Idiopathic pulmonary fibrosis diagnosed concomitantly with diffuse squamous cell lung cancer on surgical lung biopsy: a case report.

BACKGROUND: Idiopathic pulmonary fibrosis is a disease with a poor prognosis and has been associated with increased lung cancer incidence. CASE PRESENTATION: We report the case of a Caucasian 75-year-old woman, a former smoker, hospitalized for breathlessness with a chest computed tomography scan showing an interstitial lung disease. A surgical lung biopsy was performed, confirming a pattern of usual interstitial pneumonia but also numerous disseminated foci of well-differentiated focally invasive squamous cell carcinoma without hypermetabolic lung nodule, mass, or enlarged lymph node visualized on chest computed tomography or positron emission tomography scan. Nintedanib was started for its antifibrotic and antitumor properties, without any other antineoplastic treatment. Three years after initiation of nintedanib, clinical, functional, and computed tomography scan evaluations were stable, and there was no evidence for evolution of the squamous cell carcinoma. CONCLUSIONS: Data are scarce regarding the benefit of nintedanib in patients with idiopathic pulmonary fibrosis-associated lung cancer, and it is unclear whether nintedanib could have a preventive role in lung carcinogenesis in idiopathic pulmonary fibrosis patients. This experience could help the scientific community in case of similar incidental findings.

[Lung metastases of pancreatic adenocarcinoma: Watch for the second train!] / Adénocarcinome pancréatique métastatique aux poumons : un train peut en cacher un autre !

Pulmonary metastases due to a pancreatic cancer are difficult to diagnose and demonstrate a wide range of radiological patterns. We report the case of a 37-year-old female patient, without past medical history, with multicystic lung disease in a context of chronic abdominal pain, fatigue and weight loss. After several months of diagnostic delay, pathological examination of surgical lung biopsies led to the diagnosis of secondary deposits of pancreatic cancer. The clinical and radiogical situation deteriorated quickly with the development of alveolar consolidation and Aspergillus superinfection was then diagnosed. This case illustrates the value of an early decision to undertake surgical lung biopsy in the work-up of multicystic lung disease when cancer is suspected. In addition, in the specific context of cancer, faced with clinical and/or radiological deterioration, it is essential to look for infection, particularly aspergillosis.

[Interstitial lung disease and pancreatic cancer: Series of two cases]. / Pneumopathie infiltrante diffuse et cancer du pancréas : présentation de deux cas.

INTRODUCTION: Pancreatic cancer is often not diagnosed until at a metastatic stage at which point the prognosis is very poor. Pulmonary metastases are pleomorphic, often present at the time of diagnosis and can lead to the discovery of an asymptomatic primary disease. CASE REPORT: We describe two cases aged 60 and 74 years, where imaging identified what was thought to be an interstitial lung disease but which was actually metastasis from pancreatic cancer. In the first case, CT showed multiple excavated pulmonary nodules but the presentation with medullary compression led rapidly to pathological diagnosis on bone lesions. In the second patient, a history of rheumatoid arthritis and the lack of abdominal symptoms led to an initial search for disease related to the rheumatoid disease. Histopathology, from lung and bone biopsies, enabled a correct diagnosis to be achieved. CONCLUSION: Where atypical interstitial lung disease occurs, biopsy should be considered in order not to delay a diagnosis of cancer, especially pancreatic cancer.

[Parapneumonic pleural effusions: Epidemiology, diagnosis, classification and management]. / Les épanchements pleuraux parapneumoniques: épidémiologie, diagnostic, classification, traitement.

Parapneumonic pleural effusions represent the main cause of pleural infections. Their incidence is constantly increasing. Although by definition they are considered to be a "parapneumonic" phenomenon, the microbial epidemiology of these effusions differs from pneumonia with a higher prevalence of anaerobic bacteria. The first thoracentesis is the most important diagnostic stage because it allows for a distinction between complicated and non-complicated parapneumonic effusions. Only complicated parapneumonic effusions need to be drained. Therapeutic evacuation modalities include repeated therapeutic thoracentesis, chest tube drainage or thoracic surgery. The choice of the first-line evacuation treatment is still controversial and there are few prospective controlled studies. The effectiveness of fibrinolytic agents is not established except when they are combined with DNase. Antibiotics are mandatory; they should be initiated as quickly as possible and should be active against anaerobic bacteria except for in the context of pneumococcal infections. There are few data on the use of chest physiotherapy, which remains widely used. Mortality is still high and is influenced by underlying comorbidities.

