Search

Introduction. - Paraneoplastic Cushing's syndrome is a rare cause of endogenous hypercorticism. It is caused by ectopic secretion of ACTH by a non-pituitary endocrine tumor. The aetiological biological and radiological data are often inconclusive, which creates a problem of differential diagnosis with Cushing's disease. In addition, these tumors are often small and their location is extremely variable. As a result, the difficulties of localization require the use of specific imaging techniques.Observation. - We report the observation of a 44-year-old man suffering from diabetes and high blood pressure, presenting a severe and rapidly progressive Cushing syndrome, in connection with a hypercorticism caused by an ectopic ACTH secretion. The thoracic computed tomography performed within the framework of a search for a neoplastic origin objectified a 15 mm nodule isolated at the level of the middle lobe, the scintigraphy with octreotide marked with indium-111 found a significant fixation at the level of the lung nodule. The patient had a middle lobe lobectomy. The outcome was favorable with regression of Cushing's syndrome. Pathological examination was in favor of a typical carcinoid tumor, and the immunohistochemical complement showed tumor cell positivity for ACTH, CD56, chromogranin, and synaptophysin.Conclusion. - This observation illustrates the dilemma between the need to locate an ectopic ACTH secretion and the control of aggressive and threatening Cushing's syndrome. Early use of the octreotide scintigraphy should be considered if a topographic diagnosis of the causative tumor cannot be done through conventional imaging techniques.

Introduction: Risk of venous thromboembolism (VTE) in lung cancer patients substantially increases with the addition of chemotherapy. Platinum-based regimens claim to be associated with a very high VTE rate. Objectives: Determine the prevalence and characteristics of VTE in adult patients receiving platinum-based chemotherapy and analyze the importance of the patients’ tumor and treatment characteristics in predicting the occurrence of VTE. Patients and Methods: Patients who had received platinum based chemotherapy for lung cancer between January 2016 and December 2018 were retrospectively identified. Patients were followed for development of VTE throughout the entire duration of therapy and one month thereafter. Results: Eighteen patients (88.8% males, median age: 62 years) treated with platinum-based regimens (49 cisplatin, 31 carboplatin) were included. VTE were reported in 15 patients (18.8%). Thrombosis included deep vein thrombosis (DVT) in 8 (10%), pulmonary embolism (PE) in 6 (7,5%) and DVT with PE in 1 (1,25%). Most patients (70%) had stage IV cancer and only 5% had stage I or II. In the multivariate analysis, the occurrence of TVE were not associated statistically with advanced-stage disease, gender, age, and different risk scores. Carboplatin-Etoposide was associated with a higher risk of VTE (p=0.049) in univariate analysis. In multivariate analysis, Carboplatin-Etoposide (p=0,045) and carboplatin-Navelbine (p=0.048) increased the risk of VTE. Conclusion: A high incidence of VTE in patients receiving platinum based chemotherapy was demonstrated in this study. Prospective studies are crucial to highlight the necessity of thromboprophylaxis in patients receiving platinum based chemotherapy.

Introduction: In Tunisia, tuberculosis typically represents the most frequent cause of exudative pleural effusion with clear fluid. Different tools are used in the diagnosis of tuberculous pleurisy. Aim: to determine the diagnostic approach of the pleural tuberculosis. Methods: A retrospective study was conducted in the IBN NAFISS pneumo-allergology department at the Abderrahmane Mami Hospital in Ariana, Tunisia, involving 95 cases of pleural tuberculosis collected over a nine-year period from October 2009 to January 2019. Results: The mean age of our patients was 38 years. The study population was predominantly male (55%). Two patients had a history of tuberculosis. A tuberculous contagion was revealed in 17 cases (18%). The onset of symptomatology was progressive in 74% of cases. The patients presented chest pain in 84 cases (88%), fever in 62 cases (65%) and weight loss in 58 cases (61%). An associated pulmonary tuberculosis was revealed in 18 patients (19%). The diagnosis of tuberculous pleurisy was established after microscopy for acid fast bacilli (AFB) in sputum in 14 cases (15%), microscopy for AFB in pleural fluid in 4 cases (4%), Abrams pleural needle biopsy in 63 cases (66%) and thoracoscopic pleural biopsy in 4 cases (4%). Eight patients were treated for pleural tuberculosis considering the symptoms and a positive tuberculin skin test. The tuberculin skin test was positive in 65% of cases. The Abrams pleural needle biopsy was performed in 76 patients (80%) with a profitability of 83%. Conclusion: The Abrams pleural needle biopsy, a simple method that does not require general anesthesia, represent a key-step in the etiological diagnosis of exudative pleurisy with clear fluid and especially tuberculous pleurisy with a good efficiency.

