An epidermal growth factor receptor compound mutation of L858R with S768I in advanced non-small-cell lung cancer: a case report.

BACKGROUND: In the current treatment landscape for non-small cell lung cancers, epidermal growth factor receptor-tyrosine kinase inhibitors have emerged as a well-established treatment option for patients with advanced or metastatic disease. This is particularly true for those with commonly occurring epidermal growth factor receptor mutations. However, the therapeutic efficacy of these agents for so-called rare epidermal growth factor receptor mutations, and in particular those characterized by a high degree of complexity, such as double mutations, remains a subject of clinical uncertainty. CASE PRESENTATION: In this context, we present the case of a 64-year-old man of Moroccan descent, a lifelong non-smoker, diagnosed with metastatic non-small cell lung cancer characterized by a complex epidermal growth factor receptor mutation encompassing L858R and S768I. The patient subsequently underwent afatinib-based treatment, showing notable clinical results. These included a remarkable overall survival of 51 months, with a median progression-free survival of more than 39 months. CONCLUSIONS: This case report is a compelling testimony to the evolving therapeutic landscape of non-small cell lung cancers, providing valuable insight into the potential therapeutic efficacy of epidermal growth factor receptor-tyrosine kinase inhibitors in the realm of rare and complex epidermal growth factor receptor mutations.

Pseudotumor pulmonary sarcoidosis: A case report.

Sarcoidosis is a benign multisystem granulomatosis of unknown etiology. The mediastino-hilar sphere is a preferred site for the disease. It can sometimes reveal a confusing pseudotumoral presentation, constituting a diagnostic trap to be considered. We report the case of a 56-year-old woman whose lesional process rapidly resolved after 2 months of corticosteroid therapy.

Anxiety and Depression in Patients With Chronic Respiratory Diseases in the Fès-Meknès Region of Morocco.

Background Chronic respiratory diseases (CRDs) are a major public health problem in Morocco. Several studies have shown that anxiety and depression are important comorbidities of CRDs and are often associated with CRDs. This study aimed to estimate the prevalence of depression and anxiety and identify their determinants in patients with CRDs. Methodology A cross-sectional study was conducted in the Pneumology Department at the Hassan II University Hospital in Fez in 2021. An anonymous questionnaire was used to collect sociodemographic, clinical, and therapeutic data. The Moroccan version of the Hospital Anxiety and Depression Scale (HADS) was used to measure depression and anxiety. A descriptive analysis was performed, followed by a bivariate analysis to investigate the association between anxiety and depression and other factors using tests appropriate to the types of variables studied. A p-value ≤0.05 was considered significant. Data entry was performed in Excel 2013 (Microsoft Corp., Redmond, WA, USA), and data analysis was done using SPSS software version 26 (IBM Corp., Armonk, NY, USA). Results The study included 209 patients, 50.7% (n = 106) of whom were female, with an average age of 57.84 ± 15.36 years. Chronic obstructive bronchopneumopathy was the most represented CRD (43.1%; n = 90), followed by asthma (32.2%; n = 67). The prevalence of depression and anxiety was 46.4% (n = 97) (95% confidence interval (CI) = 39.2-52.8) and 57.4 % (n = 120) (95% CI = 50.3-63.7), respectively. In the univariate analysis, depression was associated with the presence of dyspnea (51.3% vs. 32.7%; p = 0.018), the presence of asthenia (56.5% vs. 38.5%; p = 0.009), the use of oxygen therapy (66.7% vs. 42.7%; p = 0.015), and a higher number of hospitalizations (76.9% vs. 44.4%; p = 0.023). Moreover, 87.6% of patients with depression also had anxiety (p < 0.001). Anxiety was associated with a history of surgery (37.2% vs. 62.4%; p = 0.003) and with the presence of chronic obstructive pulmonary disease (66.7% vs. 50.4%; p = 0.019). Conclusions The results reveal the importance of screening for anxiety-depressive disorders in patients with CRDs and taking into account psychological aspects in the management of the disease to improve quality of life.

Hydatid pulmonary embolism secondary to a right ventricular hydatid cyst: A case report.

