The development of testicular germ cell tumors may be marked by a rare phenomenon: the growing te... more The development of testicular germ cell tumors may be marked by a rare phenomenon: the growing teratoma syndrome. It consists of residual masses, usually retroperitoneal and, more rarely, thoracic, that appear during or after chemotherapy, although the tumor markers are normalized. We report a case of posterior mediastinal localization. This mediastinal localization is very rare, and because of the proximity to intercostal arteries, induces a risk of postoperative paraplegia.
Surgical resection of pulmonary aspergilloma is associated with symptoms control, complications p... more Surgical resection of pulmonary aspergilloma is associated with symptoms control, complications prevention, and improved survival, given that the disease is localized and the patient fit enough to undergo surgery. In these operable forms, the impact of perioperative antifungal therapy remains controversial. The purpose of this study was to analyze the impact of antifungal therapy on postoperative morbidity and overall survival in patients with operable pulmonary aspergilloma. The clinical records of 113 patients who underwent thoracic surgery for aspergilloma in our institution from January 1989 to December 2010 were retrospectively reviewed. Of these, 64 patients received antifungal therapy in the perioperative period and were included in group 1, and 49 patients did not receive antifungal therapy and were included in group 2. Postoperative complication rates were 31.2% in group 1 and 20.4% in group 2 (P = 0.30). Univariable analysis showed that immunocompromised status (P < 0.0...
The clinical presentations of diaphragm dysfunctions vary according to etiologies and unilateral ... more The clinical presentations of diaphragm dysfunctions vary according to etiologies and unilateral or bilateral diseases. Elevation of the hemidiaphragm from peripheral origins, the most frequent situation, requires a surgical treatment only in case of major functional impact. Complete morphological and functional analyses of the neuromuscular chain and respiratory tests allow the best selection of patients to be operated. The surgical procedure may be proposed only when the diaphragm dysfunction is permanent and irreversible. Diaphragm plication for eventration through a short lateral thoracotomy, or sometimes by videothoracoscopy, is the only procedure for retensioning the hemidiaphragm. This leads to a decompression of intrathoracic organs and a repositioning of abdominal organs without effect on the hemidiaphragm active contraction. Morbidity and mortality rates after diaphragm plication are very low, more due to the patient's general condition than to surgery itself. Function...
Peripheral neuroectodermal tumors constitute a large spectrum of small round cell tumors among wh... more Peripheral neuroectodermal tumors constitute a large spectrum of small round cell tumors among which Ewing's sarcoma is the most undifferentiated type. They are rare tumors which often concern young people and generally occur in bone tissue. Their metastatic potential is high, generally early, and rarely after five years. We report the case of a 45-year-old woman who presented a mediastinal metastasis eight years after the primitive tumor of tibia. The diagnosis was made on small core biopsies obtained by CT punction, and was based on morphologic analysis, immunohistochemistry, and confirmed by molecular biology. The presence of metastasis is the main prognostic factor. Despite therapeutic progress, the global survival rate of metastatic patients is still poor.
ABSTRACT I traumi toracici, patologia relativamente frequente e spesso grave, si definiscono come... more ABSTRACT I traumi toracici, patologia relativamente frequente e spesso grave, si definiscono come delle lesioni che interessano la parete e/o il contenuto viscerale del torace. Aperti o chiusi, i traumi gravi del torace possono alterare allo stesso tempo la funzione circolatoria e la funzione respiratoria. Il drenaggio pleurico resta il gesto iniziale e fondamentale della gestione di questi traumi, di cui riassume spesso il trattamento. Le indicazioni al trattamento chirurgico sono variabili, basate su alcuni elementi clinici, radiologici ed ecografici, e, soprattutto, sono in funzione dell’evoluzione clinica di questi pazienti. I feriti la cui emodinamica è instabile devono, in linea generale, beneficiare di un accesso chirurgico in urgenza senza un complemento di indagini. Nei feriti stabili, il bilancio si basa su una radiografia del torace, su un’ecografia, sul drenaggio pleurico e sulla TC del torace. Un accesso chirurgico precoce è indicato in presenza di un emotorace iniziale abbondante e/o persistente, di lesioni importanti della parete toracica e di una lesione tracheobronchiale e in caso di sospetto di ferita cardiaca o dei tronchi sovraortici e di una lesione diaframmatica o dell’esofago. Può anche essere indicato secondariamente, davanti a un emotorace mal drenato, a una comparsa di bolle persistente e a un piotorace, o per la rimozione di un corpo estraneo. L’avvento, da una quindicina di anni, della videochirurgia, così come delle tecniche endovascolari, ha modificato un po’ le indicazioni e le modalità di gestione di questi traumi.
