Mediastinal Mature Teratomas Penetrating the Chest Wall

Mediastinal mature teratomas (MMT) are benign and slow-growing tumors in the anterior mediastinum, which can reach a huge size. Surgical resection is often challenging, however, with proper surgical planning, complete resection is feasible with good outcomes. we report a rare case of MMT penetrating the chest wall as a result of chronic inflammation successfully treated with en bloc surgical resection.

Risk Factors for Sever Forms of COVID-19 - A Second Level Moroccan Hospital Experience

The new coronavirus (2019-nCoV) has caused the death of more than 1.68 million patients worldwide, including 6,909 deaths registered in Morocco until 12/20/2020. The main objective of this study is to investigate epidemiological, clinical, and paraclinical factors predicting progression to the severity in order to identify patients at risk and adopt strategies for individualized management.We conduct this observational, descriptive, and analytical study from 01/09/2020 to 25/12/2020, at AL FARABI regional hospital in Oujda. 567 patients were eligible for our study out of 2000 patients who were admitted since our first case on April 2020. Our sample was divided into two groups based on pulse oxygen saturation on admission. We identified 294 as a Severe/Critical case and 273 as a Mild/Moderate form on admission. The mean age was significantly higher in the severe group (63.28 ± 12.4 vs 55.13 ± 17.2). The sex ratio M/F was 0.87. Compared with non-severe cases, severe cases exhibited more comorbidities, including diabetes (60.4% vs 39.6%; P 0.003), and hypertension (63.6% vs 26.4%; P 0.002). Several biological parameters were associated with disease severity in univariate analysis, the most important being lymphopenia, elevated C-reactive protein, and ferritin levels. lymphopenia (OR 3.76; 95% CI, 4.25-9.23), elevated C-reactive protein (OR, 5.7; 95% CI, 3.84-8.48) ferritin levels (OR, 3.6; 95% CI, 1.64-7.89) were significantly associated with severe cases of COVID-19. Mortality is 2.9% for all of our patients; it increases to 4.5% if we consider severe cases only. Identification and evaluation of epidemiological, clinical, and paraclinical parameters are important to identify patients at high risk of SARS-COV2 severity to guide treatment.

Lung Carcinoid Tumors and Paraneoplastic Cushing's Syndrome: Diagnostic and Therapeutic Difficulties - A Case Report

Introduction. - Paraneoplastic Cushing's syndrome is a rare cause of endogenous hypercorticism. It is caused by ectopic secretion of ACTH by a non-pituitary endocrine tumor. The aetiological biological and radiological data are often inconclusive, which creates a problem of differential diagnosis with Cushing's disease. In addition, these tumors are often small and their location is extremely variable. As a result, the difficulties of localization require the use of specific imaging techniques.Observation. - We report the observation of a 44-year-old man suffering from diabetes and high blood pressure, presenting a severe and rapidly progressive Cushing syndrome, in connection with a hypercorticism caused by an ectopic ACTH secretion. The thoracic computed tomography performed within the framework of a search for a neoplastic origin objectified a 15 mm nodule isolated at the level of the middle lobe, the scintigraphy with octreotide marked with indium-111 found a significant fixation at the level of the lung nodule. The patient had a middle lobe lobectomy. The outcome was favorable with regression of Cushing's syndrome. Pathological examination was in favor of a typical carcinoid tumor, and the immunohistochemical complement showed tumor cell positivity for ACTH, CD56, chromogranin, and synaptophysin.Conclusion. - This observation illustrates the dilemma between the need to locate an ectopic ACTH secretion and the control of aggressive and threatening Cushing's syndrome. Early use of the octreotide scintigraphy should be considered if a topographic diagnosis of the causative tumor cannot be done through conventional imaging techniques.

Rare Case of Primary Posterior Mediastinal Hydatid Cyst with False Aortic Aneurysm

Hydatid cystic disease caused by the parasite Echinococcus granulosus is one of the major health problems in underdeveloped countries. Mediastinal localization is very rare. We report a rare case of hydatid disease in the posterior mediastinum with an enormous aorta defect. The patient underwent vascular graft placement without shunting or bypass.

Solitary fibrous tumor of the pleura with Doege-Potter syndrome.

Solitary fibrous tumor of pleura (SFTP) is a rare tumor. Complete tumor resection is the curative treatment and the key to preventing recurrence. We present here the case of a 65-year-old female diagnosed with a Doege-Potter syndrome who underwent resection of pleural solitary fibrous tumor.

The Endobronchial Inflammatory Myofibroblastic Tumor

The inflammatory myofibroblastic tumor is a rare tumor described in the literature as a type of inflammatory pseudotumor. It mainly has a pulmonary location but can appear at endobronchial or mediastinal sites on rarely. While it is a benign tumor, it can sometimes be unpredictable due to its invasive characteristic as well as its resurgence after complete excision. We report the case of a patient presenting hemoptysis. The bronchoscopy revealed a bud in the left upper lobe bronchus, and the biopsy pointed to a myofibroblastic tumor. In one month, interval, the bud extended to the left main bronchus, hence the indication of a left pneumonectomy, performed by posterolateral thoracotomy. The study of the operative specimen confirmed the biopsy diagnosis. The particularity of our case is the endobronchial presentation and the fast evolution of this inflammatory myofibroblastic tumor, which requires a pneumonectomy.

