[A case of bronchial mucous gland adenoma: A rare diagnosis that should not be mistaken!] / Un cas d'adénome muqueux glandulaire bronchique : un diagnostic rare à ne pas méconnaître !

We report the case of a 32-year-old man, who was admitted for a recurrent pneumopathy. The thoracic computed tomography revealed a small well-circumscribed lesion of the lower right lobe of the lung. Microscopic examination from the biopsy material of the endoscopy concluded a mucoepidermoid carcinoma. A lobectomy was realized. Microscopic examination revealed the presence of a well-delineated lesion composed of glands and cysts containing mucous and limited by mucous and cylindric and ciliated cells without atypia. The proliferation index was very low. A diagnosis of mucous gland adenoma was made. It is an exceptional tumor and is very difficult to diagnose on biopsy material but should be known by pathologists. It is associated with a good prognosis. The aims of our observation are to present the macroscopic and microscopic features of this tumor and data from recent literature review to better diagnose it. This is also the second observation with molecular details for this entity.

Beyond aesthetic consequences: congestive hepatopathy caused by pectus excavatum.

Pectus excavatum can lead to right ventricle compression. Although extremely rare, congestive hepatopathy should be considered when patients with severe pectus excavatum present with cardiovascular involvement.

Thoracoscopic renal denervation for intractable autosomal dominant polycystic kidney disease-related pain.

The authors report a case of intractable autosomal dominant polycystic kidney disease-related pain associated with normal renal function, treated with renal denervation. Renal denervation was performed via a thoracoscopic approach. The good medium-term result suggests that thoracoscopic sympatho-splanchnicectomy would be an attractive procedure for pain management in autosomal polycystic kidney disease.

Malignant "Triton" tumor of the posterior mediastinum: prolonged survival after staged resection.

Malignant "Triton" tumor is a rare subtype of malignant peripheral nerve sheath tumor showing rhabdomyoblastic differentiation. We report the case of a 22-year-old patient who had excision of such a tumor by video-assisted thoracic surgery. He was reoperated on by thoracotomy 2 months later and received adjuvant radiation, with prolonged survival. Radical surgical excision of malignant Triton tumor followed by adjuvant radiation therapy may provide the longest survival and represent the treatment of choice.

Videothoracoscopic resection of neurogenic tumors of the superior sulcus using the harmonic scalpel.

Resection of neurogenic tumors located in the paravertebral sulcus carries a risk of injury to the adjacent nervous structures and also to critical intercostal arteries supplying the anterior spinal artery. To avoid such complications, we have used the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) for the dissection of neurogenic tumors in 2 consecutive patients operated on by videothoracoscopy. The Harmonic Scalpel functions with ultrasonic energy, producing less heat than a regular electrocautery and allows a safer dissection of tumors located in the posterior mediastinum, particularly those located in the superior paravertebral sulcus.

Videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax: long-term results.

BACKGROUND: The goal of this study was to evaluate the long-term efficiency of videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax. METHODS: From July 1991 to December 1997, 182 patients with primary spontaneous pneumothorax were treated by a single technique at our institution. Seven patients had single-stage bilateral procedures and 11 other patients had staged bilateral procedures. Indications for operation were first episode with prolonged air leak, incomplete lung reexpansion, or job restrictions (n = 59), first ipsilateral recurrence (n = 57), second or third ipsilateral recurrence (n = 34), contralateral recurrence (n = 25), synchronous bilateral pneumothorax (n = 3), hemopneumothorax (n = 3), and tension pneumothorax (n = 1). All patient data were reviewed retrospectively, and 167 patients were available for late follow-up (92%). RESULTS: Mean operative time was 57 +/- 19 minutes. Conversion to thoracotomy was required in 1 patient (0.6%). Mean duration of pleural drainage was 5.8 +/- 1.2 days (range, 4 to 26 days), and mean postoperative stay was 7.7 +/- 1.6 days (range, 6 to 31 days). Postoperative complications occurred in 50 patients (27.4%), the most frequent being prolonged air leak (14.8%), and in-hospital mortality was 0%. After a mean follow-up of 93 +/- 22 months (range, 57 to 134 months; median, 84 months), five ipsilateral recurrences were noted (3%). Three recurrences occurred within 12 months of videothoracoscopy and required reoperation. Two patients had partial pneumothorax recurrence at 39 and 58 months, and were treated conservatively with chest tube insertion and tale slurry. After 1 year, 10.7% of patients complained of chronic chest pain or discomfort, although none was taking pain medication after 3 months. Most patients (89.8%) were satisfied or very satisfied of their operation. All patients had returned to sport activities within 2 years. CONCLUSIONS: Videothoracoscopic bullectomy and pleural abrasion is a reliable and safe method to treat primary spontaneous pneumothorax. Long-term recurrences occur with an acceptable rate that compares with results after limited thoracotomy. Chronic chest pain or discomfort is unpredictable and may represent a problem in a few patients.

