Showing papers by "Emna Braham published in 2017"

Synchronous mantle cell lymph node lymphoma and pulmonary adenocarcinoma: a case report with literature review

Abstract: Background and Aims Coexistence of mantle cell lymphoma and lung adenocarcinoma is extremely rare. The aim of this study is to present the first case of incidental discovery of primary lung adenocarcinoma associated to lymph node mantle cell lymphoma. Methods A 45 year-old man, admitted for inguinal mass appeared since three months. Physical examination showed a 1 cm axillary and 3 cm inguinal adenopathies which were hard and fixed. A biopsy of inguinal mass revealed mantle cell lymphoma. Assessment of disease extension found a right superior lobe tumor with mediastinal lymphadenopathies. Fibreoptic bronchoscopy was normal. A fine needle biopsy of lung tumor was performed to determinate the nature of the pulmonary lesion. Histopathological findings were consistent with primary poor differentiated pulmonary adenocarcinoma with TTF-1 expression. A first mediastinoscopy was realized to verify mediastinal lymphadenopathies; frozen section showed a mantle cell lymphoma. A right lobectomy was then performed confirming the diagnosis of lung adenocarcinoma. Then, the patient was treated for the mantle cell lymphoma by 6 cures of alternating RCHOP and RDHAP (dexamethasone, high-dose Ara-Cytarabine and cisplatin) regimens followed by autologous stem cell transplantation. Results The patient died because of treatment complications 3 years after diagnosis. Conclusion Progresses are necessary to understand the pathogenesis of of synchronous occurrence of both diseases.

[The 2015 classification of lung adenocarcinomas: Reproducibility in a Tunisian department specialised in thoracic pathology].

Abstract: Resume Introduction La nouvelle classification des cancers du poumon a apporte de reelles modifications sur la terminologie et la subdivision de ces tumeurs ; les modifications les plus importantes ayant porte sur les adenocarcinomes. Ces derniers sont en augmentation croissante et representent desormais le type histologique le plus frequent. Notre objectif etait d’etudier la reproductibilite de cette classification a travers l’experience d’un service de pathologie specialise en pathologie thoracique. Materiel et methodes Une lecture des 106 cas a ete realisee par deux pathologistes ayant une experience d’environ 5 ans en pathologie pulmonaire. Les 2 pathologistes ont note pour chaque cas le sous-type histologique d’adenocarcinome pulmonaire selon la nouvelle classification. Par ailleurs, tous les cas ont ete relus par un pathologiste referent. Le meme nombre de lames/cas ont ete relues par les pathologistes individuellement sans aucune limite de temps. Les sous-types retenus par le pathologiste referent ont ete consideres comme etant la reference. L’etude statistique a ete realisee a l’aide du logiciel SPSS pour evaluer la concordance inter observateurs. Le coefficient Kappa a ete calcule. Un deuxieme coefficient a ete utilise, le coefficient Rho de Spearman qui calcule le degre de concordance entre deux observateurs en tenant compte de l’accord du au hasard. Resultats Parmi les 106 cas etudies, 5 cas ont ete exclus par le lecteur referent car ils correspondaient a des carcinomes epidermoides. Pour les autres cas, une concordance totale pour l’identification du sous-type histologique etait notee dans 82 cas (81,2 %), une discordance etait notee dans 19 cas (18,8 %). Le degre d’accord etait bon avec un indice Kappa de 0,743 et Rho de 0,763. Conclusion Notre etude met l’accent sur la bonne reproductibilite de la nouvelle classification dans une equipe experimentee en pathologie thoracique. Cependant, afin d’ameliorer cette reproductibilite a plus large echelle, une formation des differents residents est necessaire afin de maintenir la fiabilite d’une telle classification et son apport pronostique.

[Acquired hypogammaglobulinemia associated with thymoma: Good syndrome].

Abstract: Good syndrome (GS) is defined as the association between thymoma and immune deficiency. It is often complicated by broncho-pulmonary bacterial infections and rhinosinusitis. This disease accounts for only 5% of all parathymic syndromes. These recurrent respiratory infections can cause bronchiectasis associated with Good syndrome. We report the case of a 52-year old woman hospitalized for non resolutive infectious pneumonitis. Chest CT scan showed bronchiectasis associated with thymoma confirmed by biopsy. The discovery of hypogammaglobulinemia allowed the diagnosis of Good syndrome.

The diagnostic importance of the bronchoalveolar lavage in lymphocytic alveolitis.

Abstract: Multidisciplinary concertation is mandatory in order to assess interstitial pneumonias. The study of the bronchoalveolar lavage helps evoking a diagnosis according to the lavage profile. In lymphocytic alveolitis, immunocytochemistry, or in flux cytometry are necessary in order to identify the different clusters of lymphocytes implicated. Our objective was to evaluate the profile of 31 lymphocytic alveolitis using 2 different techniques which are the immunocytochemistry and the in flow cytometry in order to evaluate the efficacy of each technique and to compare the different results to the final diagnoses. We describe a retrospective study about 31 patients admitted to our hospital in order to explore an interstitial pneumonia between January and July 2014. Bronchial endoscopy and bronchoalveolar lavage were performed in all cases. The sensitivity of the in flow cytometry was estimated to 53% and its specificity reached 33%. On the other hand, the immunocytochemistry presented a specificity of 42.8% and a sensitivity of 42.8%. The final diagnoses retained consisted in sarcoidosis in 12 cases, infectious pneumonia in 10 cases, hypersensitivity pneumonia in 3 cases, cryptogenic pneumonia in 3 cases, idiopathic fibrosis in 2 cases, and adenocarcinoma in 1 case. The relevance of both techniques depends on many factors. They necessitate an available material, well-trained technicians, and experimented pathologists.

[Which technique should be used in the phenotyping of lymphocytic alveolitis: Immunocytochemistry or flow cytometry].

Abstract: Resume Introduction Les pneumopathies interstitielles diffuses sont considerees comme un groupe d’affections multiples diverses et de diagnostic difficile vu la non-specificite des signes cliniques. Les moyens d’imagerie orientent dans la plupart des cas vers le diagnostic, cependant, le lavage bronchoalveolaire garde toute son importance dans les cas peu specifiques. Notre objectif est de comparer l’immunocytochimie et la cytometrie en flux dans le phenotypage des alveolites lymphocytaires. Materiel et methodes Nous avons collige 32 cas d’alveolites lymphocytaires diagnostiquees et prises en charge au service d’anatomie pathologique pour l’analyse cytologique du LBA et le marquage immunocytochimique et dans le departement d’hematologie (unite de cytometrie en flux) pour le phenotypage par cytometrie en flux. Resultats Nous avons mis en evidence une bonne reproductibilite entre l’immunocytochimie sur etalements et sur cytoblocs ( kappa = 0,7) tandis que l’immunocytochimie et la cytometrie en flux semblaient peu comparables ( kappa = 0,35). Conclusion Notre etude met l’accent sur la mauvaise reproductibilite entre l’immunocytochimie et la cytometrie en flux. Nous projetons de nous referer aux diagnostics cliniques retenus afin d’asseoir les resultats discordants entre les 2 techniques et de mettre en evidence leur fiabilite et justesse.