RESUMEN
INTRODUCTION: Pediatric cancers are a major public health problem in sub-Saharan Africa. However, they are seldom studied, especially as regards in their extensive forms. METHODOLOGY: An eight-year retrospective and descriptive study was carried out so as to specify the epidemiological and clinical characteristics of cancers with pleural and pulmonary involvement in children of 0 to 14years of age in the pediatric oncology unit at the University Hospital of Treichville, Côte d'Ivoire (Ivory Coast). RESULTS: The frequency of pleural and pulmonary involvement in pediatric cancers was 13.8%. Children's average age was 7.2years, with sex ratio at 2.11. Solid tumors were predominant, with a predominance of Burkitt's lymphoma (39.3%) and nephroblastoma (35.7%). The most affected age groups were 10 to 15years (Burkitt's lymphoma) and 0 to 5years (nephroblastoma). Time to diagnosis ranged from 31 and 60days in 40.4% of cases, and time to treatment was at most 30 days, for the overwhelming majority (97.1%) of the children. Chemotherapy was initiated in 67.9% of patients. Hospital mortality was 73.2%. CONCLUSION: Through this study, the authors established the profile of childhood cancers with pleural and pulmonary involvement. Comparative studies of mortality in pediatric cancers with and without pleural and pulmonary involvement could further underline the importance of early management before dissemination.
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Linfoma de Burkitt , Tumor de Wilms , Niño , Humanos , Adolescente , Côte d'Ivoire/epidemiología , Estudios Retrospectivos , Linfoma de Burkitt/epidemiología , Linfoma de Burkitt/terapia , Hospitales Universitarios , Tumor de Wilms/epidemiología , Tumor de Wilms/terapiaRESUMEN
POCUS - Thoracic Sonography in Times of Corona: What Sonographing Family Physicians Should Examine Abstract. When performing chest sonography of patients with symptoms such as respiratory infection, dyspnea and chest pain, the primary goal is to find or exclude significant diagnoses such as pneumothorax, pleural effusion, pulmonary edema, tumors, pulmonary emboli, etc. as the cause of the symptoms. If infection with SARS-CoV-2 is present, COVID-19 pneumonia can be confirmed or excluded as the cause of the symptoms with a high degree of probability based on the sonographic signs. COVID-19 pneumonia shows typical changes in the lungs, which are easily accessible to ultrasound due to their usually peripheral location. These are ubiquitous signs, such as a thickened, fragmented pleura with subpleural consolidations, multiple comet tail artifacts of varying size and thickness, some of which are coascent, broad bright light beams, and possibly small encapsulated pleural effusions. The more of these sonographic signs are present and the more pronounced they are, the sooner the patient must be hospitalized and possibly intubated. Ultrasound is also useful as a follow-up tool, together with clinical and laboratory findings.
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COVID-19 , Médicos de Familia , Humanos , Pulmón/diagnóstico por imagen , SARS-CoV-2 , UltrasonografíaRESUMEN
The preferred thoracic location of a schwannoma is the posterior mediastinum. A pleural location is very rare. To date there have been fewer than 20 cases in the literature. We report two operated cases of primary benign pleural schwannoma. The first occurred in a 52-year-old woman who presented with right-sided chest pain and chronic cough. The radiological appearance suggested a hydatid cyst of the lower right lobe. The second case concerned a 37-year-old, asymptomatic man with no past history, who presented with a left posterior mediastinal mass, discovered incidentally on imaging. Both patients underwent complete surgical resection via a posterolateral thoracotomy. The final anatomo-pathological investigation revealed two primary benign schwannomas of the pleura.
