Primary sarcomatoid lung cancer: clinical and evolutive features: a propos of five case reports

Primary sarcomatoid carcinoma of the lung are rare non small cell lung cancers [NSCLC] recently individualized by the World Health Organization. Their clinical, radiological and evolutive features are not well known but they seem to have bad prognosis with rapid progression and early metastases. Although they are felt to be chemo-refractory they must be treated as the other subtypes of NSCLC. To evaluate clinical, radiological and evolutive features of primary sarcomatoid carcinoma of the lung. We report the cases of five patients presenting sarcomatoid carcinomas and assess their clinical and evolutive data. One patient had stage IIB cancer underwent surgical resection and adjuvant chemotherapy, he is alive 18 months later; another had stage IIIB was treated by radio and chemotherapy and is alive 6 months later; and three other patients had stage IV in whom one had chemotherapy, the two others did not because of they had performance status. They died 1 to 3 months after the diagnosis. Lung sarcomatoid carcinomas are of bad prognosis. Their treatment is nowadays not well established. Much more good studies are therefore needed

Posterior mediastinal angiomyxolipoma with spinal canal extension

Angiomyxolipoma is a benign tumor considered as a variant of lipoma and that occurs mainly in the subcutis. The mediastinal location hasn't been previously reported. To describe the radiological features of this tumor in its posterior mediastinal location and to confront them to the pathological features. We report the case of a 49-year-old woman who was admitted for chest wall pain and neurologic disturbance of her two lower limbs. The chest X-ray showed a posterior mediastinal opacity. On CT examination, this mass contained some small areas of fat and enhanced intensily. Microscopic examination of the excised mass confirmed the diagnosis of posterior mediastinal angiomyxolipoma. Mediastinal location of angiomyxolipoma hasn't been previously reported. Clinicians and radiologists should be aware that this diagnosis should be suggested, among others, when there is a posterior mediastinal mass that contains fat and that intensely enhances with a possible spinal cord extension

[Primary malignant tumors of the sternum]

Primary tumors of the sternum are rare and account only 0.5% of all primary bone tumors. They are often malignant, osteolytic and aggressive. They often present difficulties in management. To determine clinical, pathological and therapeutic characteristics for primary malignant tumors of the sternum. We report a series of six cases of primary malignant tumors of the sternum, collected in our institution between 1993 and 2009. There were 4 men and 2 women with a mean age of 69, 5 years. Parietal swelling was the most frequent symptom. Imaging showed a sternal lytic lesion. Three tumors were treated surgically. Associated treatments were neoadjuvant chemotherapy [1 case] and postoperative radiotherapy [1 case]. A medical treatment [radiotherapy alone or chemotherapy] was performed in 3 cases. These tumors were divided as below: 3 plasmacytoma, 1 chondrosarcoma, 1 osteosarcoma and 1 large B cell lymphoma. The management of primary malignant tumors of the sternum is multidisciplinary. It depends on the histological type, the possibility of surgical treatment and the distant and local aggressiveness

[Lung cancer with venous thrombo-embolism: clinical characteristics]

Lung cancer is the most common malignancy diagnosed in patients with venous thrombo-embolism [VTE]. To investigate clinical, biological, radiological features and survival of lung cancer patients with VTE. Retrospective case-control study investigating biologic, clinical course and survival of 25 patients lung cancers with VTE [Group M] and 50 lung cancers without VTE [group T]. The frequency of the VTE was 5.88% with 2.58% pulmonary embolism [PE]. The mean age was 58 years +/- 9.8 in group M and 57.9 years +/- 9.6 in group T. No significant difference concerning medical or surgical history for both groups was found. The dyspnea and chest pain were at equal frequency [63.6%]. Regarding the clinical probability of the PE, it was no significant differences between the two groups. A rate of D-dimer > 0.7micro g/l was more frequent among group M [75% vs 20%; p = 0.054]. The most common histological type was nonsmall cell lung cancer [88%]. A stage IV was significantly more frequent in group M [86.4% vs. 52.3%; p = 0.007]. The mean period of survival in Group M was 10.6 +/- 1.2 month and 20.2 + 1.8 month in group T; p = 0.38. The VTE associated to lung cancer is under diagnosed. Prospective studies are needed to establish more adapted scores

Acute pulmonary embolism: epidemiologic and tomodensitometric study

Acute pulmonary embolism is a common disease with substantial morbidity and mortality in untreated patients. It requires an urgent positive diagnosis. To assess the prevalence of acute pulmonary embolism and calculate the sensitivity and specificity of multidetector CT for the diagnosis of acute pulmonary embolism in a hospital specialized in cardio-thoracic diseases. This is a prospective study conducted at Abderrahmen Mami Hospital, which included 200 consecutive patients suspected of acute pulmonary embolism and explored by a multidetector CT pulmonary angiography [16 slices]. Prevalence of acute pulmonary embolism was calculated at 37.5%. The multidetector CT has enabled an alternative diagnosis in 46 patients [40%]. The sensitivity and specificity of multidetector CT were calculated respectively 89.6% and 100%. The prevalence of acute pulmonary embolism, in a hospital specialized in cardio-thoracic diseases, is higher than that found in general hospitals. High sensitivity and specificity of multidetector CT makes it the gold standard for the diagnosis of pulmonary embolism

Last discovery of a congenital broncho-oesophageal fistula

Broncho-oesophageal fistula is rare and occurs mostly in acquired condition. Report of a new case. We report a case of a 58-years-old woman which has, since 38 years ago, a chronic cough, recurrent bronchopulmonary suppurations and hemoptysis. Clinical examination let to the diagnosis of a broncho-oesophageal fistula. Surgical treatment resulted in complete recovery. There was no evidence of any aetiology. Congenital origin of the fistula was deduced