Showing papers by "Emna Braham published in 2016"

Malignant glomus tumor of trachea: a case report with literature review.

Abstract: Glomus tumors of the trachea are extremely rare and generally benign, with very few cases of malignant transformation reported in literature. We present the case of a 74-year-old man explored for cough and dyspnea. Bronchoscopy showed a polypoid mass arising from the posterolateral tracheal wall. Computed tomography demonstrated a mid-tracheal tissular mass obliterating the tracheal lumen. Resection and anastomosis of the trachea were performed. The histological and immunohistochemical findings were consistent with malignant glomus tumor.

The inter-connection between fibrosis and microvascular remodeling in idiopathic pulmonary fibrosis: Reality or just a phenomenon.

Abstract: Background Idiopathic pulmonary fibrosis is the most frequent interstitial disease with the worst prognosis. It is characterized by an uncontrolled fibrosis which is difficult to manage. The pathogenesis of this disease remains unclear with many theories resulting in multiple target therapies. The relation between fibrosis and vascular remodeling has been debated in the literature with different results that may seem contradictory.

Eosinophilic lung disease

Abstract: Introduction: Eosinophilic lung diseases are a rare group of heterogeneous diseases characterized by the increase of the eosinophil ratio in airways and lung parenchyma. Objective: To describe clinical, radiological and laboratory finding in Eosinophilic lung diseases. Methods: The clinical-radiological findings, treatments performed, treatment responses, and prognoses of patients diagnosed with eosinophilic lung disease via bronchoalveolar lavage (BAL) between 2005 and 2015 were retrospectively evaluated. Results: Ten cases were diagnosed (8 women, 2 men). The mean age was 47 years (23-56). The main clinical manifestations were dyspnea and cough. Fever was found in 4 cases. Peripheral eosinophilia and total IgE elevation were present during the admission of all cases. The mean eosinophil ratio in BAL was 42% (35-62%). Asthma was present at diagnosis in all cases. Extra-pulmonary manifestations were rhinosinusitis (n=2), skin lesion (n=1) and cardiac involvement (n=1). In CT scans, all patients had bilateral involvement. The most common radiological pictures were ground-glass opacity, nodular lesions, and consolidation. Proximal bronchectasis was found in two cases. Etiologic diagnosis were chronic eosinophilic pneumonia (n=7), allergic broncho-pulmonary aspergilosis (n=2) and eosinophilic granulomatosis with polyangiitis (EGPA) (n=1). Prednisolone treatment was started for all cases associated with Cyclophosphamide in patient with EGPA. The outcome was favorable in eight patients. One patient developed corticodependant asthma. The patient with EGPA was dead for severe cardiomyopathy. Conclusion: Clinical pictures in pulmonary eosinophilia syndromes are on a wide spectrum, a specific diagnosis is important to predict treatment response and prognosis.

About thymic carcinomas: challenges in diagnosis and management.

Abstract: BackgroundThymic carcinomas are rare tumors with a challenging diagnosis. Our aim was to report our 17-year experience of these tumors and to highlight the challenges encountered and the main differential diagnoses ruled out.MethodsWe studied 12 (92%) men and 1 (7.7%) woman with a mean age of 37 years (range 15–60 years). All patients were symptomatic, with chest pain representing the most frequent symptom. Radiology revealed anterior mediastinal masses in all cases, with either infiltration of the adjacent organs or pulmonary parenchymal metastases.ResultsThe diagnosis was made on surgical biopsies in 12 cases and a lymph node biopsy in one. Microscopic examination revealed squamous carcinoma in 3 cases, synovial sarcoma in 1, mucinous adenocarcinoma in 1, undifferentiated carcinoma in 2, clear cell carcinoma in 1, lymphoepithelioma-like carcinoma in 2, atypical carcinoid tumor in 2, and sarcomatoid carcinoma in 1. Total surgical resection was possible in one patient after neoadjuvant chemotherapy and ra...

Diagnostic value of the bronchoalveolar lavage in interstitial lung disease.

