Intrathoracic extrapulmonary hydatid cysts.

Hydatid disease caused by echinococcus granulosus is still a serious problem in both underdeveloped and developing countries. Clinical signs of the disease are not specific. Most patients have a few symptoms when a hydatid cyst is discovered. Symptoms depend on its location, size and complications. Parasite can settle in every organ and tissue in the human body. We report two cases with intrathoracic extrapulmonary hydatid cyst with multiple cysts. Pathophysiology of the mode of dissemination, and surgery are discussed.

Diffuse large B-cell lymphoma presenting as large anterior chest wall mass involving pleura and lung: A possible result of post-traumatic chronic inflammation.

A 67 year-old-man was hospitalized due to chronic pain and a large mass on the anterior chest wall. His medical history showed chest trauma in 1970, the reconstitution of the scenario revealed there was blunt trauma with swelling and rib fracture on the same side. Physical examination revealed an isolated large anterior chest wall mass. Chest radiography showed two bilateral irregular masses, chest computed tomography showed a large right chest wall tumor with pleural effusion, nodules of the right upper lobe and tumor of the left lower lobe without mediastinal lymphadenopathy. Whole body exploration showed only the chest disease. Transthoracic biopsy showed inflammatory reaction. Surgical biopsy by anterior thoracotomy of the right mass was performed under general anesthesia. Histological and immunohistological analysis revealed lymphoid diffuse large cell proliferation with positive staining of CD 20, BCL-6 and MUM1, confirming the diagnosis of diffuse large B-cell malignant lymphoma. Chemotherapy based on CHOP-21 (cyclophosphamide, doxorubicin, vincristine, and prednisolone) was administered with good response after three cycles. The patient was discharged under surveillance in good condition after the end of chemotherapy. We report an infrequent neoplasm with an unusual and subtle clinical presentation.

A well-differentiated fetal adenocarcinoma of the lung with early local recurrence after limited resection.

A 42-year-old man was found to have an abnormal shadow during a systematic physical examination. Computed tomography of the chest revealed a mass in the lateral segment of the left lower lobe with parietal contact without pleural effusion or mediastinal lymphadenopathy. Bronchoscopy showed inflammation at the pyramid basal bronchus without visualization of hydatid materials or bud tumor. The hydatid serology, testing for myobacterium tuberculosis in sputum and the histological finding of bronchial biopsy, were negative. Initial surgery of a posterolateral thoracotomy showed a mass with soft consistency adherent to the parietal pleura on the seventh and eighth intercostal space. Because of the technical difficulties of extemporaneous examination, a limited resection was performed. The histopathological exam showed a well-differentiated fetal adenocarcinoma. The patient was re-operated on for complete resection 1 month and 20 days later, she was staged cT2N0M0. At exploration we discovered local recurrence with a 1.5 cm nodule in the same segment. An extended lower lobectomy to the seventh and the eighth rib was performed with lymphadenectomy. The patient was staged as Ib (pT2N0M0) with clear resected margins (R0). She was discharged in good condition from hospital 11 days postoperatively. Review at 2, 6 and 11 weeks showed no complications and chest radiograph revealed no anomaly. No adjuvant therapy was conducted and the patient is under surveillance.