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Equinococosis , Enfermedades del Mediastino , Neurilemoma , Adulto , Equinococosis/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neurilemoma/cirugía , Pleura , ToracotomíaRESUMEN
INTRODUCTION: Diffuse malignant mesothelioma (MMD) is a rare disease. The diagnosis is difficult and needs an antibody panel. The tumor suppressor gene BRCA1 associated protein 1 (BAP1) is involved in several cancers, including MMD. Loss of BAP1 expression is correlated with BAP1 somatic or constitutional genetic defects. Our work assesses the value of integrating BAP1 in the panel of antibodies used for the diagnosis of MMD. MATERIALS AND METHODS: Immunohistochemical techniques were performed on cytological and histological specimens of MMD and adenocarcinoma pleural metastasis. RESULTS: Of the 26 patients with MMD and the 24 patients with adenocarcinoma pleural metastasis, loss of BAP1 expression was observed in 11 (48%) and one adenocarcinoma (6%) on cytological specimens and in 12 MMD (48%) and in one adenocarcinoma (5%) on biopsy specimens. The concordance between immunocytochemistry and immunohistochemistry was 100%. The specificity of BAP1 was 100% on cytological and biopsy specimen for the diagnosis of malignancy in case of mesothelial proliferation. DISCUSSION AND CONCLUSION: Loss of BAP1 expression is an indicator of MMD in a context of mesothelial proliferation. This immunohistochemistry could be integrated in the panel of immunostaining used for MMD diagnosis, either on histological or cytological samples. Furthermore, loss of BAP1 expression guides the patient to an oncology genetic counseling in order to eliminate a MMD developed as part of a constitutional genetic defect.
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Biomarcadores de Tumor/análisis , Mesotelioma/química , Proteínas de Neoplasias/análisis , Neoplasias Pleurales/química , Proteínas Supresoras de Tumor/análisis , Ubiquitina Tiolesterasa/análisis , Adenocarcinoma/química , Adenocarcinoma/diagnóstico , Adenocarcinoma/genética , Adenocarcinoma/patología , Anciano , Anciano de 80 o más Años , Biopsia , Diagnóstico Diferencial , Femenino , Regulación Neoplásica de la Expresión Génica , Genes Supresores de Tumor , Asesoramiento Genético , Humanos , Mesotelioma/diagnóstico , Mesotelioma/genética , Mesotelioma/patología , Persona de Mediana Edad , Neoplasias Pleurales/diagnóstico , Neoplasias Pleurales/genética , Neoplasias Pleurales/patología , Sensibilidad y EspecificidadRESUMEN
Calcifying fibrous tumor is a rare soft tissue benign tumor (OMS 2002). Some pleural localisations are described, which affect slightly older individuals than the other soft tissue forms. The calcifying fibrous tumor is included in the 2004 World Health Organization classification of pleural tumors. A pleural tumor located in the right inferior pulmonary lobe is diagnosed in a 59-year-old man. This pleural tumor is macroscopically well-circumscribed. Histologically, the rare spindle tumoral cells are located between bundles of a collagenous tissue, sometimes hyalinized, with psammomatous or dystrophic calcifications. The tumoral cells have a fibrohistiocytic origin. They stain positively for antibodies against vimentin, factor XIIIa, CD68, CD163, CD34. Antibodies against smooth muscle actin, desmin, PS100, ALK1 and EBV are negative. Main differencial diagnoses are other benign pleural tumors (solitary fibrous tumor, inflammatory myofibroblastique tumor), some malignant tumors (desmoplastic malignant pleural mesothelioma) and pleural pseudotumors (calcified pleural plaques, chronic fibrous pleuritis, amylose, hyalinizing granuloma). Our case is the 15th pleural calcifying fibrous tumor being reported.
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Calcinosis/diagnóstico , Neoplasias de Tejido Fibroso/diagnóstico , Neoplasias Pleurales/diagnóstico , Antígenos CD/análisis , Biomarcadores de Tumor/análisis , Calcinosis/metabolismo , Calcinosis/patología , Diagnóstico Diferencial , Factor XIIIa/análisis , Granuloma de Células Plasmáticas/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Miofibroblastos/química , Miofibroblastos/patología , Neoplasias de Tejido Fibroso/química , Neoplasias de Tejido Fibroso/patología , Neoplasias Pleurales/química , Neoplasias Pleurales/patología , Tumores Fibrosos Solitarios/diagnóstico , Vimentina/análisisRESUMEN
The diagnosis of malignant pleural mesothelioma relies mostly on the pathological examination of pleural samples, validated by a panel of experts and generally obtained during medical or surgical thoracoscopy performed for the management of an exudative pleural effusion. In the absence of pleural effusion (dry-type mesothelioma), the diagnostic approach depends on the features of the lesions (pleural thickness, nodules and/or masses) and their pleural location. Ultrasound and CT-guided needle aspiration represent recognized alternative diagnostic techniques in these situations. We present the case of a patient, presenting a dry-type mesothelioma, whose diagnosis was obtained by endobronchial ultrasound (EBUS)-guided needle aspiration of a pleural mediastinal mass and confirmed by a CT-guided needle aspiration of another pleural mass in close contact with the chest wall. The samples have been compared and show quantitative and qualitative similarities. EBUS represents a minimally invasive alternative diagnostic technique for dry-type mesothelioma, showing thickness of the mediastinal pleura in contact with a central airway or when thoracoscopy, which remains the "gold standard" diagnostic approach, is not feasible.