Introduction: Mediastinal masses are frequent and characterized by clinical variability and histological diversity. Etiological diagnosis requires a rigorous approach. Aims: Analyze epidemiological, clinical, imaging and pathology data of patients with mediastinal mass, relating them with anatomical location. Methods: Medical records of patients referred by mediastinal mass between January 2006 and December 2017 were reviewed. Results: We reviewed records from 120 patients, 58% females, mean age 48+/-16.8 years. Most frequent complaints were dyspnea (36.8%), chest pain (22.6%) and cough (18.9%). Chest radiograph was normal in 15%. In 24.3% the mass was an unexpected finding on radiological examinations. Pathological diagnosis was obtained by surgery (30%), CT Scan guided needle biopsy (18%) or mediastinoscopy (20%). Masses located superiorly were most frequently associated with dyspnea and cough. Most causes were thymomas (20%), lymphomas (18%) and cystic lesions (10%). Most frequent causes of anterior, middle, posterior and superior masses were, respectively: thymoma (26%), cystic lesions (12.2%), neurogenic tumor (55%) and lymphoma (24.2 %). Surgical treatment was indicated in 30%. Conclusion: Most mediastinal masses were thymomas and lymphomas. Mediastinal masses were, quite often, an unexpected finding. They constitute often a diagnostic challenge. CT scan is essential in the etiological investigation. Histological evidence is mandatory directing the therapeutic attitude.

There is increasing evidence to suggest that neutrophil-to-lymphocyte ratio (NLR) is an independent predictor of poor outcome in patients with cancer. The aim of our study was to determine the association between baseline NLR and prognosis in patients with advanced inoperable non-small cell lung cancer (NSCLC). Methods: All patients with a new diagnosis of advanced inoperable NSCLC (stages III and IV) presenting at our thoracic oncology department between January 2005 and January 2013 (n = 142) were included. To evaluate the independent prognostic relevance of the NLR, univariate and multivariate Cox regression models were used. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Results: Median age was 60 years, all patients were male, and 50.2% had adenocarcinoma. The median NLR value was 3.42 (ranged between 0.11 and 25.06). High NLR was significantly associated with tumor metastasis (P = 0.028), high C-reactive protein (P = 0.0001), and low albumin (P = 0.0001).Patients with an NLR ≥3.42 showed a significantly lower PFS (P =0 .008) and OS (P = 0.04) than patients with an NLR Conclusion: Elevated NLR indicates a poor prognosis for patients with advanced NSCLC. It potentially represents a simple, easily-obtained, low cost and reliable biomarker with prognostic potential for advanced NSCLC.

