[The Proteus syndrome: a rare cause of pulmonary emphysema]

INTRODUCTION

The Proteus syndrome is a rare genetic disease which is characterized by the overgrowth of tissues, especially bone, connective and adipose tissue. This condition is related to a somatic mosaic activating mutation in the AKT1 oncogene.

CASE REPORT

We report the case of a 25-year-old man, diagnosed with the Proteus syndrome at the age of 6 months. He exhibited an asymmetric overgrowth of the extremities leading to bilateral amputation of the legs at the age of 10 years. He was hospitalized for acute respiratory failure due to a bronchopulmonary infection. Severe bullous pulmonary emphysema, predominantly on the left, with mediastinal deviation, was diagnosed. The patient recovered with antibiotics. An assessment 2 months later revealed mild hypoxaemia (PaO2=75 mmHg) and severe airflow limitation (FEV1=1260 mL [28% th.], FEV1/V C=69%) with hyperinflation (TLC=7840 mL [107% th.], RV=6010 mL [253% th.]).

CONCLUSION

The Proteus syndrome is a very rare cause of pulmonary emphysema. The pathophysiology of emphysema in this syndrome is unknown. It can be hypothesized that the development of pulmonary cysts leading to emphysema may share the same AKT1 activation pathway with lymphangioleiomyomatosis.

[Primary myxoid mediastinal liposarcoma]

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.

Thrombose in situ du moignon artériel pulmonaire après pneumonectomie

INTRODUCTION

Pulmonary artery stump thrombosis has been reported after pneumonectomy. The prevalence of risk factors for and outcome associated with this condition remain to be clearly evaluated.

CASE REPORT

We describe three cases of pulmonary artery stump thrombosis occurring after pneumonectomy. No pulmonary embolism was observed despite the absence of anticoagulation therapy. The prevalence of arterial stump thrombosis after pneumonectomy has been estimated as 12%. It is often detected by CT scanning performed systematically as part of the routine follow up of lung cancer. Thrombus was identified as a filling defect with concave or convex margins, located at the bottom of the stump.

DISCUSSION

Only one case of pulmonary embolism associated with pulmonary artery stump thrombosis has been described. The absence of complications associated with thrombus in this site suggests that anticoagulant therapy is not likely to be of benefit.

Présentation atypique d’adem

Acute Disseminated Encephalomyelitis is a serious demyelinating disorder of childhood that typically occurs following vaccination or a viral prodrome. Some etiologies remain unrecognized, and multiple mechanisms of immune response may explain the pathophysiology of this syndrome. Based on a report of two adult cases presenting with neurologic deficit and ataxia, we report our experience with this syndrome that may affect adults without evident infectious disorder. Prompt treatment is important to avoid rapid progression.

[Renal manifestations of Kimura disease. Apropos of a case]

A nephrotic syndrome with focal sclerosis associated with Kimura's disease is reported in a young asiatic man. The nephrotic syndrome started three years prior to the usual skin tumors and lymph nodes involvement. Epidemiological, clinical and nosological characteristics of Kimura's disease are discussed. Renal manifestations are the only visceral localisations of the disease. Thirteen Kimura's disease associated with documented nephrotic syndromes have been reported in german-english literature. They display a wide variety of histologic patterns. Their clinical course do not differ from the primary form of nephrotic syndrome with identical histology.

Clinical, mammographic, and sonographic determination of preoperative breast cancer size

Clinical, mammographic, and sonographic preoperative size measurements were correlated with the values obtained at pathologic examination in a series of 31 patients with pathologically T1 (n = 23) and T2 (n = 8) breast carcinomas. Sonographic measurements demonstrated the highest correlation coefficient (r = 0.84), with the lowest residual standard deviation calculated in relation to the regression line. As a result, real-time sonography yielded the most accurate determination of breast cancer size in this series. Sonographic tumor size determination has proved valuable when mammography failed to delineate the tumor, particularly in patients with dense breasts. It may also be recommended in the evaluation of tumor response to nonsurgical conservative treatment.

[Bilateral traumatic carotid-cavernous fistula treated using an inflatable and detachable balloon]

The authors report a case of traumatic bilateral carotid-cavernous fistula successfully treated by inflatable and detachable balloon.

