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Resume Introduction Les hyperplasies thymiques se presentent sous la forme de masses mediastinales anterieures et posent de reels problemes diagnostiques et therapeutiques. Deux types d’hyperplasies sont individualises : les hyperplasies vraies et les hyperplasies folliculaires. Les donnees de la litterature concernant ces hyperplasies demeurent lacunaires. Notre objectif etait de decrire les caracteristiques cliniques et microscopiques des hyperplasies thymiques a travers une experience uni-institutionnelle sur une periode de 11 ans. Methodes Les hyperplasies thymiques diagnostiquees entre 2009 et 2020 ont ete incluses. Resultats Au total, 46 hyperplasies thymiques ont ete diagnostiquees. Les 46 patients etaient repartis en 33 femmes et 13 hommes avec une moyenne d’âge de 30 ans. Le diagnostic d’hyperplasie thymique vraie a pose un probleme de diagnostic differentiel sur des prelevements biopsiques, avec un thymus involutif dans un cas et un thymolipome dans un second cas. Conclusion Le diagnostic d’hyperplasie thymique est anatomopathologique. Dans les cas litigieux, la confrontation aux donnees anatomo-cliniques et une confrontation avec les mensurations du thymus en fonction de l’âge permettent d’asseoir le diagnostic.

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.To assess the major characteristics of these cysts based on a single institution experience.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.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%.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.

Resume Introduction Les tumeurs carcinoides (TC) bronchiques, scindees en carcinoide typique (CT) et carcinoide atypique (CA), sont des tumeurs rares dont la prise en charge therapeutique reste non codifiee. Methodes Etude retrospective colligeant les cas de TC bronchiques operees dans le service de chirurgie thoracique de l’hopital Abderrahmane-Mami de l’Ariana et recrutees dans les services de pneumologie du Nord de la Tunisie, durant 12 ans. Resultats Quatre-vingt-dix patients ont ete colliges (74 CT et 16 CA). L’âge moyen etait de 45 ans et le sex-ratio H/F = 0,5. La radiographie du thorax etait normale dans 11 cas, ainsi que la fibroscopie bronchique dans sept cas. La tumeur etait classee : stade IA (10 cas), IIA (28 cas), IIB (31 cas), IIIA (15 cas), IIIB (6 cas). La chirurgie a permis une exerese carcinologique reglee chez 78 patients, une exerese elargie chez six patients et une resection conservatrice chez six patients. Une chimiotherapie adjuvante a ete indiquee chez 10 patients. La survie etait de 84 % a cinq ans et de 42 % a 10 ans. Conclusion Le pronostic des TC depend etroitement de leur sous-type histologique. Il est excellent pour les CT apres resection complete, contrairement aux CA, qui sont assimilables aux carcinomes bronchiques bien differencies.

Resume La localisation thoracique preferentielle du schwannome est mediastinale posterieure. Sa localisation pleurale est tres rare. A notre connaissance, moins de 20 cas ont ete denombre dans la litterature. Nous rapportons deux cas operes de schwannome pleural benin primitif. Le premier est survenu chez une femme âgee de 52 ans qui se presentait pour une douleur thoracique droite et une toux chronique ; l’aspect radiologique etait en faveur d’un kyste hydatique probable du lobe inferieur droit. La seconde observation concerne un homme âge de 37 ans, sans antecedents, asymptomatique, qui presentait une masse mediastinale posterieure gauche de decouverte fortuite a l’imagerie. Via une thoracotomie postero-laterale, l’exploration peroperatoire a note respectivement deux masses pleurales endothoraciques a base d’implantation la plevre parietale, le geste chirurgical pour chacun des cas etait une resection-exerese chirurgicale complete de la tumeur. L’etude anatomopathologique definitive a conclu a deux schwannomes benins primitifs de la plevre.

Introduction: Hydatid disease remains a real public health problem in many traditional pastoral farming countries. Its prevention is the most effective solution. Aim: Our study aimed to assess the knowledge of patients managed for a lung hydatid cyst concerning their pathology. Methods: Between November 2018 and July 2019, we carried out a descriptive cross-sectional study, in a thoracic surgery department, about the knowledge and information that patients with hydatid cyst had about the disease. Results: Thirty-four patients responded to our survey. The mean age was 37.18 ± 18.43 years old. Most of our patients came from rural areas. Among the 30 patients under the age of 60, 12 (40%) were housewives. Three patients (8.8%) had already been operated on for a cyst. Thirty patients (88.3%) reported having contact with dogs and sheep. If a cyst was suspected in the sheep’s offal, 20.6% (7 cases) threw them in the trash and 14.8% gave them to the dog (5 women). Among the respondents, 50% (17 cases) did not know the modes of human contamination. Knowledge of clinical signs suggestive of the disease and modes of contamination were correlated with the level of education. Fourteen patients (41.2%) raised the possibility of disease recurrence. Among the means of prevention, thorough washing of fruits and vegetables was cited in 3 cases (21.4%) and incineration of soiled offal in 1 case (7.2%). Conclusion: Assessment of patients9 knowledge about hydatid disease must be systematic in countries with high endemicity of hydatidosis, in order to identify false practices and correct them, to break the parasitic cycle. Educational messages should target the rural population and be adapted to their level of education.

