[Bifocal lung cancer: the same histology?]. / Cancer bronchique bifocal: une même histologie?

Whereas synchronous lung cancer is rare, synchronous small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) are exceptional. The authors report the case of a 61-year-old man with synchronous unilateral adenocarcinoma and small cell lung cancer, raising the question as to the need for the histology of all of the lesions in the same lobe or same lung as well as the treatment. The medical history, biology, CT and (18)F-FDG TEP-CT did not support a diagnosis of synchronous lung cancer. The prognosis was poor and only surgery could improve the prognosis. This is a rare case and illustrates the difficulty in the diagnosis of multiple lung cancer and the difficulty in treating synchronous lung cancer with different histologies (SCLC and NSCLC).

[Performances of the Amplified Mycobacterium Tuberculosis Direct Test in non respiratory specimens (study about 1538 samples)]. / Performances du test "Amplified Mycobacterium Tuberculosis Direct Test" sur les échantillons extrarespiratoires (étude sur 1538 échantillons).

From March 1998 to August 2009, 1538 non-respiratory samples collected from 1182 patients, were tested using the Gen-Probe Amplified Mycobacterium Direct Test™ (AMTD). After decontamination procedure, every sample was tested by AMTD and by culture on solid and liquid media. The "Gold-standard" was considered by the combination of culture results and clinical diagnosis. Tuberculosis was present in 17,59 % (208 patients). For theses 1538 non-respiratory samples (225 culture positive samples, 248 AMTD positive), 279 corresponded to tuberculosis. After resolving the discordant results, the sensitivity, specificity, positive and negative values were 89, 99, 99,6 and 97,3 %.

[Evaluation of the SD BIOLINE TB Ag MPT64 Rapid® for the diagnosis of tuberculosis]. / Évaluation du kit SD BIOLINE TB Ag MPT64 Rapid® dans le cadre du diagnostic de la tuberculose.

The purpose of this study was to evaluate the SD Bioline Ag MPT64 Rapid(®) for identification of the Mycobacterium tuberculosis complex. The method uses an immunochromatographic assay and needs 100 µl of sample taken from liquid culture or colonies suspended. The sensitivity was determined using 99 strains of M. tuberculosis complex and the specificity using 10 nontuberculous mycobacteria and 85 strains other than mycobacteria genus. The test showed excellent sensitivity (99%) and specificity (100%). This technique displays several advantages and is destined to spread in all laboratories and particularly in endemic areas.

[Mediastinal pathology: pathological treatment of frozen section]. / Pathologie du médiastin: prise en charge anatomopathologique des examens extemporanés.

Tumoral pathology of the mediastinum is extremely varied, with different prognoses and treatments. The pathological examination is essential, both etiologically and prognostically. Mediastinoscopy is generally used to check for lymph node metastases, bronchopulmonary carcinoma, but also, to a lesser degree, for the exploration of isolated mediastinal adenopathy. Finally, this technique enables a diagnostic approach to mediastinal tumours. The frozen section has its place, at the first indication, making it possible to prescribe neoadjuvant chemotherapy, and in the other situations to make sure that the quantity of material removed is sufficient or even to carry out complementary techniques.

[Pulmonary vein leiomyosarcoma extending into the left atrium]. / Léiomyosarcome de la veine pulmonaire avec extension dans l'oreillette gauche.

In this paper, the authors report the case of a 28-year-old man with pulmonary vein leiomyosarcoma presenting subacute respiratory distress. Thoracic computed tomography and transoesophagal ultrasonographic examination of the heart suggested the diagnosis of a heart tumour revealed by the obstruction of the mitral valve and pulmonary oedema. Emergency cardiac surgery revealed the mass to be a leiomyosarcoma, probably extending from the right inferior pulmonary vein and extending into the left atrium. The clinical evolution was complicated because of a sudden local relapse. The patient underwent a second cardiac intervention involving lower right lobectomy followed by adjuvant chemotherapy with an ifosfamide-adriamycin combination. This treatment failed to control the disease and a third cardiac intervention was necessary with second-line gemcitabine-paclitaxel adjuvant chemotherapy. Further recurrences were observed with metastases first in the scalp and then in the spine and adrenal glands leading to the death of the patient 2 years after the diagnosis.

[Lymph node supraclavicular metastasis of thymic carcinoma: an inaugural and unusual feature of a rare disease]. / Métastase ganglionnaire sus-claviculaire d'un carcinome thymique: présentation inaugurale inhabituelle d'une pathologie rare.

