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Thoracic endometriosis (TE) syndrome is a clinical condition known as an extrapelvic form of endometriosis with the presence of functioning endometrial tissue involving lung parenchyma, pleura, chest wall, or diaphragm. In an effort to obtain an endometriosis ex vivo model, we established the spontaneously growing TH-EM1 cell line from endometriotic implants in lung parenchyma from a woman with TE. Maintained in long-term culture, the cells grew as large mesenchymal-like cells with a doubling time between 5 and 6 days. Treatment with medroxyprogesterone acetate (10-7 mol/L) inhibited the TH-EM1 cells growth and induced morphological changes to an epithelial-like cells. Strong expression of the nuclear estrogen receptors, progesterone receptors, and erytropoietin receptors were found in both the pulmonary implant and the TH-EM1 cells by immunohistochemical analysis. Consistent immunoreactivity of TH-EM1 cells for CD9, CD13, CD73, CD90, CD105, and CD157 was revealed by flow cytometry. Likewise, the embryonic markers, SRY-box 2 (SOX-2) and the Nanog molecules, were detected in 76% and 52% of the cells, while fetal hemoglobin and a-globin were detected in 76% and 65% of TH-EM1 cells, respectively. By RHG banding, normal metaphases were observed, while the microarray chromosomal analysis showed gains of DNA sequences located on the segments 8p23.1, 11p15.5, and 12p11.23. The described in vitro cellular model can serve as a useful tool to study the pathogenesis of endometriosis and to improve the knowledge of molecular mechanisms controlling the endometriotic cell dissemination potential.

Endobronchial ultrasonography (EBUS) is a recent mini-invasive technique allowing transbronchial needle aspiration (TBNA) of mediastinal lymph nodes as well as peribronchial lesions. EBUS was initially developed for lung cancer mediastinal staging. Over the years, indications for EBUS have been progressively extended to the scope of inflammatory disorders, mediastinal lymphomas, and infectious diseases. Particularly in immunosuppressed patients, including HIV-infected patients, EBUS allows the diagnosis of several diseases that involve the mediastinum, avoiding invasive surgical explorations such as mediastinoscopy or thoracoscopy. This review aims at discussing the technical aspects, and specifies indications, results, and limits of EBUS for the internist.

Resume La demarche diagnostique d’un cancer bronchique suspecte a deux buts : (a) obtenir un diagnostic histologique ; et (b) realiser un bilan d’extension qui autorisera une stadification TNM « clinique » (cTNM). Ces deux elements, diagnostic histologique et cTNM, constitueront les bases quasi-exclusives des decisions therapeutiques initiales, modulees seulement par l’etat clinique du patient et d’eventuelles comorbidites. On peut admettre, pour certains patients selectionnes, que le diagnostic histologique ne soit obtenu que lors d’une intervention chirurgicale, qui peut alors etre a la fois diagnostique et therapeutique. En revanche, la determination pre-therapeutique d’un stade cTNM aussi fiable que possible ne doit souffrir aucune exception. De la qualite de cette evaluation dependront en effet la pertinence du traitement et ses resultats, mesurables en termes de survie et de qualite de vie.

Mediastinal liposarcomas (LPS) are rare tumours. We report a case of primary myxoid LPS in a 22-year-old woman suffering from cough, dyspnoea on exercise and asthenia for 3 weeks. Thoracic MRI showed a large tumour on the right side. After neoadjuvant chemotherapy, a complete resection was performed, followed by adjuvant thoracic irradiation. Eighteen months after the diagnosis, no sign of recurrence was detected. Mediastinal LPS include a heterogeneous group of bulky tumours, the progression of which depends on the histological type. The prognosis is dominated by the operability of the tumour. Adjuvant therapies are not established.

To evaluate the role of Transperineal Template guided Mapping Biopsy (TTMB) in determining the management strategy in patients with low risk prostate cancer (PCa).We retroscpectively evaluated 169 patients who underwent TTMB at our institution from February 2008 to June 2011. Ninety eight of them harbored indolent PCa defined as: Prostate Specific Antigen10ng/ml, Gleason score 6 or less, clinical stage T2a or less, unilateral disease and a maximum of one third positive cores at first biopsy and50% of the core involved. TTMB results were analyzed for Gleason score upgrading and upstaging as compared to initial TransRectal UltraSound (TRUS) biopsies and its influence on the change in the treatment decisions.TTMB detected cancer in 64 (65%) patients. The upgrade, upstage and both were noted in 33% (n=21), 12% (n=8) and 7% (n=5) respectively of the detected cancers. The disease characteristics was similar to initial TRUS in 30 (48%) patients and TTMB was negative in 34 (35%) patients. Prostate volume was significantly smaller in patients with upgrade and/or upstage noted at TTMB (45.4 vs 37.9; P=.03). TTMB results influenced 73.5% of upgraded and/or upstaged patients to receive radical treatment while 81% of the patients with unmodified stage and/or grade continued active surveillance or focal therapy.In patients with low risk PCa diagnosed by TRUS, subsequent TTMB demonstrated cancer upgrade and/or upstage in about one-third of the patients and resulted in eventual change in treatment decision.

