% of cases) confirmed the diagnosis in 4 patients with total endoscopic extraction of hydatid cyst membrane in 2 cases. Surgical treatment was performed in 44 cases; resection of lung parenchyma was necessary in 8 patients (18.2%). Medical treatment was associated in 2 cases. Outcome revealed recurrence of pulmonary hydatidosis in 3 patients, and the death of 1 patient with chronic pulmonary hypertension due to chronic hydatid pulmonary embolism. CONCLUSION: Complicated pulmonary hydatidosis may present some diagnostic difficulties, even in endemic regions. Management may be difficult, costly, and may require pulmonary resections.

[Inflammatory myofibroblastic tumors of the lung: Imaging features]. / Imagerie des tumeurs myofibroblastiques inflammatoires du poumon.

Inflammatory myofibroblastic tumors are ubiquitous but most frequently affect the lung. The imaging features are non-specific but the diagnosis may be suggested in the presence of solitary pulmonary nodule or mass in children or young adults. The tumor may appear locally and regionally aggressive suggesting malignancy. Diagnostic confirmation is obtained from histological evaluation of the surgical specimen. Treatment is surgical with oncologic surgical resection.

[Diagnosis of spinal diseases by MRI]. / Irm et rachis.

For a long time the imaging diagnosis of spine disease was based on conventional radiology (plain radiography, myelography and arteriography). The recent employment of MRI had changed the study of spine disease thanks to an excellent contrast and a multiplanar approache. In fact, nowadays MRI is the most sensible technic for a combined study of spine container and contents and medullar tissue.

[Inflammatory pseudotumor of the spleen and radiopathologic correlation]. / Pseudotumeur inflammatoire de la rate et corrélation radio-anatomopathologique.

Inflammatory pseudotumors of the spleen (IPTS) are rare. We report a case of an IPTS in a 48-year-old woman who was admitted for drug eruption. During her hospitalization, she complained of abdominal pain. Physical examination and laboratory investigations were unremarkable. The abdominal ultrasonography and hepatic MRI detected a heterogeneous mass in the spleen measuring approximately 5 cm in diameter. Partial splenectomy was performed. Histologically, the splenic mass was composed of an admixture of inflammatory cellular elements with hemorrhage and sclerosis, suggestive of an IPTS. The postoperative course was uneventful. The authors attempt to make a radiopathologic correlation of this rare tumor.

[Tuberculous meningitis with pituitary abscess]. / Méningite tuberculeuse avec abcès hypophysaire.

Although rare, the possibility of pituitary tuberculoma should be considered in the diagnosis of non-pituitary intrasellar masses, especially in an endemic area and if radiologic imaging shows pituitary stalk thickening. We describe the case of a 52-year-old patient who presented tuberculous meningitis complicated by a pituitary abscess. He was treated with antituberculous drugs. The follow-up MRI 16 and 48 months later showed the decreased size of the pituitary mass. Radiological features and a review of the literature of pituitary tuberculoma are briefly discussed.

[Right paraduodenal hernia: a case report]. / La hernie paraduodenale droite: a propos d'un cas.

Paraduodenal hernia is a rare etiology of intestinal obstruction. Its preoperative diagnosis can only be made by a well-performed upper gastrointestinal series. We report a case of a 19 years old man with abdominal pains and recurrent Koenig's syndromes. The upper gastrointestinal series and CT scan showed a right paraduodenal hernia. we reviewed the anatomy. physiopathology, symptoms and radiographic criteria for the diagnosis of the paraduodenal hernia.