[Enthesopathy of the upper insertion of the musculus rectus femoris. A retrospective sign of tendon rupture in sports pathology]

We report 4 cases of post-traumatic enthesopathy occurring later after rupture of rectus femoris tendon from the anterior superior iliac spine. Radiographic feature and clinical picture are typical of diagnosis.

[Synovial cysts of unusual localization. 2 cases and review of the literature]

Two patients with true synovial cysts in atypical sites (internal compartment of knee and inguinal hollow) were investigated by radioarthrography, ultrasound and computed tomography imaging. The cyst in the hip region originated from a dilated serous bursa of the iliopsoas muscle that did not communicate or was no longer in communication with the joint. In contrast, the cyst of the knee appeared to be a lateral synovial capsule hernia. Positive diagnosis in both cases was dependent on combined ultrasound-CT scan imaging, this eliminating a tumor (sarcoma) of soft tissues. However, affirmation of the synovial origin (mesothelial covering of the wall) of the lesion was obtained by histology only, this allowing differentiation from a "capsular" (fibrous wall) cyst, which probably provokes similar ultrasound and CT scan images.

[Rupture of an intracerebral dermoid cyst. Apropos of a case: x-ray computed tomographic aspects]

We report the C.T. findings of a dermoid cyst communicating with ventricular system and ruptured in the subarachnoid space. A fat-fluid level and calcifications were present on the plain skull X rays.

[Fungal mycotic aneurysms and multiple cerebral abscesses caused by Scedosporium apiospermum. Apropos of a case with review of the literature]

The authors report a case of intracranial fungal aneurysm and brain abscesses. The compromised host was a young drowned woman. Scedosporium Apiospermum was isolated in fungal culture from abscess. Radiological and clinical pictures are typical of the hyphal form.

[Spondylodiscitis after embolization of an extramedullary intraspinal arteriovenous fistula]

The authors report a case of spondylitis Th11-Th12 occurred 1 month after embolization of an intraspinal extramedullary arteriovenous fistulae; this fistulae was fed by 11th left intercostal artery. The infecting organism isolated from the affected intervertebral disc was streptococcus sanguis a common agent of dental abscess.

[Extramedullary arteriovenous fistula of the spinal canal with spinal cord venous drainage. Apropos of 2 cases]

The authors report two cases of extramedullary arteriovenous fistulas in the spinal canal with venous return into the spinal cord veins. Both patients were middle-aged men who presented with multiple nerve root involvement of the lower extremities for one year and three months respectively. Myelography demonstrated an indentation at the level of the conus medullaris by a dilated vein in both cases. Arteriography of the spinal cord demonstrated an arteriovenous malformation from the dura mater with venous return into the ascending spinal cord veins, located in both cases at T11. Unlike typical angiomas of the spinal cord, these arteriovenous fistulas do not arise from spinal cord arteries. Only the venous return is into the spinal cord system. Initial clinical manifestations are progressive and often misleading, with pseudoradicular pain of the lower extremities or intermittent claudication which was observed in both patients. Only good quality myelography enabled visualization of the dilated vein at the level of the conus medullaris which lead to localization of the arteriovenous malformation and its afferent arteries outside of the spinal cord itself. Treatment is either surgical, or neuroradiological (embolization). Similar results are obtained by both methods, in a condition which would otherwise progress to paraplegia.

[Subperiosteal (juxtacortical) chondroma of the hand. Apropos of 2 cases. Review of the literature]

Subperiosteal chondroma (juxta-cortical) is unusual benign cartilaginous neoplasm with characteristic radiographic features. We report two cases occurring in uncommon location: the hand. Radiologic differential diagnosis with others bone tumors is easy but it could be difficult with some soft-tissue tumors, especially chondrosarcoma and extraarticular chondromatosis.

[Craniopharyngioma with intraventricular development. Apropos of 2 cases. X-ray computed tomographic aspect]

We report two cases of craniopharyngioma developed within the third ventricle. In this occasion we present the different C. T. findings of these tumors.

[Dense intracerebral cholesteatoma in computed x-ray tomography. Apropos of a case]

The authors report a case of cholesteatoma which is uncommon on account of its dense appearance on the C.T. scan and its temporal localization.