The diffuse large B-cell lymphomas of the mediastinum were long considered to be a variant of the... more The diffuse large B-cell lymphomas of the mediastinum were long considered to be a variant of the classic forms of large B-cell lymphomas. However, their clinical and radiological features and especially their histopathological variants point to other lymphoid tumours such as Hodgkin&#39;s disease or anaplastic lymphomas, thymic tumours, germ cell tumours or metastatic tumors. The immunohistochemical findings are of prime importance in the diagnosis. This has recently been completed by molecular studies. Currently, they represent a distinct entity among the large B-cell lymphomas, due to their clinical, pathological and molecular features as well as the outcome. The authors report a new case in a young man.
Among non-small cell lung cancers (NSCLC), large cell carcinoma (LCC) is credited of significant ... more Among non-small cell lung cancers (NSCLC), large cell carcinoma (LCC) is credited of significant adverse prognosis. Its neuroendocrine subtype has even a poorer diagnosis, with long-term survival similar to small cell lung cancer (SCLC). Our purpose was to review the surgical characteristics of those tumors. The clinical records of patients who underwent surgery for lung cancer in two French centers from 1980 to 2009 were retrospectively reviewed. We more particularly focused on patients with LCC or with high grade neuroendocrine lung tumors. High grade neuroendocrine tumors were classified as pure large cell neuroendocrine carcinoma (pure LCNEC), NSCLC combined with LCNEC (combined LCNEC), and SCLC combined with LCNEC (combined SCLC). There were 470 LCC and 155 high grade neuroendocrine lung tumors, with no difference concerning gender, mean age, smoking habits. There were significantly more exploratory thoracotomies in LCC, and more frequent postoperative complications in high grade neuroendocrine lung tumors. Pathologic TNM and 5-year survival rates were similar, with 5-year ranging from 34.3% to 37.6% for high grade neuroendocrine lung tumors and LCC, respectively. Induction and adjuvant therapy were not associated with an improved prognosis. The subgroups of LCNEC (pure NE, combined NE) and combined SCLC behaved similarly, except visceral pleura invasion, which proved more frequent in combined NE and less frequent in combined SCLC. Survival analysis showed a trend toward a lower 5-year survival in case of combined SCLC. Therefore, LCC, LCNEC and combined SCLC share the same poor prognosis, but surgical resection is associated with long-term survival in about one third of patients.
The development of testicular germ cell tumors may be marked by a rare phenomenon: the growing te... more The development of testicular germ cell tumors may be marked by a rare phenomenon: the growing teratoma syndrome. It consists of residual masses, usually retroperitoneal and, more rarely, thoracic, that appear during or after chemotherapy, although the tumor markers are normalized. We report a case of posterior mediastinal localization. This mediastinal localization is very rare, and because of the proximity to intercostal arteries, induces a risk of postoperative paraplegia.
Surgical resection of pulmonary aspergilloma is associated with symptoms control, complications p... more Surgical resection of pulmonary aspergilloma is associated with symptoms control, complications prevention, and improved survival, given that the disease is localized and the patient fit enough to undergo surgery. In these operable forms, the impact of perioperative antifungal therapy remains controversial. The purpose of this study was to analyze the impact of antifungal therapy on postoperative morbidity and overall survival in patients with operable pulmonary aspergilloma. The clinical records of 113 patients who underwent thoracic surgery for aspergilloma in our institution from January 1989 to December 2010 were retrospectively reviewed. Of these, 64 patients received antifungal therapy in the perioperative period and were included in group 1, and 49 patients did not receive antifungal therapy and were included in group 2. Postoperative complication rates were 31.2% in group 1 and 20.4% in group 2 (P = 0.30). Univariable analysis showed that immunocompromised status (P < 0.0...
The clinical presentations of diaphragm dysfunctions vary according to etiologies and unilateral ... more The clinical presentations of diaphragm dysfunctions vary according to etiologies and unilateral or bilateral diseases. Elevation of the hemidiaphragm from peripheral origins, the most frequent situation, requires a surgical treatment only in case of major functional impact. Complete morphological and functional analyses of the neuromuscular chain and respiratory tests allow the best selection of patients to be operated. The surgical procedure may be proposed only when the diaphragm dysfunction is permanent and irreversible. Diaphragm plication for eventration through a short lateral thoracotomy, or sometimes by videothoracoscopy, is the only procedure for retensioning the hemidiaphragm. This leads to a decompression of intrathoracic organs and a repositioning of abdominal organs without effect on the hemidiaphragm active contraction. Morbidity and mortality rates after diaphragm plication are very low, more due to the patient's general condition than to surgery itself. Function...
