RESUMEN
INTRODUCTION: Haemorragic pleurisy is fairly common. The etiology is dominated by tumors and tuberculosis. The rupture of intra-thoracic vessels into the pleural cavity is a much rarer cause and the diagnosis is often delayed. OBSERVATION: A 77-year-old patient without previously known hypertension was hospitalized for investigation of a fluid density opacity occupying the entire left hemithorax. Thoracentesis revealed a non-coagulable haemorrhagic fluid. A computed tomography scan showed a Stanford type B aortic dissection. The patient was given anti-hypertensive treatment for one year. CONCLUSIONS: Aortic dissection remains among the diagnoses to consider in the case of a haemorrhagic pleural effusion despite absence of the usual suggestive symptoms.
Asunto(s)
Aneurisma de la Aorta Torácica/complicaciones , Disección Aórtica/complicaciones , Hemorragia/etiología , Pleuresia/etiología , Anciano , Disección Aórtica/patología , Aneurisma de la Aorta Torácica/patología , Hemorragia/patología , Humanos , Masculino , Pleuresia/patologíaRESUMEN
Thrombosis of the superior vena cava is attached to several causes including deficiency of the protein S. It occurs gradually by a superior vena cava syndrome. We report a patient aged 22 years, no toxic habits or bipolar aphthosis, which presented for 3 months a superior vena cava syndrome. The radiological and biological assessments confirmed thrombosis of the superior vena cava and a deficit of the protein S for which the patient was put under anticoagulant therapy with good clinical and radiological improvement. Through this observation, the authors report a rare cause of thrombosis of the superior vena cava which is the isolated protein S deficiency and provide a review of the literature.
Asunto(s)
Deficiencia de Proteína S/diagnóstico , Síndrome de la Vena Cava Superior/diagnóstico , Trombosis de la Vena/diagnóstico , Anticoagulantes/uso terapéutico , Femenino , Glucocorticoides/uso terapéutico , Humanos , Radiografía , Síndrome de la Vena Cava Superior/tratamiento farmacológico , Vena Cava Superior/diagnóstico por imagen , Trombosis de la Vena/tratamiento farmacológico , Adulto JovenRESUMEN
Carcinoma of unknown primary (CUP) is the metastasis of epithelial malignancy whose origin remains unknown. Bronchial carcinoma is the most common cause (45%), however, in more than a quarter of cases, its origin is unknown and the choice of therapy often justifies a histopathological precision brought by the immuno-histochemistry. We present a rare case of cerebral metastasis, revealing an unknown lung cancer after a comprehensive review. This is a patient aged 53 years, chronic smoker, who presented a year and a half ago a sudden loss of consciousness with afebrile tonic-clonic seizure of spontaneous resolution. Clinical examination was unremarkable. Brain imaging by MRI has objectified the presence of two parietal tissue formations, which stereotactic biopsy with histological and immuno-histochemical favored metastasis of lung adenocarcinoma origin. An etiologic in search of the primitive lung remained negative (chest X-ray of face, chest CT and bronchoscopy with sampling upper gastrointestinal endoscopy). The rest of the etiologic, looking for another primitive, remained negative. The diagnosis of a bronchogenic carcinoma with brain metastasis is therefore withheld. The patient received two brain radiotherapies (gamma kniff) with regression of the two nodular formations. We have not given specific treatment and have called for very close monitoring of the patient who remained stable after 18 months. Through this observation, we stress the interest of the histology and immuno-histochemistry of carcinoma of unknown primary (CUP) to the diagnosis, guide therapy and determine prognosis.
Asunto(s)
Adenocarcinoma/secundario , Neoplasias Encefálicas/secundario , Neoplasias de los Bronquios/patología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Well-differentiated fetal adenocarcinoma (WDFA) is a very uncommon malignant tumor originating in the lung. This report describes the case of a 38-year-old woman with a WDFA treated by surgery. The malignancy is low grade and associated with a good prognosis, and so it is important for clinicians to be aware of and to identify this rare variant of adenocarcinoma.