Endobronchial ultrasonography (EBUS) is a recent mini-invasive technique allowing transbronchial needle aspiration (TBNA) of mediastinal lymph nodes as well as peribronchial lesions. EBUS was initially developed for lung cancer mediastinal staging. Over the years, indications for EBUS have been progressively extended to the scope of inflammatory disorders, mediastinal lymphomas, and infectious diseases. Particularly in immunosuppressed patients, including HIV-infected patients, EBUS allows the diagnosis of several diseases that involve the mediastinum, avoiding invasive surgical explorations such as mediastinoscopy or thoracoscopy. This review aims at discussing the technical aspects, and specifies indications, results, and limits of EBUS for the internist.

CD245 is a human surface antigen expressed on peripheral blood lymphocytes, initially delineated by two monoclonal antibodies DY12 and DY35. Until now, CD245 molecular and functional characteristics remained largely unknown. We combined immunological and proteomic approaches and identified CD245 as the unconventional myosin 18A, a highly conserved motor enzyme reported as a receptor for the surfactant protein A (SP-A), that plays a critical role in cytoskeleton organization and Golgi budding. We report that the recruitment of CD245 strongly enhanced NK cell cytotoxicity. Further, we show that the enhancement of the NK lymphocytes killing ability toward CD137-ligand expressing target cells could result from the induction of CD137 expression following CD245 engagement. The SP-A receptor could therefore represent a novel and promising target in cancer immunotherapy.

Bronchogenic cysts are congenital malformations that are usually located in the mediastinum. Intrapulmonary location is rare.Four cases of intrapulmonary bronchogenic cysts are reported in order to discuss their clinical and radiological presentation and their treatment.Intrapulmonary bronchogenic cysts diagnostic is often missed. This condition must however be known so as to foresee a resection in order to prevent a potential complication.

Background: Microcystic adnexal carcinoma (MAC) is a rare cutaneous neoplasm, with a high rate of local recurrences. Objective: A series of MAC was analyzed and compared to previously published cases. Methods: Seven cases of MAC were identified in the register of the institution. Medical and pathological records were reviewed. Results: The primary MAC were located on the face in all patients, and 85% were initially misdiagnosed. The mean follow-up duration was 108 months. The recurrence rate was high: 4 patients developed recurrences. In 3 patients, the course of the disease was severe: one of them developed pathologically proven lung metastasis. Conclusion: The present study and review of the literature confirm the clinically aggressive evolution of MAC and its rare ability to give rise to metastasis. Long-term clinical follow-ups with imaging investigations are mandatory.

Introduction L’essai de phase II AFUGEM avait pour objectif d’evaluer l’efficacite d’une chimiotherapie de premiere ligne associant ABI-007 (paclitaxel-albumine) et gemcitabine (bras 1) ou LV5FU2 (bras 2) simplifie chez des patients atteints d’un cancer du pancreas metastatique non pre-traite. Le critere de jugement principal etait le taux de survie sans progression a quatre mois et les resultats etaient en faveur du bras 2 avec un taux de SSP a quatre mois de 53,9 % pour le bras 1 versus 55,4 % pour le bras 2. Cette etude porte sur l’analyse des donnees de qualite de vie relative a la sante (QdV) en tant qu’objectif secondaire de l’essai afin d’evaluer le benefice clinique pour le patient. Methodes La QdV a ete evaluee par le questionnaire EORTC QLQ-C30 specifique du cancer, a l’inclusion avant randomisation, le premier jour de chaque cycle de chimiotherapie puis a la visite de fin de traitement. Une analyse du profil des donnees manquantes a l’inclusion a ete realisee. Les patients pour lesquels le score a l’inclusion etait disponible ont ete inclus dans l’analyse longitudinale (analyse en intention de traite modifiee). Le temps jusqu’a deterioration definitive d’un score de QdV (TJDD) a ete defini comme l’intervalle de temps entre la date d’inclusion et l’apparition d’une premiere deterioration d’au moins cinq points du score de QdV par rapport au score a l’inclusion, sans amelioration ulterieure d’au moins cinq points par rapport au score a l’inclusion, incluant ou non le deces comme evenement. Le TJDD a ete estime selon la methode de Kaplan-Meier. L’effet du traitement a ete estime par le coefficient hazard ratio (HR) avec son intervalle de confiance a 95 % (IC95 %) issu d’un modele de Cox univarie. A titre exploratoire, des analyses multivariees de Cox ont egalement ete realisees afin d’etudier les facteurs influencant potentiellement le TJDD. Resultat Entre decembre 2013 et octobre 2014, 114 patients ont ete inclus (39 dans le bras 1 ; 75 dans le bras 2). Soixante-quatre patients (56,1 %) ont complete le questionnaire QLQ-C30 a l’inclusion (22 patients [56,4 %] dans le bras 1 ; 42 patients [56,0 %] dans le bras 2). Les non-repondeurs presentaient majoritairement un niveau de CA19,9 (p = 0,039) et d’alcaline phosphatase (p = 0,045) anormal comparativement aux repondeurs. La mediane de survie globale etait de 9,5 mois (IC95 % : 7,2–NA) et 9,1 mois (IC95 % : 7,4–NA) respectivement chez les patients avec et sans mesure de QdV a l’inclusion (HR = 0,98 [0,55–1,76], p-value Log-rank = 0,95). Les patients du bras 2 presentaient une deterioration plus tardive de la QdV comparativement aux patients du bras 1 pour 14 dimensions du QLQ-C30 parmi les 15 dimensions evaluees avec un HR (bras 2 versus bras 1 Conclusion Les patients du bras 2 semblent presenter une deterioration plus tardive de la QdV comparativement a ceux du bras 1, et sont coherents avec les resultats de SSP et OS confirmant le benefice clinique de l’association ABI-007 et gemcitabine en traitement de premiere ligne.

