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Is It Necessary to Subdivide the pN2 Group of Non Small Cell Lung Cancer? The pathological TNM staging system has been revised in 2009 but the modifications made concerned only the Tumour and the Metastasis components. This fact made many authors wonder about the necessity of improving the lymph node component in order to reach a better reliability. One of the interrogations made in the literature was the possible necessity of dividing the pN2 group into multiple-station one and singlestation one because of the better prognosis of the latter.

Background: Epithelioid hemangioendothelioma is a rare tumour whose prognosis ranges from benign form similar to hemangioma to aggressive tumors like angiosarcoma. Its localization in the rib is very rare and less than 10 cases of costal localized forms have been reported in the literature. The authors describe another case of costal epithelioid hemangioendothelioma illustrated by microscopic findings. Case presentation: We present the case of a 80-year-old man who reported a pain in the shoulder. Radiologic findings showed a hypervascularized tumour and microscopic findings diagnosed an epithelioid hemangioendothelioma. The treatment was the en-bloc resection of second to fourth posterior left ribs and the wedge resection of the left lung nodule and the patient didn’t present complications after a 6-year- follow-up period. Conclusion: This case emphasizes on the challenging diagnosis of epithelioid hemangioendothelioma and the importance of surgical resection in localized forms.

Post-traumatic fibro-osseous lesion is a rare benign osseous lesion usually affecting the ribs and relatively under-recognised. Histologically, it showed a bland fibrous stroma in which resided an anastomosing network of bone trabeculae, having a zonal pattern of maturation from metaplastic woven to mature lamellar bone, with or without an associated xanthomatous component. We report a well-documented case of mixed variant post-traumatic fibro-osseous lesion of the sixth rib, which was initially misdiagnosed as particular form of fibrous dysplasia associated with a xanthoma.

Summary Primary bone invasion by xanthoma is rare particularly in normolipidemic patients. In fact, lipid disorders are present in most patients. Xanthomatous lesions were observed in the ninth rib's posterior arch of a 45-year-old man with a history of labour accident. To our knowledge, this is the fourth case reported in the literature. Histologically, the lesion was characterized by a replacement of normal bone and marrow with xanthoma cells. The treatment approach consisted in a total removal of the lesion and the patient has not presented recurrences after a follow up of 10 years.

Although thoracoscopic surgery had been introduced in Tunisia since 1993, there were no anatomical resections performed that way. We report herein the first 3 cases of lobectomy performed by exclusive video-thoracoscopic surgery (VTS). Three female patients presenting with bronchiectasis (2 cases) and cystic adenomatoid malformation (1 case) have underwent a thoracoscopic lobectomy with different outcomes.

Primary tumors of the sternum are rare and account only 0.5% of all primary bone tumors. They are often malignant, osteolytic and aggressive. They often present difficulties in management.to determine clinical, pathological and therapeutic characteristics for primary malignant tumors of the sternum.We report a series of six cases of primary malignant tumors of the sternum, collected in our institution between 1993 and 2009.There were 4 men and 2 women with a mean age of 69, 5 years. Parietal swelling was the most frequent symptom. Imaging showed a sternal lytic lesion. Three tumors were treated surgically. Associated treatments were neoadjuvant chemotherapy (1 case) and postoperative radiotherapy (1 case). A medical treatment (radiotherapy alone or chemotherapy) was performed in 3 cases. These tumors were divided as below: 3 plasmacytoma, 1 chondrosarcoma, 1 osteosarcoma and 1 large B cell lymphoma.The management of primary malignant tumors of the sternum is multidisciplinary. It depends on the histological type, the possibility of surgical treatment and the distant and local aggressiveness.

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.

The combination of pulmonary and hepatic hydatid cysts is frequently encountered, and poses a challenge in terms of surgical accessibility. The surgical treatment of the two locations by the same incision (thoracotomy with phrenotomy) has been proposed, but always from the right side. However, applying this technique to the left side seems to be more difficult and unusual. We herein describe a new left-sided technique that was used to treat two patients with pulmonary and hepatic hydatid cysts.The first patient was 14-year-old; he had bilateral pulmonary hydatid cysts and one type I cyst of the left lobe of the liver. The second patient was a 10-year-old female who had a hydatid cyst of the upper left lobe with one type III cyst of hepatic segments 2 and 3.Both patients were operated on via a left lateral thoracotomy through the sixth intercostal space. They underwent cystectomy for the left pulmonary hydatid cysts, followed by padding, and then the hepatic cyst was treated by Lagrot's method via a radial phrenotomy. The postoperative course was uneventful in both cases, with postoperative hospital stays of 3 and 5 days, respectively.This combined treatment of pulmonary and hepatic hydatid cysts by the left-sided thoracic approach is feasible and provides a good outcome. It should be indicated under the same conditions of accessibility and feasibility applied for the right thoracic side.

