[Thrombosis of the superior vena cava revealing a protein S deficiency]. / Thrombose de la veine cave supérieure révélatrice d'un déficit de la protéine S. À propos d'un cas.

Thrombosis of the superior vena cava is attached to several causes including deficiency of the protein S. It occurs gradually by a superior vena cava syndrome. We report a patient aged 22 years, no toxic habits or bipolar aphthosis, which presented for 3 months a superior vena cava syndrome. The radiological and biological assessments confirmed thrombosis of the superior vena cava and a deficit of the protein S for which the patient was put under anticoagulant therapy with good clinical and radiological improvement. Through this observation, the authors report a rare cause of thrombosis of the superior vena cava which is the isolated protein S deficiency and provide a review of the literature.

[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.

[Doege-Potter syndrome. about one new case]. / Syndrome de Doege-Potter : à propos d'une nouvelle observation.

Syndrome Doege-Potter is a paraneoplastic syndrome in which hypoglycemia is the result of tumors producing insulin growth factor-like (IGF-II) it is most often solitary fibrous tumor of the pleura (TFSP). These are rare and may be discovered incidentally, during non-specific respiratory symptoms or during hypoglycemia. Hypoglycemia occurs in tumors of large volume and it disappears after surgery, which is the treatment of choice for a permanent cure in most cases. We present a case of Doege-Potter syndrome whose interest is to consider the TFSP as a cause of hypoglycemia in patients with pleural tumors.

[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.

[Epithelioid malignant peripheral nerve sheath tumor. A case report]. / Tumeur maligne des gaines des nerfs périphériques type épithélioïde. A propos d'un cas.

Malignant peripheral nerve sheath tumors (MPNST) are exceptional and painful. The typical localization along a peripheral nerve is not always present. Prognosis is very poor. Diagnosis is particularly difficult because of the variable pathological presentation and unpredictable differentiation. We report an exceptional case of epithelioid differentiation in a 43-Year-old patient who complained of right thoracic pain for one and a half Years. Physical examination revealed weight loss and a paravertebral mass under the scapula. The chest x-ray showed a suprahilar opacity suggestive of parietal involvement and lysis of the sixth rib. Surgical biopsy of the parietal mass led to the diagnosis of epithelioid MPNST.

[Cystic lymphangioma of the mediastinum. Seven cases]. / Les lymphangiomes kystiques du médiastin. A propos de 7 cas.

Cystic lymphangioma of the mediastinum is an uncommon vascular tumor frequently discovered incidentally on chest x-ray exams. Radiology (CT and MRI) may suggest the diagnosis and allow an assessment of the operatives difficulties, but histology of the surgical specimen is required for precise diagnosis. Complete resection is the only treatment; in some patients resection was incomplete because of the infiltrating character of these tumors, leading to recurrence. We report seven cases of mediastinal localization with a review of literature.

[The prevalence of adolescent asthma in Rabat. A survey conducted in secondary schools]. / Prévalence de l'asthme de l'adolescent à Rabat. Enquête dans les établissements de l'enseignement secondaire.

An enquiry was made to determine the prevalence of asthma in adolescents and was achieved using a questionnaire which was filled in by the pupils in secondary schools in Rabat. The sample was determined by a systematic poll of 1,616 pupils of whom 1,464 (90.6%) replied. 88 pupils (6.0%) replied in the affirmative to the question "Have you ever had whistling noises in the chest?", 78 (5.3%) to the question "Have you ever had a sensation of respiratory difficulty or suffocation with a whistling noise in the chest?", 48 (3.3%) to the question "Have you ever had asthma?" and 36 (2.5%) to all 3 questions and 114 (7.8%) to one or other of the questions. After a detailed questionnaire had been carried out on 110 of 114 pupils the diagnosis of asthma was confirmed in 50, which gives an estimation of the accumulative prevalence of 3.4% +/- 0.9%. This prevalence is higher amongst the oldest children in the family (26 out of 349, 7.4%) compared to the birth order of the other brothers and sisters (24 out of 1,112, 2.2%) (p less than 0.001). Pupils from higher social backgrounds (22 out of 256, 8.6% against 28 out of 1,208, 2.3% from more average or more poor social backgrounds, p less than 0.01). A past family history of asthma were more often noted in asthmatics (38 out of 50, 76%) than in non-asthmatics (406 out of 414, 28.7%) p less than 0.001). In the same way cough and phlegm and episodes of bronchitis occurring in autumn and winter and breathlessness on effort are more frequent in asthmatics; 20 out of 50 (40%) against 318 out of 1,414 (22.5%) for the cough (p less than 0.01), 12 out of 50 (24%) against 157 out of 1,414 (11.1%) for phlegm (p less than 0.01), 31 out of 50 (62%) against 337 out of 1,414 (23.8%) for episodes of bronchitis (p less than 0.001) and 15 out of 50 (30%) against 219 out of 1,414 (15.5%) for breathlessness on effort (p less than 0.001). Besides this we have noticed a slight predominance of asthma in boys compared to girls but the difference is not significant.