Background: Systemic inflammation has been shown to be responsible of tumor growth and shortened survival. Advanced lung cancer inflammation index (ALI) was developed to assess inflammation and prognostic in lung cancer at the time of diagnosis. Therefore, the aim of this study was to explore the relationship between ALI and the prognosis of NSCLC. Methods: Patients diagnosed with stage IV NSCLC at our institution between janv 2010 and janv 2013 were screened. ALI score was calculated as BMIxALB/NLR with BMI=body mass index, Alb=serum albumin and NLR=neutrophil lymphocyte ratio. Patients were divided into low inflammation (ALI>18) and high inflammation (ALI Results Fifty eight patients were included. Median age was 61 years, all patients were male and 48.7 % had adenocarcinoma. Compared to patients with ALI score>18, Patients with ALI score 18 (p=0.043). On multivariate analysis, Performans status (p=0.006), CRP (p=0.007), receiving chemotherapy (p=0.003) and ALI score (HR=2.38; IC95% [1.00-5.67]; p=0.049) were independent prognostic factors for OS. Conclusion: ALI is an easy to calculate tool to assess systemic inflammation in advanced NSCLC. Lower ALI could authenticate the patients with poor prognosis and be a useful marker in clinical practice.

Introduction: Cytotoxic chemotherapy is widely used to palliate advanced non-small-cell lung cancer (NSCLC) but can induce severe toxic events. The aim of this study was to evaluate the chemotherapy toxicity in adavanced non-small cell lung cancer (NSCLC) and its impact on overall survival (OS). Methods: We retrospectively reviewed 99 advanced stage NSCLC patients treated with chemotherapy over a period of 3 years. Pre-therapeutic clinical and biological data were assessed. OS was calculated using the Kaplan Meier method and compared between two groups (having or not toxicity) by log rank test. Results: Median age was 65 years, 84% of patients had Performans status (PS) Conclusion: Our study suggested that Chemotherapy-induced toxicity in advanced NSCLC patients was associated with poor survival.

Resume Introduction Les tumeurs malignes primitives du thorax constituent un large groupe de tumeurs prenant naissance au niveau du poumon, du mediastin, de la plevre, ou de la paroi thoracique. Observation Il s’agit d’un patient de 37 ans, qui nous avait consulte pour une douleur thoracique gauche. A l’examen physique, on avait releve une masse parietale basi-thoracique droite. La radiographie du thorax avait mis en evidence une opacite d’allure mediastinale de la moitie superieure du champ pulmonaire gauche, associee a une opacite pleurale. La tomodensitometrie thoracique avait note, une importante masse a point de depart pleuro-parietal envahissant le mediastin et associee a une 2eme masse parietale en regard des 8eme et 9eme cotes droites. La biopsie de la masse parietale avait conclu a un synovialosarcome parietal. Le patient avait beneficie d’une chimiotherapie a base d’ifosfamide et doxorubicine et d’une radiotherapie mediastino-pulmonaire gauche. L’evolution etait marquee par une amelioration clinico radiologique, mais le patient etait decede d’une embolie pulmonaire apres la 3eme cure. Conclusion Le synovialosarcome parietal est une tumeur dont le pronostic sombre, pourrait etre ameliore grâce a sa chimiosensibilite.

Resume Introduction L’association de l’asthme et de la tuberculose pulmonaire suscite un interet particulier du fait des problemes de prise en charge therapeutique. Patients et methodes Etude retrospective concernant sept patients asthmatiques, hospitalises pour tuberculose pulmonaire pendant la periode allant de juin 2001 a juin 2006. Resultats Il s’agit de cinq hommes et deux femmes. L’âge moyen etait de 37 ans. Deux malades avaient un asthme persistant leger, quatre malades un asthme persistant modere et un dernier avait un asthme persistant severe corticodependant. Au moment du diagnostic de la tuberculose pulmonaire, quatre patients uniquement avaient un asthme controle. Tous ces patients asthmatiques ont presente une tuberculose pulmonaire commune bacillifere. Au cours du traitement antituberculeux, deux malades avaient developpe un asthme aigu grave. L’evolution a long terme est marquee par une stabilite de la maladie asthmatique pour tous les patients avec un recul de trois a huit ans. Conclusion L’association entre asthme et tuberculose pose des problemes therapeutiques, du fait des interactions medicamenteuses des antituberculeux avec les medicaments de l’asthme. Cependant, la tuberculose peut contribuer a la stabilite et au controle de l’asthme dans les annees suivant sa guerison.