Hydatid pulmonary embolism is an exceptional but serious condition. It complicates the rupture of a hydatid cyst in the venous return circulation, often of hepatic origin, or the endo-cavitary rupture of a hydatid cyst in the right heart. We report the case of a young patient with hydatid pulmonary embolism revealed by recurrent episodes of hemoptysis.

Thirteen Cases of Pulmonary Pneumocystis in HIV-Negative Patients.

We report 13 cases of pulmonary pneumocystis (PCP) in human immunodeficiency virus (HIV)-uninfected patients. Of eight males and five females, with a mean age of 55 years, one had breast neoplasia, two had common variable immunodeficiency (CVID), one had an autoimmune disease "Goodpasture's syndrome", and one had idiopathic fibrosis (nonspecific interstitial pneumonia/fibrosis (NIP)) undergoing prolonged corticosteroid therapy for two years, with no known immunosuppression in the remaining cases. The clinical picture was characterized by constant dyspnea and severe hypoxia in 11 cases. Lymphopenia was present in nine cases with an average rate of 920.76 elements/mm3. The diagnosis was confirmed by isolation of Pneumocystis jirovecii (PCJ) from induced sputum, except in two cases where analysis of bronchoalveolar lavage (BAL) fluid was required. With trimethoprim/sulfamethoxazole (TMP/SMX) and corticosteroid therapy, the course was favorable in all cases. Prophylactic treatment was indicated in three cases.

Hydatid pulmonary embolism underlying cardiac hydatid cysts - A case report.

Cystic hydatidosis is an endemic parasitic disease with usual localization in liver and lungs. Rarely it localizes in uncommon sites, the right ventricle being an exceptional localization. We present an extremely rare case of a young man with hydatid pulmonary embolism complicating right-ventricle hydatid cysts. Echocardiography, CT pulmonary angiogram and MR-angiography were performed for the diagnostic evaluation. Our patient did not undergo surgery. He was discharged on a regimen of albendazole, and is still being followed-up. Hydatid disease rarely presents with pulmonary embolism. It has uncharacteristic clinical features, requiring particular diagnosis and therapy.

Heterogeneous distribution of EGFR mutation in NSCLC: Case report.

Background: We herein report the case of a patient with advanced lung adenocarcinoma who presented a heterogeneous distribution of EGFR mutation. Case report: A 74-year-old Moroccan male former smoker was diagnosed with advanced lung adenocarcinoma, harboring S768I exon 20 substitution mutation confirmed by Real Time PCR and Pyrosequencing, but not detected by direct sequencing despite 70% of tumor cells. The present report describes a case of minor histologic intratumoral heterogeneity with heterogeneous distribution of EGFR mutation. Conclusion: Both sensitivity and specificity of molecular methods can provide evidence of intratumoral heterogeneity, which may explain the mismatch between the validation of oncology biomarkers and predicting therapeutic response to targeted therapy.

Correlation of Epidermal Growth Factor Receptor Mutation With Major Histologic Subtype of Lung Adenocarcinoma According to IASLC/ATS/ERS Classification.

OBJECTIVE: Our prospective study aims to define the correlation of EGFR(epidermal growth factor receptor) mutations with major histological subtypes of lung adenocarcinoma from resected and non-resected specimens, according to the WHO 2015 classification, in Moroccan North East Population. METHODS: Epidermal growth factor receptor mutations of 150 primary lung adenocarcinoma were performed using Real-Time PCR or SANGER sequencing. SPSS 21 was used to assess the relationship between histological subtypes of lung adenocarcinoma and EGFR mutation status. RESULTS: 25 mutations were detected in the series of 150 lung adenocarcinomas, most of which were found in cases with papillary, acinar, patterns than without these patterns and more frequently occurred in the cases without solid pattern than with this pattern. A significant correlation was observed between EGFR mutation and acinar (P = 0,024), papillary pattern (P = 0,003) and, negative association with a solid pattern (P < 0,001). In females, EGFR mutations were significantly correlated with the acinar pattern (P = 0,02), whereas in males with the papillary pattern (P = 0,01). Association between the histologic component and exon 19 deletions and exon 21 mutations were also evaluated and, we found a significant correlation between the papillary major pattern with exon 19 mutations (P = 0,004) and, ex21 with the acinar component (P = 0,03). CONCLUSION: An analysis of resected and non-resected lung ADC specimens in 150 Moroccan Northeast patients, revealed that acinar and papillary patterns may predict the presence of a mutation in the EGFR gene. While the solid major pattern may indicate a low mutation rate of the EGFR gene.

