Granular cell tumor of the lung and tracheobronchial tree: Two case-presentation with a review of the literature.

Pulmonary granular cells tumors (CGT) are rare tumors, that derive from Schwann cells. In the tracheobronchial and pulmonary tree, they remain a diagnostic challenge. There are no well-established criteria to differentiate between benign, atypical, and malignant GCT. Moreover, its real frequency in the respiratory tract is still unknown. Here, we represent 2 cases of bronchial and lung GCTs. We aim to highlight the frequency of all clinicopathological characteristics of this rare tumor in the tracheobronchial and pulmonary tree location based on our cases and the available literature in a large systematic review.

Mediastinal cysts : a 52-case retrospective study.

INTRODUCTION: mediastinal cysts are rare lesions developed from mediastinal structures. They may be acquired like thoracic duct cysts or lymphangiomas or congenital like the bronchogenic cysts, enteric cysts or celomic cysts. These cysts are rare and may cause diagnostic challenges. AIM: To assess the major characteristics of these cysts based on a single institution experience. METHODS: the authors performed a descriptive, retrospective study from January 2009 to March 2020 in a single institution. Cystic lesions taking birth from the mediastinum for which gross features, microscopic features were available were included. RESULTS: this study contained 52 mediastinal cysts that were completely resected and no patient presented complications after the surgical resection. The bronchogenic cysts were the most frequent and represented 57.69% of all lesions. Thymic cysts and pericardial cysts represented respectively 40.38% and 1.92% of the cases. The positive diagnosis was based on the microscopic exam. The final diagnosis was concordant with the radiologic findings in 15 cases reaching a rate of 28%. CONCLUSION: the diagnosis of mediastinal cysts is based on the microscopic analysis of the cystic wall. Pericardial cysts may be suspected based on their characteristic location in the cardiophrenic angle, thymic cyst may be evoked based on their location in the thymic region and bronchogenic cysts are mainly located in the middle mediastinum. Inspite of these most frequent locations, the cysts may be located in any part of the mediastinum and may be difficult to diagnose when the key diagnostic features are absent.

Tuberculosis of the Thyroid Gland Presented as a Rapid Enlargement of a Preexisting Goiter.

Thyroid involvement with tuberculosis is an uncommon condition even in endemic countries. As its clinical presentation is not specific, diagnosis is often difficult and requires histopathological confirmation. Herein we report an observation of secondary tuberculosis of the thyroid gland in a woman with a type 2 diabetes mellitus and a primary hypothyroidism. She presented with a rapid enlargement of a preexisting goiter without compressive symptoms. The imaging exams showed a voluminous plunging multinodular thyroid gland and multiple bilateral lung nodules. Malignancy was suspected and the patient underwent a total thyroidectomy and a lung biopsy. Histopathological examination revealed multiple tuberculous foci involving both the thyroid gland and the lungs.

Malignant glomus tumor of trachea: a case report with literature review.

Glomus tumors of the trachea are extremely rare and generally benign, with very few cases of malignant transformation reported in literature. We present the case of a 74-year-old man explored for cough and dyspnea. Bronchoscopy showed a polypoid mass arising from the posterolateral tracheal wall. Computed tomography demonstrated a mid-tracheal tissular mass obliterating the tracheal lumen. Resection and anastomosis of the trachea were performed. The histological and immunohistochemical findings were consistent with malignant glomus tumor.

[Multicentric tubulopapillary carcinoma of the kidney associated with renal adenomatosis]. / Carcinome tubulopapillaire multicentrique du rein associé à une adénomatose rénale.

Tubulopapillary tumors of the kidney represent a particular group of the renal tumors. They cover a continuous spectrum of tumors ranging from the adenoma to the renal cells papillary carcinoma. The histological and immunohistochemical similarities, as well as the high recurrence of the association of these two entities suggest a continuity of the same biological process. Although rare, the association between adenoma and papillary carcinoma remains still subject to controversy and plead in favor of a narrow relation between them. We report the case of a multicentric tubulopapillary carcinoma of the kidney associated with multifocal adenomas, discovered by fortuity in a right nephrectomy at a 57-year-old patient operated for an obstructive chronic pyelonephritis.

[Fatal pulmonary mycosis in a diabetic and cirrhotic patient]. / Une mycose pulmonaire d'issue fatale chez une patiente diabétique et cirrhotique.

Pulmonary mucormycosis is a rare, devastating, opportunistic fungal infection, caused by the ubiquitous filamentous fungi of the Mucorales order of the class of Zygomycetes. This infection occurs principally in some particular conditions, specially in diabetic patients and immunocompromised host, and rarely in cirrhotic patients. The diagnosis of mucormycosis can only be confirmed by pathological and mycological examination of biopsy specimens. We report a case of pulmonary mucormycosis in a 68-year-old woman with underlying liver cirrhosis and diabetes mellitus. Endoscopic and radiologic findings supported the diagnosis of hydatid cyst of the lung. The patient underwent surgical resection and was started on amphotericin B, after pathological examination. Unfortunately, she succumbed to the infection within one month of surgery.