Solitary fibrous tumours of the pleura are usually benign. However, malignancy is observed in 13% of the cases. The authors report two cases of 27 and 69 year-old patients, presenting chest pain and dyspnoea. The roentgenograms and computed tomography scanning revealed a pleural tumour in both cases. The patients underwent complete resections of these tumours. The immunohistochemical study confirmed the diagnosis of malignant solitary pleural fibroma. The patients succumbed to their disease secondary to local recurrences. Histopathology is very helpful in the diagnosis of malignant pleural fibroma. Surgery and long-term follow-up are mandatory.

Resume L’hydatidose osseuse, en particulier costale, est une pathologie rare. Moins de 50 cas d’hydatidose costale ont ete rapportes dans la litterature. Nous rapportons le cas d’un patient âge de 76 ans qui a ete hospitalise pour une symptomatologie faite d’une paraparesie. De plus, le malade avait une enorme masse thoracique posterieure faisant environ 30 cm de grand axe, fluctuante a la palpation et sans signes inflammatoires cutanes en regard. La radiographie thoracique a objective une opacite dense et homogene occupant la quasi-totalite du champ pulmonaire droit avec des limites polylobees. Le scanner thoracique et l’IRM thoracique et dorsolombaire ont permis de conclure a un kyste hydatique costal avec envahissement vertebral et une compression medullaire. Une resection du kyste hydatique a ete pratiquee par une equipe multidisciplinaire faite de chirurgiens thoraciques et d’orthopedistes. Le patient est decede a la suite de complications postoperatoires. Le retard diagnostic dans une pathologie habituellement benigne telle que le kyste hydatique peut conduire a des consequences redoutables pouvant mettre en jeu le pronostic fonctionnel et vital.

Hemothorax is generally secondary to trauma, invasive thoracic surgery or specific lung of pleural disease. Hemothorax secondary to aortic dissection is rare. We report a case in a 69-year-old man with a history of smoking and hypertension. The patient was referred for exploration of a left pleural opacity with mediastinal widening. Pleural puncture produced a hemorrhagic fluid. The thoracic scan led to the diagnosis of Stanford type B aortic dissection. The patient was given antihypertensive treatment and now has a sixteen month follow-up. Aortic dissection can give rise to hemothorax, especially in a hypertensive subject with an anomalous aortic arch or mediastinal widening on the chest X-ray. Computed tomography generally gives the diagnosis. Treatment may be medical or surgical, depending on the site of the lesion and the severity of the clinical presentation. Aortic dissection is a cause of hemothorax, particularly in patients with favorable conditions or a suggestive radiological anomaly.

Introduction : Lung cancer is one of the most frequently occurring neoplasms and usually has a poor prognosis because most of the patients present with advanced or metastatic disease at the time of diagnosis. Numerous prognostic factors (PF) have been studied. Aim: Study the prognostic factors in non small-cell lung cancer. Methods : A retrospective study had enrolled 269 cases of non small-lung cancer between January 2008 and December 2012. Results : The average age of ourpatients was61 years [44-80 years]. Lungcancer wasmore frequently observedin men (94,5%). Smoking wasnoted in 96% of patients. Histological types were adenocarcinoma (61%), squamous cell cancer (28%), non-smallcell carcinomacellsuntyped (11%) and large cell carcinoma (1%). TNM classification revealed stage IA (1,5%), IB (2%), IIA(3%), IIB (5%), IIIA (12%), IIIB (16%) and IV (60,5%). Median survival wasestimated at 575±70 days.Women , patients aged under 45 years and non-smoking patients have a better survival (p=0,005 ; 0,05 and 0,017 respectively). The other prognostic factors were the average intoxication tobacco, the stage of cancer, performance status, the number of metastases, the introduction of aspecific treatment, consultation delay and therapeutic delay (p=0,024; 0,031; 0,006; 0,001; 0,006; 0,46 and 0,001 respectively). Conclusion : Prognostic factors (PF) have a pivotal role in Clinical Oncology. They are helpful in the selection of treatment, provide insights into the disease process and the therapeutic response, and are fundamental in the design of clinical trials or in the interpretation of data from the literature.

