A Rare Paraneoplastic Syndrome of Lung Cancer.

Achalasia is a neurodegenerative motor disease of the esophagus resulting mainly from a loss of function of the lower esophageal sphincter, the pathophysiology of which is still poorly understood. Its incidence is rare-it is 1.6 per 100,000-and its occurrence in the context of paraneoplastic syndrome has been rarely described in the literature. We report a rare case of paraneoplastic achalasia associated with lung cancer.

[A rare cause of haemorrhagic pleurisy: Dissection of the aorta]. / Une cause rare de pleurésie hémorragique : la dissection de l'aorte.

INTRODUCTION: Haemorragic pleurisy is fairly common. The etiology is dominated by tumors and tuberculosis. The rupture of intra-thoracic vessels into the pleural cavity is a much rarer cause and the diagnosis is often delayed. OBSERVATION: A 77-year-old patient without previously known hypertension was hospitalized for investigation of a fluid density opacity occupying the entire left hemithorax. Thoracentesis revealed a non-coagulable haemorrhagic fluid. A computed tomography scan showed a Stanford type B aortic dissection. The patient was given anti-hypertensive treatment for one year. CONCLUSIONS: Aortic dissection remains among the diagnoses to consider in the case of a haemorrhagic pleural effusion despite absence of the usual suggestive symptoms.

[Cerebral metastasis of a "ghost" bronchopulmonary tumor]. / Métastase cérébrale d'une tumeur bronchopulmonaire "fantôme".

Carcinoma of unknown primary (CUP) is the metastasis of epithelial malignancy whose origin remains unknown. Bronchial carcinoma is the most common cause (45%), however, in more than a quarter of cases, its origin is unknown and the choice of therapy often justifies a histopathological precision brought by the immuno-histochemistry. We present a rare case of cerebral metastasis, revealing an unknown lung cancer after a comprehensive review. This is a patient aged 53 years, chronic smoker, who presented a year and a half ago a sudden loss of consciousness with afebrile tonic-clonic seizure of spontaneous resolution. Clinical examination was unremarkable. Brain imaging by MRI has objectified the presence of two parietal tissue formations, which stereotactic biopsy with histological and immuno-histochemical favored metastasis of lung adenocarcinoma origin. An etiologic in search of the primitive lung remained negative (chest X-ray of face, chest CT and bronchoscopy with sampling upper gastrointestinal endoscopy). The rest of the etiologic, looking for another primitive, remained negative. The diagnosis of a bronchogenic carcinoma with brain metastasis is therefore withheld. The patient received two brain radiotherapies (gamma kniff) with regression of the two nodular formations. We have not given specific treatment and have called for very close monitoring of the patient who remained stable after 18 months. Through this observation, we stress the interest of the histology and immuno-histochemistry of carcinoma of unknown primary (CUP) to the diagnosis, guide therapy and determine prognosis.

Well-differentiated fetal adenocarcinoma: a very uncommon malignant lung tumor.

Well-differentiated fetal adenocarcinoma (WDFA) is a very uncommon malignant tumor originating in the lung. This report describes the case of a 38-year-old woman with a WDFA treated by surgery. The malignancy is low grade and associated with a good prognosis, and so it is important for clinicians to be aware of and to identify this rare variant of adenocarcinoma.

[Delay in the diagnosis of primary bronchial cancer. Study carried out in the pneumology unit of Ibn Sina university hospital, Rabat (Morocco)]. / Retard diagnostique du cancer bronchique primitif. Étude réalisée dans le service de pneumologie du CHU Ibn Sina de Rabat (Maroc).