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Neoplasias Pulmonares/diagnóstico por imagen , Mesotelioma/diagnóstico por imagen , Neoplasias Pleurales/diagnóstico por imagen , Anciano , Biopsia con Aguja Fina/métodos , Humanos , Neoplasias Pulmonares/patología , Masculino , Mesotelioma/patología , Mesotelioma Maligno , Neoplasias Pleurales/patología , Radiografía Torácica , Toracoscopía/métodos , Ultrasonografía IntervencionalRESUMEN
INTRODUCTION: The majority of pleural and peritoneal mesotheliomas are linked to asbestos exposure but, in around 20% of cases, no history of such exposure is found. Periodic disease is associated with recurrent serositis, which could favor the development of mesothelioma. CASE REPORT: We report a case of pleural mesothelioma in a 50-year-old Lebanese woman, with no detectable exposure to asbestos but suffering from periodic disease (familial Mediterranean fever) with recurrent episodes of serositis. DISCUSSION: Many cases of peritoneal mesothelioma in patients with FMF are reported in the literature. This is the second reported case of pleural mesothelioma associated with periodic disease. Because of the low incidence of both diseases, further publications are required to support the hypothesis of a causal link. It is important, therefore, that all cases of an association of periodic disease and mesothelioma are reported.
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Fiebre Mediterránea Familiar/complicaciones , Mesotelioma/etiología , Neoplasias Pleurales/etiología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Causalidad , Colchicina/uso terapéutico , Fiebre Mediterránea Familiar/tratamiento farmacológico , Fiebre Mediterránea Familiar/patología , Femenino , Humanos , Inflamación , Líbano/etnología , Mesotelioma/diagnóstico , Mesotelioma/tratamiento farmacológico , Persona de Mediana Edad , Compuestos Organoplatinos/administración & dosificación , Pemetrexed/administración & dosificación , Peritoneo/patología , Neoplasias Pleurales/diagnóstico , Neoplasias Pleurales/tratamiento farmacológico , Membrana Serosa/patologíaRESUMEN
Each year, there are more than eight million new cases of tuberculosis and 1.3 million deaths. There is a renewed interest in extrapulmonary forms of tuberculosis as its relative frequency increases. Among extrapulmonary organs, pleura and lymph nodes are the most common. Their diagnosis is often difficult and is based on clinical, radiological, bacteriological and histological findings. Extrapulmonary lesions are paucibacillary and samplings, in most cases, difficult to obtain, so diagnosis is often simply presumptive. Nucleic acid amplification tests, which are fast and specific, have greatly facilitated the diagnosis of some forms of extrapulmonary tuberculosis. However, their sensitivity is poor and a negative test does not eliminate the diagnosis. Treatment is the same as for pulmonary forms, but its duration is nine to 12 months for central nervous system and for bone tuberculosis. Corticosteroids are indicated in meningeal and pericardial localizations. Complementary surgery is used for certain complicated forms.