Peripheral neuroectodermal tumors constitute a large spectrum of small round cell tumors among wh... more Peripheral neuroectodermal tumors constitute a large spectrum of small round cell tumors among which Ewing's sarcoma is the most undifferentiated type. They are rare tumors which often concern young people and generally occur in bone tissue. Their metastatic potential is high, generally early, and rarely after five years. We report the case of a 45-year-old woman who presented a mediastinal metastasis eight years after the primitive tumor of tibia. The diagnosis was made on small core biopsies obtained by CT punction, and was based on morphologic analysis, immunohistochemistry, and confirmed by molecular biology. The presence of metastasis is the main prognostic factor. Despite therapeutic progress, the global survival rate of metastatic patients is still poor.
ABSTRACT I traumi toracici, patologia relativamente frequente e spesso grave, si definiscono come... more ABSTRACT I traumi toracici, patologia relativamente frequente e spesso grave, si definiscono come delle lesioni che interessano la parete e/o il contenuto viscerale del torace. Aperti o chiusi, i traumi gravi del torace possono alterare allo stesso tempo la funzione circolatoria e la funzione respiratoria. Il drenaggio pleurico resta il gesto iniziale e fondamentale della gestione di questi traumi, di cui riassume spesso il trattamento. Le indicazioni al trattamento chirurgico sono variabili, basate su alcuni elementi clinici, radiologici ed ecografici, e, soprattutto, sono in funzione dell’evoluzione clinica di questi pazienti. I feriti la cui emodinamica è instabile devono, in linea generale, beneficiare di un accesso chirurgico in urgenza senza un complemento di indagini. Nei feriti stabili, il bilancio si basa su una radiografia del torace, su un’ecografia, sul drenaggio pleurico e sulla TC del torace. Un accesso chirurgico precoce è indicato in presenza di un emotorace iniziale abbondante e/o persistente, di lesioni importanti della parete toracica e di una lesione tracheobronchiale e in caso di sospetto di ferita cardiaca o dei tronchi sovraortici e di una lesione diaframmatica o dell’esofago. Può anche essere indicato secondariamente, davanti a un emotorace mal drenato, a una comparsa di bolle persistente e a un piotorace, o per la rimozione di un corpo estraneo. L’avvento, da una quindicina di anni, della videochirurgia, così come delle tecniche endovascolari, ha modificato un po’ le indicazioni e le modalità di gestione di questi traumi.
The diffuse large B-cell lymphomas of the mediastinum were long considered to be a variant of the... more The diffuse large B-cell lymphomas of the mediastinum were long considered to be a variant of the classic forms of large B-cell lymphomas. However, their clinical and radiological features and especially their histopathological variants point to other lymphoid tumours such as Hodgkin&#39;s disease or anaplastic lymphomas, thymic tumours, germ cell tumours or metastatic tumors. The immunohistochemical findings are of prime importance in the diagnosis. This has recently been completed by molecular studies. Currently, they represent a distinct entity among the large B-cell lymphomas, due to their clinical, pathological and molecular features as well as the outcome. The authors report a new case in a young man.
Among non-small cell lung cancers (NSCLC), large cell carcinoma (LCC) is credited of significant ... more Among non-small cell lung cancers (NSCLC), large cell carcinoma (LCC) is credited of significant adverse prognosis. Its neuroendocrine subtype has even a poorer diagnosis, with long-term survival similar to small cell lung cancer (SCLC). Our purpose was to review the surgical characteristics of those tumors. The clinical records of patients who underwent surgery for lung cancer in two French centers from 1980 to 2009 were retrospectively reviewed. We more particularly focused on patients with LCC or with high grade neuroendocrine lung tumors. High grade neuroendocrine tumors were classified as pure large cell neuroendocrine carcinoma (pure LCNEC), NSCLC combined with LCNEC (combined LCNEC), and SCLC combined with LCNEC (combined SCLC). There were 470 LCC and 155 high grade neuroendocrine lung tumors, with no difference concerning gender, mean age, smoking habits. There were significantly more exploratory thoracotomies in LCC, and more frequent postoperative complications in high grade neuroendocrine lung tumors. Pathologic TNM and 5-year survival rates were similar, with 5-year ranging from 34.3% to 37.6% for high grade neuroendocrine lung tumors and LCC, respectively. Induction and adjuvant therapy were not associated with an improved prognosis. The subgroups of LCNEC (pure NE, combined NE) and combined SCLC behaved similarly, except visceral pleura invasion, which proved more frequent in combined NE and less frequent in combined SCLC. Survival analysis showed a trend toward a lower 5-year survival in case of combined SCLC. Therefore, LCC, LCNEC and combined SCLC share the same poor prognosis, but surgical resection is associated with long-term survival in about one third of patients.
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