A comparative study on ferritin concentration in serum and bilateral bronchoalveolar lavage fluid of patients with peripheral lung cancer versus control subjects.

OBJECTIVES: To assess the diagnostic value of bronchoalveolar lavage fluid (BALF) ferritin as a lung tumor marker by comparing serum and BALF ferritin concentrations in patients with peripheral lung cancer versus control subjects with benign lung disease, and to examine the theory of ferritin compartmentalization around the tumor area by comparing ferritin concentrations in serum and bilateral (affected and unaffected side) BALF in cancer patients. METHODS: Four groups of patients were investigated: 10 control nonsmokers, 10 control smokers, 10 smokers with chronic obstructive pulmonary disease (COPD), and 22 patients with primary bronchogenic carcinoma. A bronchoalveolar lavage (BAL) was performed in all subjects (both sides in 13 oncological patients, one side in the others) and samples of BALF and blood were submitted to biochemical analysis. RESULTS: As a lung tumor marker, BALF ferritin showed 54% sensitivity and 93% specificity and serum ferritin 22% sensitivity and 93% specificity. A significant difference was observed between the two sides in the cancer patients (p = 0.033), and between BALF ferritin from the affected side and COPD patients (p = 0.025). Greater differences were obtained when BALF ferritin in the affected side of cancer patients was compared with values in both control nonsmokers (p < 0.0001) and control smokers (p < 0.001). CONCLUSIONS: These findings seem to confirm the relative diagnostic value of BALF ferritin as a lung tumor marker and the theory of ferritin compartmentalization. However, further studies are required to clarify the relations between iron and ferritin on the one hand and inflammation, tumorigenesis and host response on the other.

[Complications of biliary cysts. Apropos of 10 cases]. / Complications des kystes biliaires. A propos de 10 observations.

Ten cases of complications of simple biliary cysts were reported: 4 intracystic haemorrhages including 1 intraperitoneal rupture, 3 bacterial infections including 1 case with invalidating pain. Complications of biliary cysts raises the problem of the differential diagnosis with cysts caused parasites, neoplastic processes (cystadenomas and pseudocysts of the liver) and with intrahepatic collections of pancreatic or traumatic origin. Imaging and echo-guided puncture are the most appropriate exploration techniques. MRI has been particularly helpful to evaluate bleeding in an intrahepatic cyst. A pathology examination of the cyst wall and its contents should always be performed. Theoretically, partial cystectomy (performed here in 8 cases) is the indicated treatment. Total cystectomy (1 case) is justified when the diagnosis of cystadenoma cannot be excluded. The role of liver resection is very limited. Preventive resection of a simple biliary cyst greater than 8 cm can be indicated, particularly with videolaparoscopy.

[Leiomyoma of the rectum]. / Les léïomyomes du rectum.

Most of the 150 leiomyomas of the rectum reported since 1872 were no larger than 5 cm. The authors report 3 new observations of leiomyomas of the rectum measuring more than 5 cm. The diagnosis of leiomyoma is difficult. The physical examination and rectoscopy suggest a submucal tumour of the rectum and endoendoscopy helps, describe the relations with the urogenital tract and the sphincters. Due to the lack of distinctive pathology features of malignancy, a leiomyosarcoma cannot be totally eliminated. The prognosis is uncertain due to the rate of relapse and the short follow-up (less than one year) in the previously reported cases. A slow spontaneous clinical course is however possible. The treatment goal is complete surgical removal. While local exeresis is indicated in tumours less than 5 cm in size, echo-guided endorectal protectomy with or without amputation of the sphincter should be discussed for larger tumours.

[Primary colonic linitis plastica. Apropos of 3 new cases]. / La linite colique primitive. A propos de 3 nouveaux cas.

Primary linitis plastica of the colon is unfrequent. Since Laufmann and Saphir's first cases in 1951, less than 50 cases have been described, to which our three new cases now add. The intramural origin with late involvement of the mucosa delays the onset of clinical signs, and accounts for the rarity of overt bleeding and for the frequent failure of biopsy. The radiological appearance is that a tubular colic narrowing without ulceration or intraluminal process. Endoscopy shows regular, centered stenosis with few modifications of the mucosa. The clinicopathological diagnosis is primarily microscopic: presence of isolate mucosecretory neoplastic cells infiltrating the whole wall of the colon without destroying it. Because of its potential for local invasion and of its centripetal extension, linits is often detected only at the equivalent of stage C (Astler-Coller). The prognosis is poor, with survival averaging 1 year after the onset of the first clinical signs.

[Problems posed by the association of streptococcus D infectious endocarditis and colorectal tumor]. / Problèmes posés par l'association d'une endocardite infectieuse à streptocoques D et d'une tumeur colo-rectale.

The problems arising from the discovery of a colorectal tumor during an infectious endocarditis caused by Streptococci D have rarely been mentioned in the surgical literature. The frequency of association of an asymptomatic colorectal tumor and of a Streptococcus bovi endocarditis is now undisputed. This notion implies the systematic search for an intestinal lesion (adenoma or carcinoma) in case of endocarditis or septicemia without involvement of the valves, caused by a streptococcus of group D. The authors report about 3 cases of enterococcal (1 case) and S. bovis (2 cases) infectious endocarditis revealing a colic adenocarcinoma (2 cases) and a villous adenoma (1 case), all being perfectly latent. The specific therapeutic problems arising from this association are outlined, including the antibiotic therapy, the role of the anticoagulant treatment and the priority given to valve surgery in case of hemodynamic instability.

[Post-stress acute hemorrhagic ulcers of the cecum. Apropos of 3 cases]. / Ulcères aigus hémorragiques post-agressifs du caecum. A propos de trois cas.

Three cases of acute ulcers of the cecum causing massive bleeding with hemodynamic impact are reported. These three cases involve young subjects (28, 31 and 51 years old). Bleeding occurs after an aggression (post-traumatic context in 2 cases, postoperative in 1 case). For these three patients, the angiographic location of arterial bleeding allows elective colic exeresis without rebleeding. From a pathogenetic point of view, the most likely hypothesis seems to be that of ischemic lesions following an aggression.

[Inflammatory pseudo-tumors of the liver. Apropos of 2 cases]. / Les pseudo-tumeurs inflammatoires du foie. A propos de deux cas.

Inflammatory pseudotumors of the liver (IPTL) are a reaction pathology of most often mysterious etiology. This is an ill-known clinicopathological entity, of which 13 cases only have been reported. The authors report about 2 cases for which an infectious or parasitic etiology can be suggested. They sum up the characteristics of these pseudotumors, which are most often single, solid, preferentially developing in the right liver. The clinical signs of these lesions are pain and fever, associated to jaundice in case of pedicular extension. From a morphological and macroscopic point of view, IPTLs have the features of a primary or secondary malignant tumor. Cytological puncture usually fails. The diagnosis can be based only on an extensive surgical biopsy or the study of the specimen of liver exeresis. Finally, IPTLs are characterized by a spontaneously regressive evolution. This notion justifies a prudent, even conservative surgical attitude.