Abstract: Background The bronchoalveolar lavage (BAL) cellular analysis is an invasive method of exploration of the lung. Its diagnostic value in interstitial lung disease (ILD) is integrated to a multi-disciplianry approach implicating clinicians, radiologists and pathologists. Aim We targeted to evaluate the diagnostic value of the BAL. Methods We reported a retrospective study about patients hospitalized for an ILD since the 1st January 2011 to the 31th December 2013. Thirty three patients were admitted in the Department of Pulmonology and the BAL analyses were studied in the Department of Pathology of the same hospital. The different cell patterns were compared to the final diagnostics. Results our study contained 4 non specific interstitial pneumonia (NSIP), 10 usual interstitial pneumoniae (UIP), 4 organizing pneumoniae (COP), 8 sarcoidosis, 2 hypersensitivity pneumonitis, 3 infectious pneumonitis, 1 lymphoma and a pulmonary adenocarcinoma. We considered positive results those that were compatible with the final diagnosis. The profile lavage was typical in 1 NSIP, 3 UIP, 3 COP, 1 hypersensitivity pneumonitis, 6 sarcoidosis, 3 infectious pneumonitis and 1 adenocarcinoma. Among the 17 cases with an atypical profile lavage, radiological features were diagnostic in 10 cases. This finding highlights the fact that 7 cases/ 33 presented simultaneously an atypical profile lavage and non specific radiological findings Conclusion Our results put emphasis on the diagnostic value of BAL especially when it is integrated to a multi-disciplinary approach. Its value in the follow up, the evaluation of the activity of the disease and the prognosis is being more and more reported.

Clinicopathologic and prognostic factors of thymoma in Tunisia.

Abstract: Background although rare, thymomas are the most common tumors of the thymus in adults. They represent about 20% of all mediastinal tumors. Aim the aim of this study is to present clinicopathological features of thymomas in Tunisia and analyse the prognostic factors. Methods From 1993 to 2004, clinical data of 40 cases of thymomas were compiled retrospectively. Microscopic slides were reviewed and reclassified according to the WHO classification of thymic tumors 2004. Clinical staging adopted was Masaoka system. Analysis of survival was determined by Kaplan-Meier method and log-rank test was used to compare survival curves. These statistical analyses were performed by SPSS. Results they were 23 women and 17 males of ages ranging from 14 to 76 years (mean age 51 years). The distribution of histological WHO types was: 1 type A, 7 type AB, 6 type B1, 17 type B2, 6 type B3, 2 cases of micronodular thymoma with lymphoid stroma and 1 case of metaplastic thymoma. According to Masaoka stage, 10 patients were in stage I, 11 stage II, 9 stage IIIa, 4 stage IIIb, 5 stage Iva and 1 stage IVb. The average overall survival was 56 months. Univariate analyses showed that Masaoka stage, completeness surgical resection and age were prognostic factors whereas in multivariate analysis, age was the only prognostic factor. Neither myasthenia gravis nor histological WHO subtypes had effect in survival. Conclusion masaoka stage, completeness surgical resection and age are the prognostic factors predicting survival in our series.

Place de l’examen anatomopathologique dans le diagnostic de la dysplasie fibreuse costale

Abstract: Resume Problematique La dysplasie fibreuse des os est une lesion benigne rare ou l’os normal est remplace par un tissu pseudo-fibreux renfermant une osteogenese immature. La localisation costale est rare. Elle peut etre monostotique ou polyostotique. Le diagnostic est suspecte sur des elements cliniques et radiologiques. But du travail Face aux progres techniques en imagerie, on s’est interroge sur le role de l’examen anatomopathologique et ce a travers l’experience de notre service. Methodes Nous decrivons une etude retrospective a propos de 12 dysplasies fibreuses costales diagnostiquees sur une periode de 17 ans (1996–2013). Les dossiers des patients ont ete retires des services de chirurgie thoracique du meme hopital. Resultats La dysplasie fibreuse costale etait observee de facon presque egale dans les deux sexes avec une predominance pour la 3 e et 4 e decade de la vie. La symptomatologie fonctionnelle etait marquee par les douleurs thoraciques. L’examen etait sans particularite dans la majorite des cas. Le diagnostic a ete suspecte dans 33 % des cas. L’examen anatomopathologique a permis d’etablir le diagnostic dans tous les cas et a ete delicat dans un cas necessitant une concertation pluridisciplinaire. Les difficultes diagnostiques etaient imputees aux artefacts de decalcification. Conclusion La dysplasie fibreuse costale est une lesion benigne dont le diagnostic de certitude est anatomopathologique. Les moyens d’imagerie montrent des signes non specifiques mais orientent vers la benignite. L’evolution est generalement favorable bien que des transformations malignes exceptionnelles aient ete rapportees.