[Nodular amyloidoma associated with primary pulmonary Malt lymphoma]. / Amyloïdome associé à un lymphome du Malt pulmonaire primitif.

INTRODUCTION: Pulmonary amyloïdoma is a nodular formation containing amyloid deposits, which can mimick a pulmonary carcinoma. Its etiologic diagnosis require the search of an underlying infectious disease, a connective tissue disorder or a lymphoma. CASE REPORT: We report the case of a 73 year old woman, asymptomatic, presenting an incidental pulmonary opacity in the left upper lobe, associated with hilar lymphadenopathies, positive on PET scan. The patient underwent a left superior lobectomy with mediastinal lymphadenectomy. Histologically, the nodule was composed of amylodosis deposits. It was surrounded by a dense lymphoïd infiltrate. The phenotype (CD20+, CD5-, CD3-, CD23-) of the lymphoïd cells, like the demonstration of a lambda light chain restriction permited to pose the diagnostic of pulmonary Malt lymphoma and to characterize the AL lambda type of the amyloïdosis CONCLUSION: Association of amyloïdoma and Malt lymphoma is a rare condition. The histologic diagnosis of lymphoma may be difficult in this case, the lymphomatous process being concealed by the volume of the amyloïd mass. Therefore it is necessary in case of amyloïdoma to search histological signs of Malt lymphoma and to confirm diagnosis by demonstrating a B clonality and a immunoglobulin light chains restriction.

[Epidemiology and delays in the management of 355 patients with lung cancer]. / Epidémiologie et délais de prise en charge de 355 patients atteints de cancer bronchique.

BACKGROUND: The epidemiology of patients with lung cancer in a Seine-Saint-Denis hospital are reported, as well as causes of diagnostic and therapeutic delays in their management. MATERIAL AND METHODS: Retrospective analysis of cases diagnosed from January 1, 1997 to December 31, 2003. RESULTS: Of 355 cases, 15.8% were women; the average age was 62 +/- 11. Mean smoking history was 50 +/- 24 pack years. Women were more likely to be non-smokers than men (16% and 1% respectively, p < 0.01) and were more likely to present at a young age (under the age of 50: 26.8% and 13.7% respectively, p < 0.05). Among women, adenocarcinoma was more frequent (41% vs. 25%, p < 0.05), and often presented with stage IV disease (74%). Squamous cell carcinoma occurred more frequently with increasing age (18.7% vs. 32.2% before and after the age of 60, p < 0.01). The median pre hospital, diagnostic and treatment delays were respectively 30, 10 and 9 days, the global delay from first symptom to treatment was 62 days. Surgery increased therapeutic delay by 20 days. CONCLUSION: Our results are complementary to those found in KBP-2000-CPHG study. Young women are diagnosed at a late stage. Influence of delays on prognosis is not proved and require others studies.

[Pulmonary nocardiosis and broncho-oesophageal fistula in a patient infected with HIV]. / Nocardiose pulmonaire et fistule broncho-oesophagienne chez un patient infecté par le VIH.

INTRODUCTION: We report a case of extensive pulmonary nocardiosis in a patient infected with HIV. CASE REPORT: It presented as bilateral cavitated masses and bulky necrotic mediastinal lymphadenopathy causing broncho-oesophageal fistulae. There was associated infection with Mycobacterium Avium. There was satisfactory progress following bipolar oesophageal isolation, nutrition via a jejunostomy and antibiotic therapy with co-amoxiclav. Healing of the fistulae after 11 months allowed surgical restoration of oesophago-gastric continuity. CONCLUSION: As with other bacteria, HIV can modify the clinical spectrum of nocardiosis.

[Home chemotherapy for lung cancer: a five year retrospective study]. / Chimiothérapie à domicile du cancer bronchique. Etude rétrospective sur cinq ans.

INTRODUCTION: We present the results of a five year retrospective study of chemotherapy delivered at home for patients suffering from non-small cell lung cancer. METHODS: In partnership with "hospital at home" we have developed mechanisms to improve safety: secured prescriptions, treatments confirmations transmitted by fax, designed specific chemotherapy file and approval of family doctor prior to administration. RESULTS: We treated 74 patients and administered 401 injections of which 72% were for Vinorelbine and 28% for Gemcitabine. These protocols corresponded to day 8 injections for Cisplatin-based double drug therapies in 47% of cases and to weekly single drug chemotherapies in 53%. CONCLUSIONS: Constraints regarding medical staff availability were exceeded by many advantages: better hospital bed management, guaranteed treatment, improvements in patients' quality of life and strengthening of links between hospital and community.