Dyshormonogenetic goiter is a rare cause of congenital hypothyroidism occurring due to a lack of enzymes necessary for the synthesis of thyroid hormones. It is morphologically characterized by architectural and cellular pleomorphism that may mimic thyroid malignancy and cause difficulties in differential diagnosis. We report a new case occurring in a 37-year-old male with history of hypothyroidism since the age of 6 years treated by L-thyroxin. He developed a progressively slow growing multinodular goiter and consulted for recent dyspnea. Computed tomography scan showed a multinodular plunging goiter with compression of the trachea and vessels in the left side. A total thyroidectomy was performed. Gross examination revealed an enlarged and multinodular thyroid gland, presenting hemorrhagic changes in the larger nodules. Histologically, the features were consistent with dyshormonogenetic goiter. The literature on the histopathology of dyshormonogenetic goiter is reviewed and clues to avoid inappropriate overdiagnosis of malignancy are given.

Sarcomatoid carcinoma (SC) of the lung is defined by the World Health Organization as poorly differentiated non-small cell carcinoma that contains a component of sarcoma or sarcoma-like elements. It represents an overall continuum of epithelial and mesenchymal differentiation. Five subtypes are recognized: pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, carcinosarcoma, and pulmonary blastoma. The diagnosis is pathological and requires a good sampling of the tumor.Twenty-eight cases of primary sarcomatoid carcinoma, diagnosed between 1993 and 2010, were reviewed retrospectively, noting the clinicopathological characteristics.The patient population consisted of 25 males and 3 females with mean age of 62.9 years (48-75 years). The symptomatology was dominated by respiratory symptoms. Imaging features showed a pulmonary mass invading pleura or thoracic wall in 5 cases. The diagnosis was made in all cases on histological examination. These 28 tumors were divided as below: into 19 pleomorphic carcinomas, 4 giant cell carcinomas, 1 spindle cell carcinoma and 4 carcinosarcomas. Twenty-seven tumors were treated surgically. Associated treatments were neoadjuvant (3 cases) or adjuvant chemotherapy (1 case) and preoperative radiotherapy (5 cases). Deaths occurred in 7 patients. Twenty-two patients were lost to follow up.These tumors are frequently symptomatic, are locally advanced, and have higher rates of recurrence. Its prognosis is worse than that of other non-small cell lung cancer.

Pulmonary actinomycosis is a rare bacteriological disease, caracterized by local suppuration and an extensive fibroinflammatory process, with a possible pseudotumoral outcome.To report a new observation of a pulmonary actinomycosis.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.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.

Post-traumatic fibro-osseous lesion is a rare benign osseous lesion usually affecting the ribs and relatively under-recognised. Histologically, it showed a bland fibrous stroma in which resided an anastomosing network of bone trabeculae, having a zonal pattern of maturation from metaplastic woven to mature lamellar bone, with or without an associated xanthomatous component. We report a well-documented case of mixed variant post-traumatic fibro-osseous lesion of the sixth rib, which was initially misdiagnosed as particular form of fibrous dysplasia associated with a xanthoma.

Background: Thymomas are rare tumors with a challenging management. After a review of the literature, we noticed the absence of a simplified decisional diagram. We aimed to present a scheme for the management of these tumors based on the experience of a Tunisian multi-disciplinary team and a review of the literature. Patients and Methods: We report a retrospective study 100 thymomas diagnosed between 1994 and 2011. We also performed an exhaustive PubMed research using the keywords: Thymoma, prognosis, management. We noticed, that the most famous studies were reported in the 1990s with most of them being a review of the literature. Results: The proposed decisional diagram is quite similar to the National Comprehensive Cancer Network (NCCN) guidelines with some particularities. These particularities consist in the recommendation of an initial surgical resection even in advances disease (stages IIIb or IVa) and the association of a radiation therapy in R1 or R2 stages I, II, and IIIa thymomas. Conclusion: This study highlights the necessity of further research performed in the field of thymoma in order to answer the unresolved question. This work seems to be necessary and helpful in daily practice of thoracic surgeons and clinicians.

An acquired factor VII deficiency was identified in a 63-year-old man with bronchogenic carcinoma. Initial studies indicated a normal activated partial thromboplastin time and a prolonged prothrombin time. The factor VII level was 6%. No evidence of a factor VII inhibitor or inactivator was demonstrable. However, on account of the initial normal laboratory test of emostases, the partial correction of the prothrombin time with 50% normal plasma in vitro and the family history, the congenital deficiency in factor VII was ruled out. Whatever the mechanism involved, this factor VII deficiency was related to malignancy.