Introduction: Lung cancer remains the leading human cancer worldwide with a high rate of mortality .When diagnosis is made early, surgical treatment may have a huge benefit on survival. Aims: To identify surgical treatment outcomes on patients with early stage of non small cell lung cancer (NSCLC). Method: A cohort study carried out in our pneumology department; we enrolled 90 patients diagnosed with early stage NSCLC between 2003 and 2012. Results: The medium age was 60 y with male predominance. Tobacco smoking interested 88% of our patients. Chronic respiratory disease was the major comorbidity especially COPD(21%).Main symptoms were cough (62%)and chest pain(54%).Consultation delay average was 2 months.97% of patients had PS 0-1.Positive diagnosis was done through fiberscopy in 28% of cases, transthoracic biopsy in 42%, surgical biopsy in 30% and mediastinoscopy in 10%. Adenocarcinoma was the predominant histological type(60%). Confirmation delay was about 22d. Classification: Ia 7%;Ib17%;IIa11%;IIb34%;IIIa31%.Surgery was the first option treatment in 78% of cases. Survival average delay was about 47 months in these patients versus 11 months for non operated patients(p=0.001).This delay was even better in the group of patients who received adjuvant chemotherapy: 67 months vs 51months(p Conclusion: It is clear that surgery have positive outcomes on survival within early stages of NSCLC especially when associated to adjuvant chemotherapy.

Resume Les plasmocytomes solitaires sont rares et representent moins de 5 % de l’ensemble des neoplasies a cellules plasmocytaires. Le diagnostic est base sur la mise en evidence d’une tumeur localisee, constituee de cellules plasmocytaires monoclonales cytologiquement identiques a celles du myelome multiple, en l’absence d’autres signes en faveur d’une forme disseminee. Nous rapportons l’observation d’un patient âge de 52 ans, presentant une masse parietale axillaire gauche. L’imagerie a revele une masse tissulaire avec une large osteolyse de la 6 e cote et l’infiltration de la paroi thoracique. La biopsie chirurgicale, avec etude anatomo-pathologique et immunohistochimie, a conclu a un aspect de plasmocytome costal. L’immunoelectrophorese des protides sanguines a revele un pic monoclonal d’immunoglobuline G type kappa avec une proteinurie de Bence-Jones positive. Le bilan a la recherche d’autres localisations etait negatif, et le diagnostic de plasmocytome solitaire costal a ete retenu. Une radiotherapie a donc ete instauree et, apres un recul d’une annee, le patient est en remission L’atteinte costale au cours du plasmocytome solitaire osseux est rare. Le diagnostic repose sur l’imagerie et l’etude anatomopathologique. La radiotherapie constitue le traitement de choix mais l’evolution peut se faire vers la survenue de nouvelles lesions osseuses, le developpement d’une plasmocytose medullaire et l’apparition d’un myelome multiple. Les facteurs predictifs d’une recidive systemique n’ont pas encore ete clairement determines et une surveillance reguliere est necessaire.

Resume La survenue d’une pleuresie au cours du myelome multiple est rare, sa frequence est estimee a 6 % et elle est d’origine plasmocytaire dans seulement 1 % des cas. Elle est exceptionnellement revelatrice. Nous rapportons 2 dossiers de patients ayant un myelome multiple (IgA, IgG) revele par un epanchement pleural. Il s’agit, dans le premier cas, d’une pleuresie associee a une atteinte osseuse, bronchique et pericardique chez une femme de 61 ans et, dans le second, d’une pleuresie isolee chez un homme de 65 ans. Le diagnostic de l’origine plasmocytaire de la pleuresie repose sur la presence d’une immunoglobuline monoclonale serique et pleurale de meme type, associee a la presence des plasmocytes anormaux dans le liquide pleural.