[Retrospective analysis of 50 thymic epithelial tumors in Rennes university hospital]. / Analyse rétrospective portant sur 50 tumeurs épithéliales thymiques au CHU de Rennes. Quelle concordance avec le référentiel RYTHMIC publié en 2010 ?

BACKGROUND: Thymic epithelial tumors (TET), including thymomas and thymic carcinomas, are rare and characterized by very different evolutionary patterns depending on histology and invasion stage. The therapeutic management is not well defined but is a subject of increasing interest. The descriptive and analytic objectives of this retrospective monocentric study were to analyze the clinical characteristics of patients with TET, and to assess the management of these tumors in our centre. METHODS: Adult patients with TET managed in the Rennes university hospital in the period 2000-2011 were selected via the pathology department. Their clinical and pathological features and survival were analyzed retrospectively. RESULTS: Fifty TET were retrieved (46 thymomas and 4 thymic carcinomas). Their clinical and histological features and their invasion stages were concordant with published studies. Their diagnostic and therapeutic managements were also in accordance with current guidelines. In univariate analysis, myasthenia and surgery were associated with better survival rates. CONCLUSION: Management of TET in Rennes university hospital is in accordance with guidelines.

[Tracheal adenoid cystic carcinoma treated by complete carinal reconstruction with the help of an ECMO: about a case]. / Carcinome adénoïde kystique trachéal traité par reconstruction complète de la carène sous ECMO: à propos d'un cas.

Primitive tumors of the trachea are rare, accounting for 0.1% of the airway tumors. Cystic adenoid carcinoma (or cylindroma) represents the second most frequent type of tracheal cancers. Histologically speaking, this tumor type is divided in three patterns: cribriform, tubular and solid; it presents a slow growth, perineural invasion and potential local recurrence and metastasis. We presented herein the case of a 56-year-old female suffering from a cystic adenoid carcinoma of the low trachea. She has been treated by carinal resection with negative airway margin and complete reconstruction, with the help of an extra corporeal membrane oxygenation (ECMO).

Bypass to the perigeniculate collateral arteries: mid-term results.

PURPOSE: The purpose of this report is to present mid-term results of infrainguinal revascularizations using either the highest genicular artery or medial sural artery as the distal anastomosis site. MATERIAL AND METHODS: Between 1996 and 2005, a total of 59 bypass procedures to perigeniculate collateral arteries were performed in 57 patients (14 women, 43 men) with a mean age of 74. Fifty five patients presented with critical ischemia (tissue loss in 28 and rest pain in 27). Four patients presented with intermittent claudication. Mean ankle brachial index was 0.48. The distal anastomosis site was the highest genicular artery in 18 patients, medial sural artery in 37 cases, highest genicular and/or medial sural artery and/or tibial artery in sequential fashion in four cases. The proximal anastomosis was to the common femoral artery in 26 cases and superficial femoral artery in 33. RESULTS: There were two deaths during the immediate postoperative period. Mean follow-up duration was 35 months (range 1-108 months). One patient was lost to follow-up. Six patients required major amputation. At 3 years, primary patency was 65+/-7%, secondary patency was 70+/-7%, limb salvage and survival rate were 90+/-4% and 64+/-7% respectively. CONCLUSION: Bypass to perigeniculate collateral arteries provides acceptable patency and limb salvage rates.

Paraganglioma of the cauda equina: MR findings. One case.

Paraganglioma of the filum terminale is a rare tumor but well described in the neurosurgery and pathology literature. Few MRI reports are mentioned. Paraganglioma, often misdiagnosed with ependymoma or schwannoma on MRI images, must be kept in mind, when a highly vascular lesion with serpentine vessels is observed.