Asunto(s)
Adenocarcinoma/patología , Neoplasias Pulmonares/patología , Adulto , Femenino , HumanosAsunto(s)
Criptococosis/diagnóstico , Inmunocompetencia/inmunología , Enfermedades Pulmonares Fúngicas/diagnóstico , Granuloma de Células Plasmáticas del Pulmón/diagnóstico , Adulto , Antifúngicos/uso terapéutico , Biopsia , Biopsia con Aguja , Broncoscopía , Terapia Combinada , Criptococosis/tratamiento farmacológico , Criptococosis/inmunología , Criptococosis/patología , Fluconazol/uso terapéutico , Humanos , Cuidados a Largo Plazo , Pulmón/patología , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/inmunología , Enfermedades Pulmonares Fúngicas/patología , Masculino , Granuloma de Células Plasmáticas del Pulmón/tratamiento farmacológico , Granuloma de Células Plasmáticas del Pulmón/inmunología , Granuloma de Células Plasmáticas del Pulmón/patología , Neumonectomía , Radiografía Intervencional , Toracotomía , Tomografía Computarizada por Rayos XAsunto(s)
Neoplasias del Mediastino/diagnóstico , Mediastinitis/diagnóstico , Esclerodermia Sistémica/complicaciones , Tuberculosis/diagnóstico , Adulto , Anticuerpos Antinucleares/sangre , Anticuerpos Antinucleares/inmunología , Autoantígenos/inmunología , ADN-Topoisomerasas de Tipo I , Diagnóstico Diferencial , Femenino , Humanos , Huésped Inmunocomprometido , Mediastinitis/complicaciones , Mediastinitis/diagnóstico por imagen , Mediastinitis/patología , Mediastinoscopía , Proteínas Nucleares/inmunología , Radiografía , Esclerodermia Sistémica/sangre , Esclerodermia Sistémica/diagnóstico , Tuberculosis/complicaciones , Tuberculosis/diagnóstico por imagen , Tuberculosis/patología , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico , Pérdida de PesoRESUMEN
INTRODUCTION: Primary bronchial cancer (PBC) is a major public health problem. The diagnosis is often late resulting in a poor prognosis. PURPOSE: To determine the factors leading to a late diagnosis. PATIENTS AND METHODS: All PBCs diagnosed between 01 January and 31 December were included. The factors studied were: "age, sex, smoking, place of residence, socioeconomic level, clinical signs, diagnostic means, histological types, the stages and date of treatment". The date of the first symptom (D1s), the date of care (Dpch), the date of the diagnosis (Ddg) and the date of the beginning of treatment (Dttt) were used to determine the delay before care. RESULTS: One hundred and three cases of PBC were included. The medium delay before hospitalisation (D1s to Dpch) was 76 days, the delay before the diagnosis (Dpch to Ddg) was 25 days, the time before treatment (Ddg to Dttt) was 27 days, the time between hospitalisation and treatment (Dpch to Dttt) was 69 days, the overall delay (D1s to Dttt) was 160 days. The time before the diagnosis was longer in cases with a low socioeconomic level (30 days vs. 21 days, p: 0.06). The time before treatment was shorter for small cell carcinomas (SCC) (23 days vs. 31 days: p: 0.06). The time between hospitalisation and treatment was shorter for stages IIIB and IV of NSCBC (60 days vs. 67 days, p: 0.03). The overall delay was shorter for SCC (152 days vs. 168 days, p: 0.001). CONCLUSION: The study confirms the problem of a delay in diagnosis. The effect of these delays on the prognosis has not been demonstrated and requires further study.
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Carcinoma Broncogénico/diagnóstico , Países en Desarrollo , Neoplasias Pulmonares/diagnóstico , Adenocarcinoma/diagnóstico , Adenocarcinoma/epidemiología , Adenocarcinoma/patología , Adenocarcinoma/terapia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Broncogénico/epidemiología , Carcinoma Broncogénico/patología , Carcinoma Broncogénico/terapia , Carcinoma de Células Grandes/diagnóstico , Carcinoma de Células Grandes/epidemiología , Carcinoma de Células Grandes/patología , Carcinoma de Células Grandes/terapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hospitales Universitarios , Humanos , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Marruecos , Estadificación de Neoplasias , Admisión del Paciente/estadística & datos numéricos , Fumar/efectos adversos , Fumar/patología , Factores Socioeconómicos , Atención no Remunerada/estadística & datos numéricosRESUMEN
Cryptococcal infections occur frequently in immunocompromised patients particularly in the context of AIDS, lymphomas and following immunosuppression for organ transplant recipients. In these contexts the infection is readily considered and diagnosis straightforward. The diagnosis is rarer and thus less likely to be considered in immunocompetent patients which can lead to late diagnosis and delay in initiation of therapy. We report the case of disseminated cryptococcosis with endobronchial, cutaneous, bone and meningeal involvement in an apparently immunocompetent patient. Before antifungal treatment could be initiated the patient died of cerebral complications.