Malignant phyllodes tumor of the breast with liposarcomatous differentiation and intraductal hyperplasia.

Phyllodes tumor of the breast is a biphasic fibroepithelial neoplasm. 10 to 20% of phyllodes tumor show malignant transformation, often in the form of stroma, which usually shows fibrosarcomatous differentiation and rarely heterologous sarcomatous elements. Liposarcomatous differentiation is not common among phyllodes tumors. The correct diagnosis of heterologous liposarcomatous differentiation in a malignant PT requires identification of the biphasic component of the tumor. We reported a case of malignant phyllodes tumor which initially transformed into liposarcoma, in addition to a very rare intraductal hyperplasia and flat epithelial atypia. The patient was a 75-year-old woman, with a lump in the left breast without axillary lymphadenopathy. She also have a positive family history of breast carcinoma. She underwent surgery and still alive and disease free after one year.

Sub-cutaneous histiocytic sarcoma in a child: a case report.

BACKGROUND: Histiocytic sarcoma (HS) is a rare hematologic malignancy with morphologic and immunophenotypic evidence of histiocytic differentiation. This tumor follows an aggressive clinical course. CASE PRESENTATION: We report the case of a 14 year-old white girl who presented with a nodular lesion in the thigh, involving the skin and soft tissue. The histologic diagnosis retained was a HS. CONCLUSION: HS is a rare neoplasm that may cause a diagnostic pitfall. Unfortunately, incomplete clinical data and histopathologic disparities in addition to the overall rarity of the neoplasms induced difficulties of management and of full appreciation of their clinical behavior.

Elastofibroma of scapula: a case report and literature review.

Elastofibromas are benign soft tissue tumors. They occur mostly in the infrascapular region between the thoracic wall, the serratus anterior and the latissimus dorsi muscle, with a prevalence of up to 24% in the elderly. The etiology of this lesion remains uncertain and is a source of ongoing debate. We herein report a 54-year-old female patient, manual worker who presented with bilateral subscapular slow growing tumors for 7 months. Physical examination showed two masses of 4 cm in diameter on the right, and 8 cm on the left, both located inferior to the inferior margin of the scapula. They were more or less firm and mobile on palpation. Computed tomography scan showed large fusiform subscapular soft tissue heterogeneous solid masses with linear areas of low density secondary to fat. The lesions measured 5 cm × 4 cm on the right side and 8 cm × 8 cm on the left. Resection of the largest left tumor was achieved. Macroscopic and histological findings were consistent with elastofibroma.

Surgery in thoracic actinomycosis.

BACKGROUND: Diagnosis and treatment of thoracic actinomycosis is difficult. In most cases, surgery is performed to rule out lung cancer or to control severe symptoms such as hemoptysis. METHODS: 6 patients with a mean age of 42 years underwent pulmonary resection and were given a pathologic diagnosis of thoracic actinomycosis at our institution between 2003 and 2010. We reviewed preoperative clinical characteristics, computed tomography findings, surgical indication, postoperative clinical course and outcome. RESULTS: All patients were symptomatic. One patient had a history of cervical actinomycosis. The mean interval between radiographic identification of the abnormality and surgical intervention was 8 months (range, 4-17 months). Radiographic findings in all cases included a mass-like appearance, simulating lung malignancy or chronic suppuration. The various histological and bacteriological examinations had failed to make the diagnosis. Thoracic actinomycosis was confirmed after thoracic surgery. All patients received penicillin-based antibiotic treatment for at least 2 to 3 months. Good clinical results were observed in 5 patients. In one patient, we noted recurrence of actinomycosis after 10 months; it was a multidrug-resistant form. CONCLUSION: Diagnosis of actinomycosis can be problematic because of difficulty in isolating actinomyces. In these cases, surgery is very helpful.

[Pulmonary atinomycosis: a great clinical polymorphism]. / Actinomycose pulmonaire: un grand polymorphisme clinique.

BACKGROUND: Pulmonary actinomycosis is a rare bacteriological disease, caracterized by local suppuration and an extensive fibroinflammatory process, with a possible pseudotumoral outcome. AIM: To report a new observation of a pulmonary actinomycosis. CASE REPORT: A 52-year-old patient, smoker, admitted in our department for infectious pneumopathy complicated by purulent pleurisy. Clinical and radiological findings were not contributive.Fiberoptic had evocate the diagnosis of bronchopulmonary cancer. Evolution had been marqued by abondant hemoptysia indicating right low lobectomie. The diagnosis of actinomycosis was obtained by the pathology of the surgical resection. CONCLUSION: Diagnosis of pulmonary actinomycosis can be difficult because it can mimic the presentation of lung carcinoma.If the diagnosis is no late established, and if the patient is correctely treated medically, the prognosis still excellent.