AB thymoma revealed by a huge intraparenchymal lung mass: a case report.

Thymoma is an epithelial neoplasm of the thymus, which commonly lies in the anterior mediastinum. Unusually it can be found in other locations as well. Ectopic thymoma rarely presents as an intrathoracic tumor. We report a case of ectopic thymoma presenting as a giant right intrathoracic tumor, the patient was 51-year-old, and who was presented with heaviness in chest and breathlessness. Detailed investigation including chest computed tomography scan revealed a well-defined large solid tumor in the right thoracic cavity, in this case, immunohistochemical analysis demonstrated a thymome AB. The tumor was metastatic to the lung. Patient received a neoadjuvant chemotherapy, with favorable evolution.

Οbstructive tracheal neοplasm: Primary tracheοbrοnchial nοn-hοdgkin lymphοma.

The trachea is an unusual site οf primary malignancy. Very few cases οf primary tracheal lymphοma with central airway οbstructiοn have been repοrted sο far. Cοmmοn cοmplaints are dyspnea and cοugh that cοuld mimic a partially refractοry asthma in sοme cases. In this article; we will present the case οf a 63-year-οld wοman diagnοsed with a tracheal lymphοma causing life-threatening airway οbstructiοn, this was cοnfirmed by brοnchοscοpy biοpsy and histοpathοlοgical exminatiοn. The mοrtality depends οn the prοgressiοn οf the disease, the οbstructiοn οf the airway. Hοwever, this entity has a gοοd prοgnοsis if diagnοsed immediately and treated with specific chemοtherapy. This case will shοw that the diagnοsis οf tracheal lymphοma shοuld be kept in mind within the differential diagnοsis οf central airway οbstructiοn.

Diffuse pulmonary ossification associated with fibrosing interstitial lung disease.

Diffuse pulmonary ossification (DPO) is a rare condition that presents with metaplastic mature bone formation in the pulmonary parenchyma. DPO is usually associated with cardiovascular or respiratory disease. We report a case of 75-year-old man with chronic dyspnea, cough, asthenia and low sputum production. A chest x-ray revealed reticular pulmonary infiltrates on both sides. Computed tomography (CT) revealed peripheral, basilar predominant reticular opacities with areas of subpleural cystic change, compatible with fibrosis, fine branching calcifications within areas of linear reticulations were also visible in both mid and lower zones. Based on the clinical presentation and CT results, the patient was diagnosed with diffuse pulmonary ossification associated with idiopathic pulmonary fibrosis. Despite its rarity, the radiologist must know suggest the diagnosis of DPO especially in the presence of idiopathic pulmonary fibrosis associated with linear branched calcified densities in areas of fibrosis, avoiding a surgical biopsy that is not stripped of risk.

The diagnostic value of the bronchoalveolar lavage in interstitial lung diseases.

OBJECTIVE: Bronchoalveolar lavage (BAL) is a diagnostic tool often used during the management of interstitial lung diseases (ILD). However, its diagnostic value in discrimination between entities comprising the very heterogenous group of ILD, is still a controversial issue. The objective of our study is to assess the diagnostic value of BAL in the management of ILD, by comparing the cytological findings in BAL fluid among the different diseases of this group. METHODS: It was a retrospective, observational study of 151 patients between January 2012 and December 2015. BAL fluid cytology was performed to analyse the distribution of leucocytes population subsets in patients with ILD. RESULTS: The mean age was 52.78 years; 74.83% were women. The analysis of the following main groups of diseases was performed : sarcoïdosis (n = 30), idiopathic pulmonary fibrosis (IPF; n = 22), other idiopathic interstitial pneumonia (non specific interstitial pneumonia, cryptogenic organising pneumonia and respiratory bronchiolitis interstitial lung disease; n = 20) and connective tissue disease (n = 14). Overall, out of 141 patients, 22% had sarcoïdosis, 15.6% had idiopathic pulmonary fibrosis (IPF), 14.18% had other idiopathic interstitial pneumonia (IIP) and 9.9% had connective tissue disease (CTD). Mixed alveolitis was common in the 4 groups, sarcoïdosis had higher proportion of lymphocytes and IPF had higher neutrophils count. However, there was no significant statistical difference of BAL cellular count among these diseases (p > 0.05). Also, the prevalence of studied diseases did not change with variation of BAL cellular count (p > 0.05). CONCLUSION: Alone, the BAL cytological analysis has a limited value to provide substantial information that could lead to discriminate between diseases that form ILD. Thus, it must be always associated with other diagnostic methods.

