Unexpected infant death secondary to a pulmonary infiltration due to acute myelocytic leukaemia

Acute myeloid leukaemia (AML) often presents with non-specific symptoms such as fatigue, anaemia or infection. Pulmonary involvement is uncommon in AML during the course of the disease and is usually caused by infection, haemorrhage, leukaemic pulmonary infiltrates and leukostasis. Lung localization of AML is very uncommon and potentially life threatening if not diagnosed and treated rapidly. The authors describe the sudden death of an asymptomatic five-month-infant because of a misdiagnosed lung localization of AML. Autopsy examination followed by histopathological studies showed an extensive leukostasis and extramedullary leukaemic infiltrating the lungs. Special stains and immunohistochemical studies revealed findings consistent with acute myelogenous leukaemia. This case suggests that underlying acute leukaemia should be considered as a cause of flu-like symptoms in infants. Medical personnel are urged to be alert to fever, sore throat, weakness and dyspnea that may be characteristic of serious systemic diseases.

Organizational Ostracism: A Potential Framework in Order to Deal with It

BACKGROUND: Organizational ostracism is defined as a violation of norms that we are suggested to acknowledge at the workplace. It results in the exclusion of one person or multiple persons, and causes damage to our innate need to belong. This kind of behaviorism can be engaged through a hierarchical or nonhierarchical relationship. Three elements interact in the framework of organizational ostracism: the actor, the target, and the institution. Our aim was to describe the different factors interacting with every element in order to produce recommendations targeting to prevent the occurrence of such behaviorism in an institution and to help targets of such a violence in order to handle this situation and go forward. As psychological impact of ostracism has frequently been studied in the literature, we focused on its impact on professional tasks. METHODS: We performed a questionnaire-based study about organizational ostracism. This questionnaire was established through an online platform (https://www.sondageonline.com) and made available through the following link: https://goo.gl/forms/KrkVXe3bMEc79cau2. A keyword was sent to all participants. We created a 23-interrogation questionnaire with open and short questions. Nonwritten consent was obtained from all participants. RESULTS: The actor of ostracism engaged in ostracism, in most of the cases, with other persons without a real purpose. The actor of ostracism had an antecedent of problematic relationship at work in 82.9% of the cases. Of the participants, 58.5% were of the view that ostracism aimed to cause hurt and isolate them. Professional isolation was observed in 58.5% of the cases; 51.2% of the participants tried to improve their work potential and explained their reaction by an intrinsic motivation. The organization atmosphere was judged to be bad in most of the cases. CONCLUSION: Our study showed that ostracism was mainly observed in public practice.

[Diagnostic value of the bronchoalveolar lavage in interstitial lung disease]

Background: The bronchoalveolar lavage [BAL] cellular analysis is an invasive method of exploration of the lung. Its diagnostic value in interstitial lung disease [ILD] is integrated to a multi-disciplianry approach implicating clinicians, radiologists and pathologists

Aim: We targeted to evaluate the diagnostic value of the BAL

Methods: We reported a retrospective study about patients hospitalized for an ILD since the 1st January 2011 to the 31th December 2013. Thirty three patients were admitted in the Department of Pulmonology and the BAL analyses were studied in the Department of Pathology of the same hospital. The different cell patterns were compared to the final diagnostics

Results: our study contained 4 non specific interstitial pneumonia [NSIP], 10 usual interstitial pneumoniae [UIP], 4 organizing pneumoniae [COP], 8 sarcoidosis, 2 hypersensitivity pneumonitis, 3 infectious pneumonitis, 1 lymphoma and a pulmonary adenocarcinoma. We considered positive results those that were compatible with the final diagnosis. The profile lavage was typical in 1 NSIP, 3 UIP, 3 COP, 1 hypersensitivity pneumonitis, 6 sarcoidosis, 3 infectious pneumonitis and 1 adenocarcinoma. Among the 17 cases with an atypical profile lavage, radiological features were diagnostic in 10 cases. This finding highlights the fact that 7 cases/ 33 presented simultaneously an atypical profile lavage and non specific radiological findings

