Calcifying fibrous pseudotumor of the mediastinum.

Calcifying fibrous pseudotumor has recently been described in the soft tissues. It is a rare benign lesion characterized by the presence of abundant hyalinized collagen with psammomatous or dystrophic calcifications and lymphoplasmacytic infiltrate. We report a case of a young woman with a mediastinal mass treated by a complete resection. The mass had all the pathologic features of calcifying fibrous pseudotumor.

Leiomyosarcoma of the pulmonary artery.

Primary leiomyosarcoma of the pulmonary artery is an extremely rare tumor that is frequently misdiagnosed as chronic pulmonary embolism. In the present case, early diagnosis and location in the left pulmonary artery permitted resection by pneumonectomy with total cardiopulmonary bypass.

Bilateral thoracoscopy for sympathectomy in the treatment of hyperhidrosis.

Thoracoscopic sympathectomy has been established as the least invasive technique with high success rates for treatment of palmary hyperhidrosis [1,4,5]. In our procedure both sides are treated during the same operation. A bilateral thoracoscopy was performed in 20 patients for incapacitating hyperhidrosis. Immediate complications at operation were minimal. All patients reported satisfaction with the procedure in spite of compensatory sweating. The short hospital stay has significant financial benefits and these are increased if both sides are treated at the same time. This procedure is more aggressive than the single side procedure but the morbidity is not increased.

Does a thoracoscopic approach for surgical treatment of spontaneous pneumothorax represent progress?

OBJECTIVE: Surgical management is indicated in recurrent forms of pneumothorax and for failure of tube drainage. We have for several years performed pleurodesis and apical blebs stapling by axillary thoracotomy. Thoracoscopy has been a well established procedure for 70 years and recently further developed as the result of current technological progress. For 10 years thoracoscopy has been developed as an alternative to thoracotomy in several indications. Spontaneous pneumothorax is ideally suitable for thoracoscopic management. The aim of this retrospective study is to evaluate this new approach. METHODS: We compare our results of axillary thoracotomy management of spontaneous pneumothorax in 237 patients (group 1) with those of thoracoscopic management in 101 patients (group 2). Sex distribution, average age, indications and stapling of apical blebs were comparable in both groups. RESULTS: Etiologies were comparable in both groups. The average operation time was 71 min in group 1 and 57 min in group 2. The average duration of chest tube placement was 8 days in group 1 and 6.5 days in group 2. The mean hospital stay was 14 days in group 1 and 9.5 days in group 2. The overall morbidity was 16 and 11% in groups 1 and 2, respectively. The most frequent complication was early or late failure of pleurodesis which required second drainage or a subsequent operation. Late failure occurred more frequently after thoracoscopy (3 vs. 0.4%) but there was no statistically significant difference between the two groups. CONCLUSIONS: Thoracoscopic management of spontaneous pneumothorax is a safe procedure. Moreover, it offers the benefits of a shorter hospital stay and less postoperative pain.

[Primary malignant germinal tumors of the mediastinum. Surgical aspects]. / Tumeurs germinales malignes primitives du médiastin. Aspects chirurgicaux.

Surgery retains an important place in the treatment of malignant germ cell tumours of the mediastinum though in order to achieve complete excision the appropriate moment for surgery needs to be chosen carefully. Complete excision, which is the great benefit of surgery, is rarely possible as first treatment because of the large volume of these tumours and their extension into mediastinal vascular structures. Considerable surgical experience is essential in order to allow extended incision involving the lung and the large vessels which might involve prosthetic replacements. Excepting in situations of great urgency surgery usually follows chemotherapy and is used as follows: in patients who appear to be in complete remission but who have residual lesions which require eradication, and those with malignant tissue which is persisting or more often of a mature teratoma which may have a risk of progressing. The return of tumour markers to normal values does not guarantee the absence of some residual cancer, in some patients with a partial remission complementary surgery may allow a further 20% to achieve a complete response, in the absence of a response to chemotherapy, surgical excision should be attempted without too long a delay and then followed by a different chemotherapy regime.

[Primary malignant dysembryoma of the mediastinum]. / Dysembryomes malins primitifs du médiastin.