Synovial sarcoma is a soft tissue sarcoma. Its occurrence as a primary mediastinal neoplasm is very rare. We report a case of mediastinal synovial sarcoma in a 14‐year‐old girl with exertive dyspnoea at presentation. On physical examination, there was a superior vena cava syndrome and café‐au‐lait spots. Chest X‐ray revealed a white left hemithorax with mediastinal deviation to the opposite side. Thoraco‐abdomino‐pelvic scanner showed a voluminous posterior cervico‐mediastinal tissue mass. Computed tomography (CT)‐guided biopsy of the mediastino‐pleural mass was performed. Histological examination reported fusocellular malignant mesenchymal proliferation. A complementary immunohistological study with a broad range of antibodies was performed with a high‐grade single‐phase spindle cell synovial sarcoma of the mediastinum. She presented a respiratory distress, did not respond to resuscitation, and died. Mediastinal synovial sarcoma is a rare tumour that is difficult to diagnose. Its slow progression and delay in diagnosis may lead to a fatal evolution., Synovial sarcoma is a soft tissue sarcoma. Its occurrence as a primary mediastinal neoplasm is very rare. We report a fatal case of mediastinal synovial sarcoma in a 14‐year‐old girl with exertive dyspnoea at presentation. We highlight the role of imaging, the means of diagnosis, and the importance of the speed of therapeutic management. Mediastinal synovial sarcoma is a rare tumour that is difficult to diagnose. Its slow progression and delay in diagnosis may lead to a fatal evolution.

Background Neurogenic tumors of the mediastinum are rare tumors located mainly in the posterior mediastinum. The aim of this study was to report a single-institution experience of these tumors. Methods This study was conducted between 2005 and 2017. Bivariate analysis was performed to assess correlations between the cellularity, mitotic index, presence of a capsule, and potential for malignancy of peripheral nerve sheath tumors. Results There were 86 patients enrolled in the study. The mean age was 42.51 years. Nineteen patients were asymptomatic and their tumors were discovered incidentally. Microscopic diagnosis confirmed a schwannoma in 45 cases, neurofibroma in 12, malignant peripheral nerve sheath tumor in 9, ganglioneuroma in 14, ganglioneuroblastoma in 4, and neuroblastoma in 2. Bivariate analysis showed a significant correlation between the absence of a capsule, the degree of atypia, a high mitotic index, and high cellularity with the potential for malignancy ( p Conclusion Even if radiologic means are helpful in suggesting the diagnosis, a positive diagnosis of neurogenic tumors is based on microscopic features. High mitotic activity and cellularity, and severe cytonuclear atypia are the features most suggestive of malignancy.

Objectives:Primary cardiac tumors are rare and account for 0.001 to 0.03% of cardiac lesions. The authors aim to describe the clinical, the microscopic and the therapeutic characteristics of these tumors through a 13-year-experience in order to highlight the diagnostic challenges faced.Methods:We report 10 primary cardiac tumors diagnosed in the Departments of Pathology and Thoracic Surgery of the same hospital through a 13-year-period.Results:Our study was conducted on 7 women and 3 men. The mean age of the patients was 54.22 years (average, 12 to 79 years). Dyspnea represented the most frequent symptom. Physical examination was normal in all patients. Trans-thoracic ultra-sound examination was performed in all patients. Cardiac MRI allowed localizing the tumors in 2 patients. They were located into the left auricle (6 cases), the right auricle (1 case) and the pericardium (3 cases). The microscopic examination was concluded to myxoma (7 cases), haemangioma (2 cases) and hemangioendothelioma (1 case). Surgical resection was possible in 9 patients. It was impossible in the case of hemangioendothelioma because of the adherence. One death was recorded secondary to postoperative arrhythmia. The other patients presented no complications after a follow-up period ranging from 2 months to 5 years.Conclusion:Cardiac tumors are challenging in their diagnosis and management. A positive diagnosis is based on microscopic examination. Surgical treatment plays a key role and is possible in the majority of benign tumors. The prognosis of malignant tumors remains poor even if a complete surgical resection is possible.