Endobronchial Metastasis of Colorectal Carcinoma

Background: Endobronchial metastasis is an infrequent secondary location of an extra thoracic cancer. Colorectal cancer is one of the most affected primary tumours. Case presentation: We report the clinical case of a patient who has had endobronchial metastasis of a adenocarcinoma of the colon, confirmed by mass biopsy. Surgical treatment was indicated after chemotherapy cures. The patient is currently asymptomatic 33 months after treatment. Conclusion: Endobronchial metastasis is a rare entity, occurring after years of primary disease progression. Surgery allows for prolonged survival and disease control.

« Neglected » Endothoracic Goitres : The Point of View of Thoracic Surgeon

Introduction : Neglected endothoracic goiter is an endothoracic mediastinal portion that was neglected during the surgical removal of a plunging cervical goiter in contrast to autonomous ectopic mediastinal goiter which has its own mediastinal vascularization without connection between the two components and but who was not diagnosed during the cervical thyroidectomy. The aim of this work is to report the point of view of thoracic surgeon to avoid "forgetting" this endothoracic component.Materiel and methods : This is a retrospective study involving four patients, all operated for an endothoracic goiter only by thoracotomy.Results : Among four patients, it was 3 women and one men with an average age of 46 years. All Four cases have already been operated for cervical goiter by cervicotomy alone. Also, for all patients, the discovery was accidental. the cervicothoracic scan found a posterior mediastinal heterogeneous mass, with calcification lesions in 2 patients, and necrosis zone in 2 patients. The four patients were operated by posterolateral thoracotomy. Operative outcome was simple in all patients except 2 cases of wound infection.Conclusion : Neglected endothoracic goiter poses a diagnostic and also a therapeutic problem because its a difficult surgery due to the adhesions already formed following a first cervical thyroid surgery and therefore it is essential not to miss the diagnosis of any diving goiter.

Spontaneous Bilateral Idiopathic Hemothorax

The spontaneous hemothorax is defined by the presence of blood in the pleural cavity, outside any traumatic context. Idiopathic spontaneous hemothorax is an extremely rare form of spontaneous hemothorax, in which there is no apparent cause that justifies bleeding.We report the case of a young patient, treated in our department, for a spontaneous bilateral idiopathic hemothorax.

Survie et facteurs pronostiques des patients opérés pour cancer broncho-pulmonaire envahissant la paroi thoracique à l’hôpital Ibn Sina de Rabat (Maroc)

Les cancers broncho-pulmonaires non à petite cellule (CBNPC) envahissant la paroi thoracique sont des cancers opérables au prix d’un sacrifice pariétal. Leur survie est estimée à 15 % à 5 ans dans la littérature. Les facteurs de mauvais pronostic notamment de récidive ont été diversement étudiés dans la littérature. L’objectif de notre travail est de décrire la survie globale et la survie sans récidive des patients opérés dans notre service pour cancer broncho-pulmonaire non à petites cellules envahissant la paroi thoracique (plèvre pariétale et paroi osseuse) et d’évaluer les facteurs pronostiques. Matériel et méthodes : Nous avons procédé à une étude rétrospective sur une série de cas de cancer broncho-pulmonaire envahissant la paroi thoracique opérée dans notre service entre 2010 et 2014. Nous avons analysé la survie globale et sans récidive selon la méthode de Kaplan-Meier selon plusieurs paramètres. Résultats : vingt neuf patients ont été opérés, tous étaient de sexe masculin, avec une moyenne d’âge de 57 ans. Le principal signe clinique retrouvé était la douleur thoracique. L’atteinte osseuse était retrouvée chez 7 patients 22 patients présentaient un envahissement de la plèvre pariétale seule. La résection a été en monobloc emportant le parenchyme pulmonaire et la paroi chez 23 patients. Les résections parenchymateuses étaient dominées par la lobectomie effectuée chez 23 patients (79,31%). Six patients ont été perdus de vue au cours du suivi. La survie globale des patients est en moyenne de 34 +/- 4,9 mois et la survie sans récidive est de 24 mois+/-5,53 mois chez 9 patients qui n’ont pas présenté de récidive (39,1%). Nous avons analysé la survie globale en fonction de l’atteinte osseuse, de la résection en monobloc et l’association à un traitement périopératoire.Le test de khi 2 était respectivement de p =0,659 ; p=0,194 ; p=,402. La survie sans récidive a été analysé selon les memes paramètres avec p = 0,197 ; p=0,055 ; p= 0,036 . Conclusion :Les CBNPC envahissant la paroi thoracique ne sont pas des limites à la résection chirurgicale. Outre le stade où un envahissement ganglionnaire médiastinal est confirmé, l association à un traitement adjuvant périopératoire semble avoir un impact sur l’amélioration de la survie et sur la survenue de la récidive.