INTRODUCTION: Primary bronchial cancer (PBC) is a major public health problem. The diagnosis is often late resulting in a poor prognosis. PURPOSE: To determine the factors leading to a late diagnosis. PATIENTS AND METHODS: All PBCs diagnosed between 01 January and 31 December were included. The factors studied were: "age, sex, smoking, place of residence, socioeconomic level, clinical signs, diagnostic means, histological types, the stages and date of treatment". The date of the first symptom (D1s), the date of care (Dpch), the date of the diagnosis (Ddg) and the date of the beginning of treatment (Dttt) were used to determine the delay before care. RESULTS: One hundred and three cases of PBC were included. The medium delay before hospitalisation (D1s to Dpch) was 76 days, the delay before the diagnosis (Dpch to Ddg) was 25 days, the time before treatment (Ddg to Dttt) was 27 days, the time between hospitalisation and treatment (Dpch to Dttt) was 69 days, the overall delay (D1s to Dttt) was 160 days. The time before the diagnosis was longer in cases with a low socioeconomic level (30 days vs. 21 days, p: 0.06). The time before treatment was shorter for small cell carcinomas (SCC) (23 days vs. 31 days: p: 0.06). The time between hospitalisation and treatment was shorter for stages IIIB and IV of NSCBC (60 days vs. 67 days, p: 0.03). The overall delay was shorter for SCC (152 days vs. 168 days, p: 0.001). CONCLUSION: The study confirms the problem of a delay in diagnosis. The effect of these delays on the prognosis has not been demonstrated and requires further study.

[Disseminated cryptococcosis in an apparently immunocompetent patient]. / Cryptococcose disséminée chez un sujet apparemment immunocompétent.

Cryptococcal infections occur frequently in immunocompromised patients particularly in the context of AIDS, lymphomas and following immunosuppression for organ transplant recipients. In these contexts the infection is readily considered and diagnosis straightforward. The diagnosis is rarer and thus less likely to be considered in immunocompetent patients which can lead to late diagnosis and delay in initiation of therapy. We report the case of disseminated cryptococcosis with endobronchial, cutaneous, bone and meningeal involvement in an apparently immunocompetent patient. Before antifungal treatment could be initiated the patient died of cerebral complications.

[An unusual localization of a rare tumor: giant-cell tumor of the rib. Case report and review of the literature]. / Une localisation inhabituelle d'une pathologie rare: la tumeur costale à cellules géantes. A propos d'un cas avec revue de la littérature.

INTRODUCTION: Giant-cell tumors of bone are rare primary neoplasms commonly encountered in young adults. Women are slightly more affected than men. CASE REPORT: We report the case a 27 year old woman presenting with a twelve months history of painful and progressively growing thoracic mass in the right anterior chest wall. Physical examination found out a fixed thoracic mass in the right retro-mammary area measuring 8 x 6 centimeters. The overlying skin was normal. Chest roentgenogram demonstrated a large ill defined mass continuing the anterior arc of the fourth right rib. Computed tomography evidenced a well defined pathologic process originating from the fourth right rib without expansion of the surrounding soft tissue. Pulmonary functional tests were normal and other complementary investigations evidenced no abnormalities. Our patient first had a fine needle cytological biopsy that brought strong suspicion of Giant-cell tumor of the rib. She then underwent an "en bloc" resection of the tumor whose histopathologic analysis allowed a definitive diagnosis. The post-surgical follow up during 12 months showed no signs of tumor recurrence. CONCLUSION: Through this observation the authors emphasize not only the rarity of the giant-cell tumors of bone but also its unusual costal localization (few cases reported till date). They focus on the importance of precocious screening and treatment and underline the value of the follow up in order to detect timely any sign of local recurrence or sarcomatous transformation. Finally, they report a current review of the literature.

[Endobronchial tuberculosis. Report of 21 cases]. / La tuberculose endobronchique. A propos de 21 observations.

Since the advent of antituberculosis drugs, endobronchial tuberculosis has become an exceptional finding, often in a misleading context. Cases reported generally occur in patients with immune deficit. We report 21 cases of endobronchial tuberculosis in immunocompetent patients (mean age 37 years). Clinical and radiological signs were not specific. Bronchial fibroscopy was essential for certain diagnosis, particularly in budding forms. Early treatment reduced the risk of complications. Based on our experience with these 21 cases, we propose a discussion of the pathogenic mechanisms involved and the diagnostic difficulties encountered as well as the disease course and risk of complications that can be expected.