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Enfermedades Óseas Infecciosas , Criptococosis , Dermatomicosis , Enfermedades Pulmonares Fúngicas , Meningitis Criptocócica , Enfermedades Óseas Infecciosas/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Absceso Encefálico/diagnóstico por imagen , Criptococosis/diagnóstico , Criptococosis/diagnóstico por imagen , Dermatomicosis/diagnóstico , Humanos , Inmunocompetencia , Enfermedades Pulmonares Fúngicas/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Meningitis Criptocócica/diagnóstico , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Giant-cell tumors of bone are rare primary neoplasms commonly encountered in young adults. Women are slightly more affected than men. CASE REPORT: We report the case a 27 year old woman presenting with a twelve months history of painful and progressively growing thoracic mass in the right anterior chest wall. Physical examination found out a fixed thoracic mass in the right retro-mammary area measuring 8 x 6 centimeters. The overlying skin was normal. Chest roentgenogram demonstrated a large ill defined mass continuing the anterior arc of the fourth right rib. Computed tomography evidenced a well defined pathologic process originating from the fourth right rib without expansion of the surrounding soft tissue. Pulmonary functional tests were normal and other complementary investigations evidenced no abnormalities. Our patient first had a fine needle cytological biopsy that brought strong suspicion of Giant-cell tumor of the rib. She then underwent an "en bloc" resection of the tumor whose histopathologic analysis allowed a definitive diagnosis. The post-surgical follow up during 12 months showed no signs of tumor recurrence. CONCLUSION: Through this observation the authors emphasize not only the rarity of the giant-cell tumors of bone but also its unusual costal localization (few cases reported till date). They focus on the importance of precocious screening and treatment and underline the value of the follow up in order to detect timely any sign of local recurrence or sarcomatous transformation. Finally, they report a current review of the literature.
Asunto(s)
Neoplasias Óseas/cirugía , Tumor Óseo de Células Gigantes/cirugía , Costillas , Adulto , Neoplasias Óseas/diagnóstico por imagen , Femenino , Tumor Óseo de Células Gigantes/diagnóstico por imagen , Humanos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Malignant peripheral nerve sheath tumors (MPNST) are exceptional and painful. The typical localization along a peripheral nerve is not always present. Prognosis is very poor. Diagnosis is particularly difficult because of the variable pathological presentation and unpredictable differentiation. We report an exceptional case of epithelioid differentiation in a 43-Year-old patient who complained of right thoracic pain for one and a half Years. Physical examination revealed weight loss and a paravertebral mass under the scapula. The chest x-ray showed a suprahilar opacity suggestive of parietal involvement and lysis of the sixth rib. Surgical biopsy of the parietal mass led to the diagnosis of epithelioid MPNST.
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Neoplasias de la Vaina del Nervio/patología , Neoplasias Peritoneales/patología , Costillas/patología , Escápula/patología , Adulto , Humanos , Inmunohistoquímica , Masculino , Dolor/etiología , Pérdida de PesoRESUMEN
Cystic adenoid carcinoma (CAC) of the trachea, also called cylindroma, is a rare malignant tumor accounting for 1 per thousand of all respiratory tract cancers. We report three cases of cylindroma in patients hospitalized for inspiratory dyspnea due to a tracheal tumor. Bronchoscopy using a rigid tube revealed a smooth tumor of the trachea. Pathology analysis of the biopsy specimen diagnosed CAC. The three patients underwent resection with end-to-end anastomosis. Adjuvant radiotherapy was given in one patient. The short-term outcome was good but one patient developed local recurrence and lung metastasis at six years.