The primary malignant dysembryomas of the mediastinum are highly malignant tumours, which originate from embryonal cells. This name excludes seminomas and dysgerminomas which derive from non-fecund germinal cells. In this general review only the dysembryomas will be touched on. They are relatively rare tumours found in young men and are characterised by the rapidity of their spontaneous growth. The absence of a gonadal tumour is sufficient to confirm the primary mediastinal character of malignant dysembryomas. There is little specific in the clinical data. The tumour markers, Beta HCG and above all alpha feto-protein play, at the same time, a leading role not only for diagnosis but also for therapeutic decisions and follow up under treatment. In spite of the appalling reputed prognosis of this disease, the malignant dysembryomas have benefited from the considerable therapeutic progress which has been made in recent years. It is vital to achieve a rapid and accurate diagnosis and to start on treatment without delay with a regime incorporating Cisplatin. As radical surgery as possible usually follows the initial chemotherapy. Post operative treatment depends on the anatomical observations made at the time of surgery.

[Primary pulmonary sarcoma with spindle-shaped cells. Apropos of a case]. / Sarcome pulmonaire primitif à cellules fusiformes. A propos d'un cas.

Primary pulmonary sarcoma is a very rare malignant tumour. The authors report a case of a fusiform cell sarcoma simulating a pulmonary metastasis in a woman who previously had a mammary carcinoma. Lymph node invasion is rare. The nature of the tumour was confirmed by histology and aided by immunochemistry or electron microscopy. The primary origin of the tumour can only be confirmed after negative results from careful examination of the marrow, the gastro-intestinal tract, the genito-urinary system and above all the uterus. The prognosis depends on the size of the tumour and the mitotic score. Surgery is the only curative treatment.

[Similarities between pleuropulmonary blastoma and Askin tumor]. / Similitude du blastome pleuropulmonaire de l'adulte et de la tumeur d'Askin.

Adult pleuropulmonary blastoma is an uncommon mesenchymal tumor of the peripheral lung parenchyma composed of undifferentiated cells. The differential diagnosis with Askin-Rosaï's tumor, an extrapulmonary pleuroparietal neuroectodermal tumor, may be a difficult task. We propose a similar therapeutic approach for these two malignant conditions: surgical excision associated with chemotherapy and autologous bone marrow transplant with adjuvant radiotherapy in case of recurrence. These two entities have many epidemiological, clinical, histological and immunohistochemical similarities.

[Splenic abscess. A rare pathology requiring a multidisciplinary approach]. / Abcès splénique. Une pathologie rare qui nécessite une approche multidisciplinaire.

The clinical presentation of the splenic abscess is poorly specific. Its natural evolution is often fatal. The three case reports illustrate the difficulty of the diagnosis and management of this disease. Ultra sound and C.T. scan are the procedures of choice for the diagnosis and follow-up. The choice of the treatment depends on the number of abscesses, their volume, and also the presence of extrasplenic involvement. Antibiotherapy and interventional radiology have modified its therapeutical approach. Although the conservative treatment (antibiotherapy, transparietal drainage) is often successful, splenectomy is still indicated as a first line treatment, or as a salvage procedure.

[Traumatic rupture of the cervical trachea. Emergency diagnosis and treatment]. / Rupture traumatique de la trachée cervicale. Diagnostic et thérapeutique en urgence

The authors report 3 cases of traumatic rupture of the cervical trachea including one associated with total division of the oesophagus. They were impressed by the lack of precision and rapidity of the first surgical measures. They then give an account of the therapeutic gestures which are possible in a non-specialised unit.

[Excavated, thin-walled pulmonary metastases of a sarcoma of the cervix uteri]. / Métastases pulmonaires excavées, à parois fines, d'un sarcome du col utérin.

A case of excavated pulmonary metastases from a fusiform cell sarcoma of the cervix uteri is reported. These metastases had special features: their wall were thin and they changed during the course of the disease. Excavation of pulmonary metastases is exceptional. The authors mention the low frequency of such metastases, describe the circumstances in which they are discovered and discuss their pathogenesis.