Resume L’embolie pulmonaire hydatique est une pathologie rare, de diagnostic particulierement difficile, dont le traitement est mal codifie et dont le pronostic est generalement pejoratif. Nous avons effectue une etude retrospective concernant les dossiers de patients hospitalises entre 1994 et 2002, chez qui le diagnostic d’embolie pulmonaire hydatique a ete retenu. Sept observations ont ete colligees. Chez tous nos patients, la rupture du kyste dans la circulation s’est produite spontanement. Tous nos patients etaient symptomatiques. La radiographie thoracique a revele des images d’echinococcose metastatique pulmonaire dans tous les cas. Le scanner et/ou l’angioscanner thoracique ont permis de poser le diagnostic dans 5 cas. Dans un cas, le diagnostic a ete fait par l’angiographie pulmonaire, et dans un autre par les donnees de la chirurgie et de l’examen anatomo-pathologique. La recherche de la localisation hydatique primitive a permis de retrouver la notion de kystes hepatiques chez tous les patients associes dans un cas a un kyste de l’oreillette droite. Le kyste cardiaque n’a pas ete opere et tous les kystes hepatiques ont ete reseques. Une embolectomie a ete effectuee chez un seul patient. Un traitement medical a base d’albendazole a ete entrepris chez 5 patients. L’evolution a ete marquee par le deces de 2 patients dans un tableau d’hemoptysie abondante. Les 5 autres patients sont regulierement suivis, avec un recul allant de 6 mois a 5 ans. Le diagnostic de l’embolie pulmonaire hydatique repose essentiellement sur l’imagerie. Le traitement repose sur l’extirpation chirurgicale du foyer emboligene, puis en second lieu une embolectomie peut etre proposee. La place du traitement medical n’est pas encore clairement etablie. Le pronostic est generalement redoutable a plus ou moins breve echeance.

Introduction Les masses mediastinales sont rares et sont souvent de decouverte fortuite. Elles posent un probleme de diagnostic etiologique. Le diagnostic definitif est histologique et le traitement peut etre chirurgical, medical ou parfois necessiter une approche medico-chirurgicale. Patients et methode Etude retrospective incluant 60 cas de masses mediastinales entre janvier 2009 et decembre 2013. Resume L’âge moyen etait de 42 ans [35–77 ans]. L’atteinte masculine etait predominante (55 %). Le delai moyen de diagnostic etait de 22 jours. La decouverte etait fortuite chez 15 patients (25 %). Ailleurs par des symptomes respiratoires dans 45 cas (75 %). Le diagnostic histologique etait obtenu par mediastinoscopie (40 %), biopsie bronchique (33 %), thoracotomie (15 %), biopsie transparietale sous scanner (10 %) et mediastinotomie anterieure (2 %). L’examen anatomopathologique complete par immuno-histochimie a montre un carcinome a petites cellules (40 %), un lymphome (20 %), un thymome (16 %), un kyste bronchogenique (8 %), un schwannome (5 %), un kyste pleuropericardique (3 %), un cas de goitre endothoracique, un cas de sacome de l’artere pulmonaire droite, un cas de teratome et un cas de moelle tumeur a cellules geantes. Le traitement consistait en une chimiotherapie dans 30 cas, la chirurgie dans10 cas, la radiotherapie dans 6 cas. Les soins palliatifs etaient indiques chez 3 patients. Douze patients etaient adresses en hematologie pour complement de suivi. Conclusion Les masses mediastinales constituent souvent un probleme de diagnostic etiologique. Le scanner thoracique est la plaque tournante dans la demarche diagnostique. La preuve histologique est obligatoire pour orienter l’attitude therapeutique ulterieure et predire du pronostic.