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Tuberculosis/diagnóstico , Tuberculosis/epidemiología , Diagnóstico Diferencial , Salud Global , Humanos , Incidencia , Pericarditis Tuberculosa/diagnóstico , Pericarditis Tuberculosa/epidemiología , Prevalencia , Factores de Riesgo , Tuberculosis/mortalidad , Tuberculosis/terapia , Tuberculosis Gastrointestinal/diagnóstico , Tuberculosis Gastrointestinal/epidemiología , Tuberculosis Ganglionar/diagnóstico , Tuberculosis Ganglionar/epidemiología , Tuberculosis Meníngea/diagnóstico , Tuberculosis Meníngea/epidemiología , Tuberculosis Osteoarticular/diagnóstico , Tuberculosis Osteoarticular/epidemiología , Tuberculosis Pleural/diagnóstico , Tuberculosis Pleural/epidemiología , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/epidemiología , Tuberculosis de la Columna Vertebral/diagnóstico , Tuberculosis de la Columna Vertebral/epidemiología , Tuberculosis Urogenital/diagnóstico , Tuberculosis Urogenital/epidemiologíaRESUMEN
INTRODUCTION: The pleural involvement (PLI) in non-small cell lung cancer (NSCLC) has a poor prognosis, even though it might be very heterogeneous. PATIENTS AND METHODS: A multicentric retrospective descriptive study was performed over 2329 patients who were operated for NSCLC between 1979 and 2010. The patients with PLI were classified in P(Parietal)PLI and V(visceral)PLI and then each subdivided : VPLI to peripheric (VPLI-P) and fissural (VPLI-F) and PPLI to mediastinal (PPLI-M) and costal (PPLI-C). Characteristics and survival were compared between the subgroups as well as with patients without PLI (WPLI, n=1439). RESULTS: The sex-ratio was 2.8 (males: n=1713). The PLI patients were significantly younger, with a less sex-ratio, less R0 resections (96% versus 98.7%, P=0.000076), and less N0 (60% vs 70%, P<10(-6)) as their 5-year survival (45.7% vs 55.5%, P<10(-6)). The PLI was related to the size of NSCLC (P<10(-6)) and N2 involvement (P=0.0020). It was less frequent after neoadjuvant treatment (36.2% vs 39.1% P=0.03). In the VPLI-F or PPLI-M, pneumonectomies were more frequent (P<10(-6)). In VPLI-P (n=196/561), there were more pN1 and pN2 (P=0.0065) with a 5-year survival of 42.9% vs 54.4%, P=0.013. In multivariate analysis, the PLI was not an independent prognostic factor contrary to age, sex, type of resection, pT and pN. CONCLUSION: The pleura play a major role in NSCLC dissemination. Its involvement affects pN, the type of surgical resection and justifies the use of neoadjuvant treatment.
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Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias Pulmonares/patología , Pleura/patología , Adulto , Factores de Edad , Anciano , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Supervivencia sin Enfermedad , Femenino , Humanos , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Factores Sexuales , Carga TumoralRESUMEN
INTRODUCTION: Intrapleural rupture of pulmonary hydatid cyst (PHC) is a rare but dangerous complication. The purpose of this study was to report the characteristics of this form of thoracic hydatidosis and analyze the favoring factors. MATERIALS AND METHODS: Between 1996 and 2011, 75 patients were operated in our department for PHC ruptured in the pleura (PHCP). The characteristics of this group were compared with those of a control group of 300 patients randomly selected from patients operated during the same period for PHC. RESULTS: PHCP patients were younger than controls (23 years old vs. 27,56) (P=0.03) with male predominance (70% vs. 46%) (P=0.01). The PHCP were often located in the lower lobes (64% vs. 48%) (P=0.03). Anatomic resections were more used in control group (P=0.03) whereas decortication and pleurectomy were more frequently in PHCP (P=0.001). CONCLUSION: Young age, male sex, and basal locations of PHC promote their rupture in the pleura. Surgical treatment of these cysts requires less anatomic resections but more decortication and pleurectomy.
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Equinococosis Pulmonar/epidemiología , Enfermedades Pleurales/epidemiología , Adulto , Albendazol/uso terapéutico , Antihelmínticos/uso terapéutico , Estudios de Casos y Controles , Equinococosis Pulmonar/complicaciones , Equinococosis Pulmonar/diagnóstico por imagen , Equinococosis Pulmonar/terapia , Femenino , Humanos , Hidroneumotórax/complicaciones , Hidroneumotórax/diagnóstico por imagen , Hidroneumotórax/epidemiología , Hidroneumotórax/terapia , Masculino , Enfermedades Pleurales/diagnóstico por imagen , Enfermedades Pleurales/etiología , Enfermedades Pleurales/terapia , Neumonectomía/métodos , Radiografía , Rotura Espontánea , Adulto JovenRESUMEN
Four cases of nosocomial aspergillosis are described where the responsibility of pleural drainage is advocated. Infection was pulmonary once, pleural three times. Pleural suction had been long lasting with incomplete re-expansion of the lung and major air leaks. The hypothesis of the responsibility of pleural drainage in the advent of aspergillosis is reinforced by the revision of medical papers, which leads to the conviction that similar cases have been described yet, even though the mechanism of the contamination had not been understood. Prevention needs to limitate the lasting of the suction, especially if there are major air leaks. Cure needs total re-expansion of the lung and suppression of any pleural cavity, even if a thoracoplasty is needed. An anti-fungal therapy is not always needed.