Conclusion: Our results put emphasis on the diagnostic value of BAL especially when it is integrated to a multi-disciplinary approach. Its value in the follow up, the evaluation of the activity of the disease and the prognosis is being more and more reported

Genomic classification of lung cancer: toward a personalized treatment

Lung cancer is the first cause of death by cancer worldwide. In Tunisia, its incidence has increased from 17.6 cases per 100.000 persons in 1997 to 27.6 cases per 100.000 persons in 2003. Its prognosis has been improving thanks to the emergence of molecular targets. The first one is represented by EGFR [Epidermal growth factor receptor], which marks this year [2014] its tenth anniversary. Many other targets have been identified. The most famous and useful of them is the fusion gene ALK-EML4 but other oncogenic pathways have been implicated and are under investigations including HER2, BRAF, MET, RET…. The most relevant challenges encountered are represented by the difficulty to achieve a consensual decisional and therapeutic algorithm, the absence of standardized diagnostic techniques and the unavoidable occurrence of secondary resistance due to the activation of other oncogenic pathways that must be explored and targeted. In this update, we tried to present the major pathways implicated and the most relevant practice routine strategies

[Carcinogenesis of non small cell lung cancer and therapeutic implications]

The occurrence of a lung cancer is a consequence of a long-lasting process dealing with a transformation of a normal cell to a malignant one. The four steps of transformation reflect the genetic modifications of the cells. The molecular studies of pre-invasive lesions have already established a correlation between the lesion continuum and the multi-step carcinogenesis. Gradual genetic alterations are correlated with the increase of the cell's malignant potential. We tried to present the carcinogenesis of the lung non microcellular carcinomas and to highlight the main therapeutic targets

[ new classification of lung adenocarcinomas according to the American Thoracic society and the European respiratory society: new recommendations to improve management]

Lung cancer represents a major public health problem.It represents the first cause of mortality by cancer in Tunisia. Its incidence reaches 40% of lung cancers. Its clinical, radiologic and molecular aspects have been improved inducing the necessity of a new classification which will consider the necessity of a multidisciplinary management. To highlight the new classification of lung adenocarcinomas and to present the major recommendations. We tried to present the main recommendations of the American Thoracic Society and the European Respiratory Society of lung adenocarcinoma. This new classification identifies pre-invasive lesions represented by in-situ adenocarcinoma [the ancient bronchioloalveolar], the micro-invasive adenocarcinoma and invasive adenocarcinoma. The latter have been divided in sub-types according to the predominant architectural features. Thus, three groups of invasive adenocarcinoma with presumed different prognoses have been identified: the lepidic predominant adenocarcinoma which has a good prognosis, the micro-papillary and solid predominant adenocarcinomas which have a bad prognosis and the papillary and acinar adenocarcinomas which have an intermediate prognosis. All these entities have specific diagnostic features and criteria. These recommendations are available for biopsies and surgical resected specimen. The new classification of lung adenocarcinoma puts emphasis on the necessity of a multi-disciplinary management of these tumors in order to improve their prognosis. It identifies new entities with different prognoses that could justify specific modalities of treatment and follow up

Prognostic value of pheochromocytoma of the adrenal gland scaled score [PASS score] tests to separate benign from malignant neoplasms