Schwannomas are a form of rare tumor, arising from neural tissue and representing 2 % of mediastinal tumors. They are usually located in the posterior mediastinum, most often in the paravertebral gutters and typically appended to intercostal nerves.We report two cases of unusual mediastinal schwannomas, appended to the vagus nerve. The schwannoma was located in the subcarinal region in the first case and in the right para-tracheal region in the second case. The lesions were thought to be bronchogenic cysts preoperatively in both cases because of a cystic appearance on preoperative CT scan and endobronchial ultrasonography. A surgical approach was adopted to remove the tumors. Video-assisted thoracoscopy was used in one case and robotic-assisted surgery in the second case, without any complication, allowing for complete resection and to establish a certain pathological diagnosis.Despite this location and cystic presentation being unusual, schwannoma should be considered as a possible cause of cystic lesions in the mediastinum. Minimally invasive surgery allows for complete resection and definitive pathological diagnosis.

Objective. The objective of this study was to evaluate, for patients with ovarian cancer, the feasibility, reliability, and complications of a laparoscopic second look and to compare them with those of a second look by laparotomy. Methods. Twenty patients treated by initial surgery and adjuvant chemotherapy for ovarian carcinoma underwent a laparoscopic second look, immediately followed by a comparative laparotomy. All were in complete remission after chemotherapy. Both operations were performed according to a predefined checklist, identical for both surgical techniques and for each patient: after liberation of adhesions, an exhaustive intraperitoneal inspection was performed, with systematic peritoneal cytology and biopsies. Each patient therefore was her own control for the two techniques. Results. The positive predictive value of laparoscopy for the diagnosis of residual disease was 100% (6 of 6 cases), while the negative predictive value was 86% (2 false-negative cases out of 14). Because of the presence of postoperative adhesions, the rate of complete intraperitoneal investigation was 95% for laparotomy versus 41% for laparoscopy. The complication rate of laparoscopy requiring laparotomy was 5.3%. Conclusions. After treatment of ovarian cancer, a laparoscopic second look appears to be less reliable than one performed by laparotomy. The presence of severe postoperative adhesions is the main obstacle to an exhaustive, reliable, and safe laparoscopic second look.

Introduction – objectifs L’echo-endoscopie bronchique ( EndoBronchial UltraSound , EBUS) associee a une ponction-aspiration ganglionnaire transbronchique (PTB) est couramment pratiquee pour le staging ganglionnaire mediastinal des cancers bronchiques. L’objectif de notre etude etait d’evaluer sa performance diagnostique dans les suspicions de tuberculose ganglionnaire mediastinale (TGM). Materiels et methodes Entre septembre 2012 et septembre 2013, nous avons effectue 10 EBUS pour une suspicion de TGM. Au TDM, les adenopathies etaient multiples (n = 6) ou isolees au site 7 (n = 3) ou 11 l (n = 1), avec un aspect heterogene (n = 7) ou homogene (n = 3), et mesurant en moyenne 22 mm (14 a 35 mm). Les EBUS etaient pratiquees sous AG en ambulatoire et ont permis de prelever un (n = 7) ou 2 (n = 3) sites ganglionnaires, avec etalement sur lames et cytobloc. Le nombre moyen de passages etait de 4,3 (3 a 6). Aucune complication n’a ete observee. Resultats Il s’agissait de 8 femmes, 2 hommes, âge moyen 39 ans (17- 57 ans), 9 provenaient de pays de forte endemie tuberculeuse, un patient vivait avec le VIH. Tous les patients ont eu des cultures de prelevements respiratoires negatifs pour les mycobacteries. L’anatomopathologie a montre une adenite necrotique (n = 8), sans necrose (n = 1), et/ou des cellules epithelioides gigantocellulaires (n = 2). La coloration de Ziehl a ete positive 1 fois sur 10 (10 %). La culture a ete positive dans 6 (60 %) cas, pour M. tuberculosis . Excepte un perdu de vue, tous ont ete traites avec un succes clinique. Conclusion L’EBUS avec PTB a permis le diagnostic de TGM dans tous les cas : par culture de M. tuberculosis (60 % des cas) et/ou la presence d’une adenite tuberculeuse (80 % des cas). L’EBUS a permis d’eviter un recours a une chirurgie thoracique diagnostique par mediastinoscopie dans 9 cas et par thoracoscopie dans 1 cas.