[Pleural epithelioid sarcoma: about a case and review of the literature]. / Sarcome épithélioide pleural, à propos d'un cas avec revue de la littérature.

Proximal epithelioid sarcoma (PES) originating from the pleura is a clinical entity rarely reported in the literature. We report the case of a young patient with immediately metastatic proximal epithelioid sarcoma (PES) treated at the Department of Medical Oncology, Fes. Treatment consisted of chemotherapy based on doxorubicin and ifosfamide. After the first cycle of chemotherapy, the disease led to a fatal outcome. Our case study highlights the potentially aggressive behaviour of PES which represents a clinical trap and can be life-threatening.

Askin's tumor: a case report and literature review.

Askin's tumor is a primitive neuroectodermal tumor developing from the soft tissues of the chest wall. Its diagnosis approach is complex and requires a multidisciplinary team. Given the rarity of this entity, no regimen has been validated in the literature. We report two cases of Askin's tumor with a major response to polychemotherapy and surgical resection in one case. These cases show that treatment of Askin's tumor should be multimodal, requiring discussion in multidisciplinary tumor working groups.

Spontaneous pneumorrhachis and transverse myelitis complicating purulent meningitis.

Pneumorrhachis is the presence of air in the spinal canal; mostly, it has an iatrogenic origin. The association of this entity with spontaneous pneumomediastinum without any pneumothorax is rarely reported in the literature. The spontaneous resorption is the usual evolution. The association to acute transverse myelitis is discussed by the authors. The patient is a 21-year-old male with pneumorrhachis associated to a spontaneous pneumomediastinum was admitted at the emergency department for bacterial meningitis. The antibiotherapy has marked the clinical profile by disappearance of the meningeal signs in the 48 h after admission. In contrast, the neurological symptoms were of marked aggravation by appearance of a tetraparesis with a respiratory distress syndrome having required artificial ventilation. The computed tomography (CT) scan showed a typical hypodensity corresponding to paramedullary air extending to several thoracic segments. The spinal magnetic resonance imaging (MRI) showed a high cervical medullary edema without signs of compression. The patient died within 15 days with a profile of vasoparalysis resistant to vasoactive drugs. Pneumomediastinum associated to pneumorrhachis and transverse myelitis complicating purulent meningitis is a rare entity. Although the usual evolution is favorable, the occurrence of serious complications is possible.

Pseudotumoral tracheobronchial amyloidosis mimicking asthma: a case report.

INTRODUCTION: Tracheobronchial amyloidosis is an uncommon localized form of amyloidosis that can simulate a tracheal tumor. Clinical signs are not specific and the diagnosis is rarely given before performing a bronchoscopy with multiples biopsies. CASE PRESENTATION: We report the case of a 60-year-old Moroccan woman, complaining of dyspnea and wheezing for three years, who was treated at our institution for management of severe asthma. A bronchoscopy revealed a tumor formation of her trachea; multiples biopsies were performed and a diagnosis made of amyloid light-chain amyloidosis. She successfully received an endoscopic resection. CONCLUSION: This case highlights the importance of routinely carrying out an endoscopy in any patient complaining of atypical bronchial symptoms or with uncontrolled asthma. Tracheal amyloidosis is a rare disease, confirmed by histological examination of bronchial biopsies, and the treatment of choice is based on the bronchoscopic resection.