Benign myoepithelioma of the lung - a case report and review of the literature.

INTRODUCTION: Benign myoepithelioma is extremely rare in the lung, to the best of our knowledge; only five cases have been reported in the literature. CASE REPORT: An 18-years woman complained from tiredness and fever during four months. Laboratory findings and fibroscopies were normal. CT of the thorax demonstrated a nodule in the left segment of the Fowler. Left inferior lobectomy was performed comporting a firm nodule of 25 mm, lifting the bronchial mucous membrane. Histologically, there was a proliferation of small cells of a plasmocytoid-type, with a predominantly whorled pattern. No mitotic activity or necrosis was seen in the tumor. Immuhistochemically, the tumor cells positive for smooth muscle actin, vimentine, and S100 protein. They were negatives for cytokeratine, chromogranine and HMB45. The diagnosis of benign myoepithelioma of the lung is so confirmed. The patient recovered well at 6 months follow-up. CONCLUSION: Benign myoepithelioma is a rare pulmonary neoplasm distinct from pleomorphic adenoma, which should be considered in the differential diagnosis of lung nodules.

Castleman's disease: an intrapulmonary form with intrafissural development.

Castleman's disease (CD) is an uncommon, mainly benign, lymphoproliferative disorder of unknown etiology, mostly involving the mediastinum. Parenchymal lung involvement of the disease is exceedingly rare. We describe a case of CD in a 23-year-old woman with a 4-year history of recurring dyspnea and nonproductive cough, whose chest X-ray showed an abnormal shadow of the right hilum. Chest computed tomography confirmed the presence of a tissue-density mass of the right lower lobe, demonstrating poor contrast enhancement, associated with multiple laterotracheal and mediastinal lymphadenopathies. The patient underwent curative surgery, revealing a right hilar compressive mass, with an intrafissural development between the superior and middle lobes. Pneumonectomy was performed due to profuse bleeding. This case of CD is particular because of its unusual intrapulmonary location and its intrafissural development. Poor contrast enhancement is atypical in CD.

Bronchoalveolar lavage impact in sarcoidosis: study of 40 cases.

INTRODUCTION: Studies on bronchoalveolar lavage (BAL) fluid samples profile characteristics in sarcoidosis patients hitherto reported in literature give rise to conflicting data. The typical finding is lymphocytic alveolitis with a high CD4/CD8 ratio, although a broad range of values has been found. THE AIM of the study was to evaluate different parameters of BAL fluid in patients with sarcoidosis before and after corticosteroid treatment and to determine the reliability of BAL in evaluating prognosis of sarcoidosis. METHODS: The study involved 40 patients with clinical and histological evidence of sarcoidosis. RESULTS: Before treatment, BAL fluid showed an increase in total cell count and a T lymphocytosis with an increase in the CD4/CD8 ratio. After treatment, we have noted a significantly increase in macrophage proportion, a significantly decrease in lymphocyte proportion and in CD4/CD8 ratio. A significant higher CD4/CD8 ratio was noted in patients with multiple extrathoracic lesions compared with patients with only intrathoracic involvement and in patients with unfavourable evolution compared with patients with improved evolution. CONCLUSION: When typical clinical and radiological findings definitely suggest sarcoidosis, BAL results may add a biological support. Our data suggests that a high CD4/CD8 ratio seems to be predictive of poor prognosis with a multiple extrathoracic organ involvement and an unfavourable outcome.

Posterior mediastinal paragangliomas: a report of three patients with peculiar tumours.

Paragangliomas of the mediastinum are rare neoplasms, representing less than 0.3% of mediastinal tumours and less than 2% of all paragangliomas. To date, no definitive morphologic criteria exist that correlate with the clinical outcome of these tumours. This report describes three patients with peculiar primary paragangliomas of the posterior mediastinum: gangliocytic, dumbbell and functional paraganglioma. The clinicopathological characteristics of these patients are presented and the literature reviewed.

Pulmonary blastomycosis: a case from Africa.

Pulmonary blastomycosis is an uncommon pathologic condition that is quite rare in Africa compared to endemic regions of Canada and the upper Midwest of the U.S. We describe a 45-year-old patient who complained of productive cough, hemoptysis, and dorsal rachiodynia. Chest imaging revealed a necrotic tissue-density pulmonary mass involving both the upper and lower right lobes. Chest MRI showed signal abnormality of the third thoracic vertebral body and the greater trochanter, consistent with metastatic lesions. Clinical and radiological findings were strongly suggestive of lung cancer. Diagnosis of pulmonary blastomycosis was made by visualization of yeast in bronchial biopsies and further confirmed by culture of bronchoalveolar lavage specimens. The patient was treated with itraconazole and his clinical condition improved markedly. Pulmonary blastomycosis is unusual in Africa and that fact caused a considerable delay in diagnosis. We suggest that this disease may be more common in Africa than has been previously suspected.