Among the epithelial tumours of the thymus, thymic carcinomas are rare, involving more aggressive locoregional behaviour and a poor prognosis. More than one-third of cases present lymph node metastasis during an evaluation of the extension of a primitive mediastinal tumour of thymic origin. The authors report an unusual case in a 46-year-old woman presenting a metastatic form. The diagnosis of epidermoid thymic carcinoma was based on the histopathological examination of a right supraclavicular lymph node, associated with an anterior radiological mediastinal tumoral syndrome, raising the delicate problem of its diagnosis and treatment.

[Management of pulmonary masses by guided transthoracic fine needle biopsy under computed tomography. Contribution from the Pathology and Radiology Departments of the Percy Military Hospital (Clamart, France) over 10 years]. / Prise en charge des ponction-biopsies guidées sous tomodensitométrie des masses pulmonaires. Contribution de la radiologie et de l'anatomie pathologique à l'Hôpital d'instruction des Armées Percy sur dix ans.

Examining 260 samples of pulmonary nodules obtained by percutaneous biopsy under tomodensitometric control from the departments of radiology and pathology over 10 years, the authors note the advantages and disadvantages of this technique, provide the results of their experience and emphasise the importance of these biopsies in malignant pathology. The results of this series can be superposed with those found in the literature. Malignant tumours account for 75 % of the cases, with a clear prevalence of primitive adenocarcinoma. Benign pathology (approximately, 14 % of the cases) was represented by necrosis without any specificity, fibrous reaction and infectious causes. The act had to be repeated for the false negatives (7 %).

[Primary mediastinal large B-cell lymphoma: histopathologic features. A specific tumour]. / Le lymphome B à grandes cellules primitif du mediastin, une tumeur particulière. Aspects anatomopathologiques.

The diffuse large B-cell lymphomas of the mediastinum were long considered to be a variant of the classic forms of large B-cell lymphomas. However, their clinical and radiological features and especially their histopathological variants point to other lymphoid tumours such as Hodgkin's disease or anaplastic lymphomas, thymic tumours, germ cell tumours or metastatic tumors. The immunohistochemical findings are of prime importance in the diagnosis. This has recently been completed by molecular studies. Currently, they represent a distinct entity among the large B-cell lymphomas, due to their clinical, pathological and molecular features as well as the outcome. The authors report a new case in a young man.

[Poorly differentiated endocrine carcinoma of the colon]. / Carcinome endocrine peu différencié du côlon.

Small-cell endocrine carcinoma is a particularly aggressive form of endocrine carcinoma characterized by its rapid and early metastatic dissemination. We report a 59-year-old man who presented with abdominal pain as the initial manifestation of a colonic small-cell endocrine carcinoma with early liver metastases and poor prognosis. Poorly differentiated endocrine carcinomas are rare tumours that generally occur in the lung, but are exceptionally localized in other sites. Generally, these tumours have an aggressive behaviour with early metastatic spread, and curative surgical resection is often impossible. Despite aggressive chemotherapy, these extended tumours have an unfavourable outcome.

[Pleuro-pulmonary manifestations disclosing hepatic amoebiasis]. / Manifestations pleuropulmonaires révélatrices de l'amibiase hépatique.

During a mission in ex-Yugoslavia between 2001 and 2004, three French soldiers were sent home because of right pneumopathy, right pleurisy after appendicectomy, haemoptysis and liver haematoma, respectively. They previously were stationed in Africa and/or South America. The initial diagnosis was quickly modified: pleuropulmonary manifestations of amoebic hepatic abscess in two cases, and pleuropulmonary amoebiasis in the last case. The outcome was favourable with standard anti-amoebic treatment. The reports illustrate the possibility of hepatic amoebiasis with local pleuropulmonary manifestations and an exceptional case of pleuropulmonary amoebiasis with hepatobronchial fistula. The authors report this experience because it demonstrates that amoebiasis in European countries remains an often forgotten diagnosis. Although known for a long time in developing countries, amoebiasis in the military or in tourists should be systematically considered.

[Solitary fibrous tumour of the pleura: five cases]. / La tumeur fibreuse solitaire pleurale : à propos de cinq observations.

Solitary fibrous tumours are unusual mesenchymatous tumours, most often found on the pleura. The authors report five cases hospitalised between 1998 and 2003. With the greatest occurrence in the fifth decade, they are often accidentally found but sometimes associated with a paraneoplastic syndrome such as refractory hypoglycaemia. The diagnosis is based on computed tomography and complete surgical resection is the best treatment. Adjuvant therapy is proposed for the histologically aggressive forms. Because of the possibility of local or distant recurrence and malignant transformation, long-term monitoring is strongly recommended.

