[Management of pulmonary masses by guided transthoracic fine needle biopsy under computed tomography. Contribution from the Pathology and Radiology Departments of the Percy Military Hospital (Clamart, France) over 10 years]

Examining 260 samples of pulmonary nodules obtained by percutaneous biopsy under tomodensitometric control from the departments of radiology and pathology over 10 years, the authors note the advantages and disadvantages of this technique, provide the results of their experience and emphasise the importance of these biopsies in malignant pathology. The results of this series can be superposed with those found in the literature. Malignant tumours account for 75 % of the cases, with a clear prevalence of primitive adenocarcinoma. Benign pathology (approximately, 14 % of the cases) was represented by necrosis without any specificity, fibrous reaction and infectious causes. The act had to be repeated for the false negatives (7 %).

[Primary pleural lymphoma: a late complication of pleural decortication for tuberculosis: two cases in western countries]

Pleural lymphomas after a long standing pyothorax due to pleuropulmonary tuberculosis are now well identified, but rarely observed in Europe. We report two new cases in a non-immunocompromised patients. The two cases occurred 5455 years following artificial pneumothorax for pulmonary tuberculosis. The patients presented with a localized pleural tumor mass. Histology revealed high-grade lymphomas, diffuse large B-cell lymphoma and anaplastic lymphoma. Serology for Epstein-Barr virus was positive. Pleural lymphomas are an established complication of artificial pneumothorax. Epstein-Barr virus is known to play a crucial role in the pathogenesis, but despite the large number of artificial pneumothorax operations, these lymphomas remain rare, suggesting additional oncogenic factors.

[Cutaneous blastomycosis revealing intravascular B-cell lymphoma: a case in Morocco]

Blastomycosis is a systemic fungal infection caused by a thermally dimorphic fungus, Blastomyces dermatitidis. The incidence in immunocompromised patients has increased in the last two decades. A 55-year-old man consulted for inflammatory nodules on the forearm. Biopsy of one nodules showed a pseudoepitheliomatous hyperplastic epidermis overlaying a dense agranulomatous inflammatory infiltrate containing free-formed ovoid bodies enclosing giant macrophageous cells. These findings were consistent with blastomycosis. After a month of treatment cutaneous lesions regressed partially but the patient's general status continued to deteriorate with the appearance of an edematous-ascitic syndrome and icterus. Laboratory blood testing demonstrated cholestasia and abdominal ultrasound showed hepatosplenomegaly. Needle liver biopsy revealed giant B-cell lymphomatous infiltration of the hepatic ducts. The patient's condition worsened rapidly and he died five months after diagnosis despite four rounds of chemotherapy. Blastomycosis is rare in Morocco. Primary infection is usually a pneumonic process. Isolated cutaneous infection is possible but uncommon. To our knowledge the association of blastomycosis and intravascular lymphoma has not been previously reported. In immunocompromised patients, clinical findings can be alarming and the outcome can be rapidly fatal.

[Ganglioneuroma of the zygoma]

INTRODUCTION

Ganglioneuroma is an uncommon benign tumor that arises from the sympathetic nervous system accounting for less than 1% of all soft-tissue neoplasms.

CASE REPORT

We report the case of a 22 year-old man who presented a ganglioneuroma localized in the zygoma.

DISCUSSION

Ganglioneuroma generally develop in the abdomen or thorax soft tissue. The occurrence of ganglioneuroma in the bone is exceptional. To date less than ten cases have been reported, six of which involved the mandible. We discuss the possible causes of tumor development at this site.

[Large ossifying fibroma of the jaws and hyperparathyroidism in a chronic hemodialyzed patient]

OBJECTIVE

Describe the exceptional and fortuitous character of the association of ossifying fibroma and hyperparathyroidism in a chronic hemodialyzed patient.

CASE REPORT

A twenty-year-old man who had undergone dialysis for ten years as the result of an indeterminate nephropathy was admitted for a functional disability in the standing position and a serious dysmorphic syndrome with swelling of the jaws that hindered proper closure of the mouth.

RESULTS

Medical imagery revealed a polyostotic attack pleading in favor of renal osteodystrophy or a fibrous dysplasia. The surgical reduction of the tumor of the jaws shown, from the histological viewpoint, a large aggressive ossifying fibroma of the jaws.

CONCLUSION

The association of ossifying fibroma and hyperparathyroidism in a chronic hemodialyzed patient is exceptional and fortuitous. The difficult treatment points out the need for early rigorous prevention of hyperparathyroidism in a chronic hemodialyzed patient.

[Benign granular cell anal tumor]

INTRODUCTION

Granular cell tumors (GCT) are rarely located in the perianal area.

OBSERVATION

Over the past 3 years, a 56 year-old man presented a papule of the right margin of the anus that had progressively increased in size (1.5 cm). Cell proliferation was located in the dermis and strongly expressed the S100 protein. It was covered by a pseudo-epitheliomatous hyperplasia of the overlying epidermis. Forty months after local surgical excision, there was no sign of recurrence.

COMMENTS

Granular cell tumors are rare and usually benign. When cutaneous or mucosal, the pseudo-epitheliomatous hyperplasia of the overlying epithelium may, on superficial samples, be mistakenly diagnosed as squamous cell carcinomas. Malignant GCT may, histologically, appear identical to a benign GCT and only the appearance of metastases (generally after local recurrence) permits the subsequent diagnosis of malignancy.

[Nodular fasciitis or pseudosarcoma]

Nodular fasciitis is a benign neoplastic and reactive proliferation of fibroblasts of soft tissues, which is often mistaken for a sarcoma because of its rapid growth, rich cellularity and mitotic activity. A case is reported that provides the opportunity to discuss the specific clinical and pathological features of nodular fasciitis.

[Infectious crystalline keratopathy: a case report]

We report a case of perforated infectious crystalline keratopathy in a 88-year-old woman. Corneal surgery like keratoplasty and topical corticosteroids are the main causative factors present in the rare reported cases. Clinically, the anterior layers of cornea exhibit slowly progressive stellate infiltrates. "Viridans streptococci" are the most common micro-organisms involved but their culture for identification is difficult. As compared to cultures, histologic examination is more sensitive for diagnosis, by showing clusters of bacteria in the corneal stroma with no inflammatory response.