The standard control parameters of cardiopulmonary bypass (CPB) currently used in Tunisia are replaced in Western countries by the concept of "goal-directed-perfusion" requiring oxygen delivery (DO2) minimum at 270ml / min / m2.In this study, we explored the association between the DO2 and the postoperative morbidity and mortality.This is a cross-sectional and retrospective observational study including a series of 50 patients operated on for myocardial revascularization under CPB.We noticed a significant correlation between starting DO2i and Creatinine clearance at day 0, Δcreate (day 1-day 0) and ventilation time. There was also a significant correlation between discharge DO2i and daytime urine output, ventilation time, hospital stay and in-hospital mortality. Through a univariable study, we compared the classic parameters of perfusion monitoring during CPB in addition to the starting DO2i with the different postoperative results. It was noted that the starting DO2i figures below the threshold of 270ml / min / m² were significantly correlated with the duration of administration of catecholamines postoperatively, with prolonged ventilation, with the variation in serum creatinine postoperatively and with in-hospital mortality.DO2 is a monitoring tool that has proven its advantages for monitoring under CPB.

Pulmonary adenoid cystic carcinoma (PACC) is an exceedingly rare tumor of low-grade malignancy. Diagnosis is often late, so the tumoral process may be huge at presentation. Surgical resection could be challenging, and the recurrence rate would be greater. We report, hereby, a case of proximal PACC with involvement of the carina in a young male adult, without respiratory distress. Surgical resection was performed through a left pneumonectomy followed by a complex trachea-bronchoplastic procedure. During the operative time, the assisted ventilatory mode was carefully chosen. No adjuvant treatment was needed. Our patient is still under clinicoradiological surveillance and remains disease-free.

Mediastinal paraganglioma presented as a large dumbbell tumor is a rare entity. We report a case of a 47 year old woman who suffered from spinal pain and sporadic lower limb paresis. The imaging studies showed a voluminous mass occupying the posterior mediastinum with right foraminal extension. For excellent results, a combined effort was necessary including thoracic and neurosurgeons teams. Complete resection was successfully performed without laminectomy. The operative course was uneventful.

Lung carcinoid tumours are rare neoplasms with a favourable prognosis. Bronchoplasty can be a conservative treatment for typical carcinoid tumours and can be applied for patients with limited respiratory function. We report the case of a 34‐year‐old woman, with a polypoid tumour located at the distal right main bronchus. Bronchial biopsy showed a typical carcinoid tumour. After resection of the tumour in the right main bronchus, bronchoplasty was performed by end‐to‐end anastomosis of the remaining right main bronchus, right upper lobar bronchus, and the upper bronchus intermedius. Bronchoscopy showed a good quality anastomosis with slightly reduced endoluminal calibre only. The post‐operative period was uneventful and the patient was discharged at the seventh day. One year later, no complications occurred and the patient is still being followed up regularly., In this article, we try to demonstrate the possibility of creating a "neo‐spur" without lobectomy to treat an intra‐bronchial typical carcinoid tumor.

Introduction: Primary tracheal tumors are rare. They represent less than 1% of primary tumors of the chest. However, they are diagnostic and therapeutic challenges. Our aim was to study the characteristics and management of primary tracheal tumors Methods: We retrospectively reviewed the clinical data from patients who were operated for primary tracheal tumors within 17 years at the thoracic surgery department of Abderrahmen Mami Hospital Ariana – Tunisia Results: There were 5 women and 4 men.The main symptom was dyspnea, accompanied with dysphonia in 1 case and dysphagia in another case. Bronchoscopy showed the lesion within the lumen in all cases. The median size of the tumor was 32.5 mm.The tumor was located in the upper third of the trachea (2 cases), the middle third (4 cases) and the lower third (3 cases). A tissue diagnosis was obtained in all patients by direct biopsy at bronchoscopy. Pathological study revealed : adenoid cystic carcinoma (4 cases), mucoepidermoid carcinoma (1 case), carcinoma with lymphoid stroma (1 case), schwannoma (1 case), glomus tumor (1 case) and cylindroma (1 case). All patients were managed by resection with reconstruction by primary anastomosis. Neck-collar incision was used in 4 cases, median sternotomy in 3 cases and posterolateral thoracotomy in 2 cases. Negative margin resection was achieved in 6 cases. The postoperative course was complicated in 3 cases. Two weeks postoperatively, bronchoscopy showed satisfactory lumen (6 cases), a lesion in the carina (1 case) and a reduced lumen (2 cases) Conclusion: Primary tracheal tumors are the least common neoplasic lesions of the airways. Non specific symptoms delay diagnosis. Resection with primary reconstruction should be preferred in initial treatment