Cushing´s syndrome: high aggressiveness of low-grade tumors.

Cushing´s syndrome is caused by prolonged exposition supraphysiological to endogenous or exogenous cortisol. Ectopic production of adrenocorticotropic hormone by lung carcinoid tumors is relatively rare. Most documented cases have been reported individually. This rare neoplasm low grade that may secrete adrenocorticotropin (ACTH) leading to rapid development of hypercortisolism which is the main mode of discovery, can be a real aggressive form. This report shows a high aggressiveness of this endocrine neoplasia, wich was marked on the general, morphological, bone and psychiatric level. The trivialization of clinical signs had caused the delay in diagnosis with irreparable bone consequences.

Unusual mode of presentation of intrathoracic bronchogenic cyst: A double location.

A 63 year old woman presenting chronic back pain and neuralgia had abnormal shadow on chest radiograph. She has a history of pulmonary tuberculosis treated in 1977. The chest-CT scan showed a soft tissue mass in the lower lobe of the right lung and a cystic mass in the paravertebral region. The patient had right lower lobectomy and complete excision of a paraoesophageal cyst. Both masses were bronchogenic cysts at histology. The patient had an uneventful discharge the seventh postoperative day. After 4 years and 7 months of follow-up with CT-scann, the patient was free of symptoms with no evidence of recurrent disease.

Malignant melanoma of the lung: a case report.

Primary melanoma of the lung is an extremely rare pathological entity and sparsely reported in the literature. A 68-year-old man was admitted with 3 months history of cough, sputum production, dyspnea, hemoptysis and chest pain. The chest radiography demonstrated bilateral mass lesion and thoracal computerized (CT) showed a bilateral tissu mass with left parietal invasion. Bronchoscopy revealed a large polypoidal tumor arising from the left lower lobe bronchus, histology at bronchial biopsy revealed a malignant melanoma. Surgical biopsy of the left parietal mass was confirmed by invasive malignant melanoma. Primary melanoma of the lung represents a rare pathological entity; careful interpretation of histopathological information in correlation with all other findings from clinical studies can establish a diagnosis.

Pancreatic-pleural fistula in chronic pancreatitis.

Pancreatic-pleural fistula is a rare condition and few data related to its diagnosis and treatment are available. A fistulous connection linking the pancreas with the pleura via the diaphragm or mediastinum through the retroperitoneal area is formed. We report on a case with pancreatic-pleural fistula at its early stages in an alcoholic male patient aged 45 years with known chronic pancreatitis. The operation by Roux-en-Y jejuno-pseudocystostomy was followed by chest tube drainage.

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.

Desmoplastic small round cell tumor of the pleura.

In July 2006 a 19-year-old woman presented with a history of few months of back ache. Routine chest radiograph and computed tomography (CT) examination revealed a thickening of the parietal pleura with a collapsed right lung. The abdominal pelvic CT scan was normal. Thoracotomy was performed with decortication lung, parietal pleurectomy and pleural biopsy. The histological examination and immunohistochemical coexpression of cytokeratin AE1-AE3, vimentin and desmin confirmed the diagnosis of desmoplastic small round cell tumor of the pleura. After resection, the patient received radiotherapy and chemotherapy with doxorubicin, ifosfamide, etoposide and cisplatin in six cycles which resulted in complete remission. The patient was seen regularly in consultation; the last examination was in December 2010 and clinically and radiologically showed a stable condition. The whole follow-up period was 53 months. We thought this case to be worth presentation because of the unusually long survival, which is probably due to the aggressive complex anticancer treatment.

Parietal pleura lipoma: a rare intrathoracic tumor.

Lipoma is a common benign tumor of soft tissues in adults. An intrathoracic location, particularly in the parietal pleura, is rare. We report two cases of pleural parietal lipoma with a review of literature. A preoperative diagnosis was established histologically by fine-needle aspiration in the first case and radiologically by computed tomography scan in the second. Both patients underwent surgical excision via thoracotomy and video-assisted thoracic surgery. Pathology examination confirmed the diagnosis of lipoma. The authors emphasize the necessity of surgical resection because of preoperative diagnostic difficulty of discerning lipoma from well-differentiated liposarcoma.

Mediastinal hydatid cyst.

BACKGROUND: The objective of this study was to report our experience in the management of hydatid cysts of the mediastinum. METHODS: Among 206 patients who underwent surgery in our department for intrathoracic hydatid cysts between September 2001 and September 2008, 7 patients (3.4%) aged 24 to 49 years (mean, 36.2 years) had mediastinal hydatid cysts. Imaging consisted of chest X-ray and computed tomography. Surgical approach was by posterolateral thoracotomy in all cases. RESULTS: The cyst was located in the posterior mediastinum in 3 cases (42.8%), in the anterior mediastinum in 2 cases (28.5%) and in the middle mediastinum in 2 cases (28.5%). Two patients had cysts in other thoracic locations (diaphragm, pleural). All cysts were intact. Surgical approach was right thoracotomy in 5 patients (71.4%) and left thoracotomy in 2 patients (28.5%). In 5 cases, a small part of the cyst wall intimately adherent to vital structures was left in place. There were no postoperative complications or mortality. CONCLUSION: Mediastinal hydatid cyst is an uncommon disease. Because of the surrounding vital structures, the cyst should be removed immediately. Surgical removal remains the treatment of choice for mediastinal echinococcosis, without extensive resection when progression of dissection is impossible or dangerous.

Primary hydatid cyst of the posterior mediastinum.

Hydatid cystic disease is still a health problem in Morocco. Mediastinal localization is very rare. We report the case of a 24-year-old man who presented with right chest pain and dyspnea. Chest X-Ray and computed tomography showed a mediastinal mass. The diagnosis was confirmed perioperatively by macroscopic and histologic investigations. Resection of the cyst was performed, and a small part intimately adherent to the inferior vena cava and oesophagus was left in place. There were no complications or recurrence.