Traumatic extrathoracic lung herniation.

Traumatic extrathoracic lung herniation is an exceptional complication of blunt chest trauma. We report the case of a 46-year-old man who was involved in a motorcycle accident and who suffered a left clavicle fracture-dislocation associated with multiple rib fractures and massive herniation of the left upper lobe through an upper anterior chest wall defect. Immediate surgical repair through an atypical transcostal vertical thoracotomy resulted in full recovery of pulmonary function at 1 year.

Management of superior sulcus tumors: experience with 139 cases treated by surgical resection.

BACKGROUND: The management of non-small cell carcinomas of the lung involving the superior sulcus remains controversial. The goal of this retrospective study was to evaluate the role of surgery, radiotherapy, and chemotherapy for the treatment of superior sulcus tumors, to define the best surgical approach for radical resection, and to identify factors influencing long-term survival. METHODS: Between 1983 and 1999, 139 patients underwent surgical resection of superior sulcus tumors in seven thoracic surgery centers. According to the classification of the American Joint Committee, 51.1% of cancers were stage IIB, 13.7% stage IIIA, 32.4% stage IIIB, and 2.9% stage IV. RESULTS: The resections were performed with 74.1% using the posterior approach and 25.9% using an anterior approach. A lobectomy was accomplished in 69.8% of the cases and a wedge resection in 22.3%. Resection of a segment of vertebrae or subclavian artery was performed, respectively, in 19.4% and 18% of the cases. Resection was complete in 81.3% of cancers. The overall 5-year survival rate was 35%. Preoperative radiotherapy improved 5-year survival for stages IIB-IIIA. Surgical approach, postoperative radiotherapy, or chemotherapy did not change survival. CONCLUSIONS: The optimal treatment for superior sulcus tumors is complete surgical resection. The surgical approach (anterior/posterior) did not influence the 5-year survival rate. Preoperative radiotherapy should be recommended to improve outcome of patients with a superior sulcus tumor.

[Combined traumatic rupture of the bladder and ileum]. / Ruptures traumatiques vésicale et iléale associées.

Intraperitoneal bladder rupture represents 2% of all abdominal lesions requiring surgical exploration. It has a poor prognosis due to the frequent associated lesions, particularly involving abdominal and retroperitoneal organs. An associated small bowel injury is rarely reported in the literature. The limited intestinal symptoms, the poor sensitivity of emergency imaging and the minor lesions detected at surgical exploration justify a systematic search for ileal lesions in this type of trauma, by an incision providing broad exposure of the entire abdominal cavity.

[Neurogenic spindle-cell tumors of the mediastinum: two cases]. / Tumeurs nerveuses à cellules fusiformes du médiastin: deux observations.

INTRODUCTION: Neurogenic tumors can develop from neural cells in any location. They are commonly found, however, in the mediastinum, most often in its posterior compartment. Neurogenic tumors can be benign or malignant. In the anterior compartment, they must be distinguished from their differential diagnoses. CASES: We report one case of a malignant peripheral nerve sheath tumor in the posterior mediastinum of a 29-year-old man and another of a schwannoma of the anterior mediastinum, in an 82-year-old woman. DISCUSSION: Neurogenic tumors of spindle-shaped cells in the mediastinum are generally benign, but can be malignant. Often asymptomatic, they are usually detected on standard pulmonary radiography, but computerized tomography is necessary, supplemented by magnetic resonance imaging, especially for posterior mediastinal tumors, to provide additional information and to assess its possible extension to adjacent structures. Radiographic, clinical, and especially histopathological features are essential for diagnosis.