Differentiating malignant from benign pheochromocytoma has been challenging when based on histologic features. This is due to the definition of malignant pheochromocytoma which are defined by the presence of metastases. A PASS score was developed and according to many authors, a PASS score> =4 identified potentially malignant tumors. To assess the prognostic value of PASS score in differentiating benign pheochromocytomas from malignant ones. The records of 11 patients with tumors diagnosed as "pheochromocytoma" were identified from 1970 to 2010 in the files of the pathology, intern medicine and biochemistry departments of the Charles Nicolle hospital and Pasteur Institute. Receiver operating characteristics [ROC] curve analysis was performed to evaluate the diagnostic performance of PASS. The logistic model was developed using the 11 predictive variables. Its performance was evaluated by calculating the area under the ROC curve and comparing it with that of the PASS. In benign tumors, The PASS score was <4 in 3 cases and >/= 4 in 6 cases. In malignant tumors, the PASS score was >/= 4 in both cases. According to the ROC curve analysis, a PASS equal or superior to 4 identifies malignant pheochromocytoma with a sensitivity of 50% and a specificity of 45%. I think that PASS score, despite its low sensitivity, may help to reserve the more aggressive treatment and narrow follow up for potentially malignant tumors. Widespread of this called score with complete clinical data will help to validate these findings and to add other prognostic factors of value that could be a part of this scaled score such as immunohistochemical findings

utility of alpha-methyl CoA racemase [P504S] expression as a marker of renal cell carcinomas

Renal cell tumours are numerous and heterogeneous. Because of their clinicopathological heterogeneity, their accurate diagnosis may be challenging. In case of an equivocal diagnosis, immunohistochemistry may be a useful mean of diagnosis. Recently, alpha-methyl CoA racemase has been identified as a useful marker in kidney cancers. Our objectives are to highlight the role of alpha-methyl CoA racemase [AMACR] as a diagnostic marker in papillary renal carcinoma and to assess its utility in the other tumour types. A retrospective review was performed on 62 patients who were treated for renal tumours between January 1994 and November 2005. Immunoreactivity was evaluated with a qualitative manner. Positive AMACR staining was defined as a coarse dense cytoplasmic granularity. The 62 renal tumours were diagnosed as papillary tumours in 22 cases, clear cell tumours in 18 cases, chromophobe carcinoma in 12 cases and oncocytoma in 10 cases among the 22 cases of papillary tumours, all the cases [100%] showed cytoplasmic immunoreactivity staining. 4 cases between the 18 clear cell carcinomas [22%] showed positivity with AMACR. The 12 cases of chromophobe carcinoma didn't express AMACR by immunohistochemistry. Only one case between the oncocytomas [1%] expressed AMACR. This study confirms the high sensitivity of AMACR for papillary renal cell carcinomas but we must keep in mind that weak focal AMACR staining could be present in other renal cell carcinomas

[ exceptional hepatic tumor]

Hepatic localization of non Hodgkin's lymphoma is generally secondary. Primary localizations are rare.To report a rare case of primary hepatic lymphoma particular by its association with dermatopolymyositis. A 55-year-old woman with a past medical history of dermatopolymyositis diagnosed one year before presented with abdominal pain and fever. Laboratory tests showed pancytopenia. Radiologic examination revealed multiple hepatic masses. Surgical biopsy revealed a large B cell hepatic lymphoma. No other localizations were found so the diagnosis of primary hepatic lymphoma was retained. The patient died after a few days due to a severe sepsis. Primary hepatic lymphoma is a rare tumor with a bad prognosis. Its diagnosis is based on histologic examination. Treatment of these tumors remains non consensual

[Pulmonary lymphangiomatosis revealed by an interstitial syndrome in a young adult]

Diffuse pulmonary lymphangiomatosis is an extremely rare congenital lesion affecting the lymphatic pulmonary system. It is charcterized by a multifocal proliferation and a pulmonary lymphatic vessels dilatation. It is essentially observed in newborns and infants. The diagnosis is based on histological findings. The purpose of this article is to describe the main clinical and pathological features of this rare entity difficult to diagnose. We report a case of a 19-year old girl who presented with a 2- month standing dyspnea. Radiographic findings consisted in a soft tissue infiltration and thickening in the two lobes. Based on histological and immunohistochemical findings, the diagnosis of diffuse pulmonary lymphangiomatosis was retained. Diffuse pulmonary lymphangiomatosis is a difficult diagnosis which can be confused with lymphangioleiomyomatosis. Its worse prognosis could be improved by an early diagnosis enabling the use of interferon alpha 2B at the proper time