[A rare pulmonary tumour, primary malignant melanoma]. / Une tumeur rare du poumon, le mélanome primitif.

INTRODUCTION: Malignant melanoma most commonly presents as a primary neoplasm of the skin, but has been described in other mucosal sites. Rarely, malignant melanomas have been reported as primary visceral neoplasms, including the lung. Most such lesions have been dismissed as metastases from undocumented or regressed primary cutaneous or ocular melanomas. CASE REPORT: We report an original observation of an 82-year-old man with a pulmonary nodule presenting with chest pain. The diagnosis of melanoma was established on biopsies carried out under computerized tomography scanning and confirmed after right upper lobectomy two months later. DISCUSSION: Melanomas of the respiratory tract are usually metastatic in origin and a primary melanoma in very rare. Strict criteria must be applied before a diagnosis of primary malignant melanoma of lower respiratory tract can be accepted. Melanoma may be confused with more conventional types of lung cancer and other pigmented tumours.

[Solitary fibrous tumor of the retroperitoneum]. / Tumeur fibreuse solitaire du rétropéritoine.

Solitary fibrous tumour is unusual, arising most commonly in the pleura and can also occur in a large number of other sites. We report the case of a 34-year-old man with a retroperitoneal solitary-fibrous tumour, revealed by abdominal pain and hypoglycaemia. We describe the histopathological and immunohistochemical features. Solitary-fibrous tumour should be included in the differential diagnosis of spindle cell tumours in this location. Despite complete local excision, local recurrence and metastasis are seen. The behaviour of theses tumours is unpredictable and patients with solitary fibrous tumour require careful and long-term follow-up.

[A rare splenic lesion, the splenoma or splenic hamartoma]. / Une lésion rare de la rate, le splénome ou hamartome splénique.

We report a new case of splenoma in a previously healthy adult. A 52-year-old man was admitted for a splenomegaly with thrombocytopenia. The computed tomographic scan showed a tumor which measured 56 mm in diameter. A splenectomy was performed. Histologic examination of the splenectomy specimen revealed a splenoma. Splenoma or splenic hamartoma is a rare primary splenic tumor most often incidentally discovered, radiologically. It can also meet in a particular pathological context, evoking more a coexistence rather than an association or a complication, underlying the role of the pathologist in its diagnosis.

[Late mediastinal metastasis of Ewing's sarcoma of tibia]. / Métastase médiastinale tardive d'un sarcome d'Ewing du tibia.

Peripheral neuroectodermal tumors constitute a large spectrum of small round cell tumors among which Ewing's sarcoma is the most undifferentiated type. They are rare tumors which often concern young people and generally occur in bone tissue. Their metastatic potential is high, generally early, and rarely after five years. We report the case of a 45-year-old woman who presented a mediastinal metastasis eight years after the primitive tumor of tibia. The diagnosis was made on small core biopsies obtained by CT punction, and was based on morphologic analysis, immunohistochemistry, and confirmed by molecular biology. The presence of metastasis is the main prognostic factor. Despite therapeutic progress, the global survival rate of metastatic patients is still poor.

[Ectopic sebaceous glands in the esophagus]. / Ectopie oesophagienne des glandes sébacées.

Ectopic sebaceous glands have been detected in many tissues of ectodermal origin, but their presence in the esophagus remain, until now, a very rare anomaly. We report two new cases diagnosed by endoscopic biopsy.

[A rare primary tumor of the cerebellopontine angle: melanotic schwannoma, a pigmented tumor with unpredictable prognosis]. / Une tumeur primitive rare de l'angle pontocérébelleux: le schwannome mélanocytique, une tumeur pigmentée au pronostic réservé

Schwannomas are common ubiquitous benign tumours of the nervous sheaths. Among the various histopathological types, the pigmented schwannoma has to be distinguished from melanoma. We report a case of melanotic schwannoma of the cerebellopontine angle in a 52-year-old man with a slowly progressive cerebellar syndrome since 1978, who presented with a posterior cerebral fossa bleeding. Melanotic schwannoma is a rare form of schwannoma. The diagnosis remains difficult and melanotic schwannoma has been described as a part of the Carney complex. Distinguishing melanotic schwannoma from malignant melanoma is of paramount importance in planning the management, but these two tumours are probably sharing the same origin. It must be distinguished from classic schwannoma because its behaviour is unpredictable, requiring long-term follow-up.