Connaître les principaux déficits humoraux primitifs. Connaître les différentes atteintes parenchymateuses et médiastinales pouvant être rencontrées chez des patients présentant un DIHP. Connaître les mécanismes physiopathologiques des lésions. Définir les rôles de l’imagerie médicale dans le diagnostic initial, le suivi et la prise en charge multidisciplinaire des patients. Les modifications chroniques et les infections récurrentes du système respiratoire sont la première cause de morbimortalité. L’imagerie médicale, principalement le scanner, joue un rôle crucial dans le diagnostic initial, le suivi et la prise en charge des patients. Les atteintes bronchiques (bronchiectasies) secondaires à des infections récurrentes sont les modifications pulmonaires les plus fréquentes et précoces et représentent un virage dans la maladie. L’apparition d’une granulomatose est un marqueur de mauvais pronostic. la recherche d’une anomalie thymique est nécessaire à la recherche d’un thymome (syndrome de Good) de mauvais pronostic.

Les biopsies guidées par l’imagerie prennent un rôle majeur dans la stratégie diagnostique et thérapeutique, mais leurs résultats restent conditionnés par une bonne technique. Ce travail illustre l’importance du choix de l’aiguille de biopsie. Nous avons revu les biopsies réalisées au cours des 15 dernières années en notant le site, le type et la taille des lésions, le modèle et le calibre d’aiguille utilisés, les résultats de l’analyse histologique, et la survenue de complications éventuelles. Les aiguilles coaxiales à guillotine permettent d’effectuer la plupart des biopsies thoraciques et abdomino-pelviennes. Elle autorisent également la biopsie de certaines lésions osseuses lytiques. Pour les autres, un trocart spécifique de biopsie osseuse est nécessaire. Dans tous les cas, le calibre de l’aiguille est adapté à la nature des structures traversées et aux besoins de l’anatomo-pathologiste. Le choix raisonné de l’aiguille permet d’augmenter la rentabilité diagnostique et de réduire le risque de complications des procédures de biopsie guidées par l’imagerie.

Les tumeurs primitives de la côte représentent environ 5 % des tumeurs osseuses. Nous rapportons un cas exceptionnel de pseudotumeur costale par hyperplasie hématopoïétique focale (HHF). Une femme de 36 ans consulte pour des dysesthésies de l'hémicorps gauche, spontanément résolutives en cours de bilan. Une radiographie de thorax systématique révèle une lésion de l'arc antérieur de la 3e côte gauche, soufflant l'os. Au scanner, elle est de densité osseuse, avec amincissement cortical, sans réaction périostée. Macroscopiquement, la masse osseuse de 10x7x7 cm est constituée d'un tissu brun hémorragique. À l'histologie, des travées osseuses grêles et irrégulières entourent une moelle hématopoïétique très hyperplasique, voisinant avec des zones de moelle adipeuse. L'hyperplasie hématopoïétique est harmonieuse, touchant les 3 lignées, sans troubles de la maturation ou anomalies morphologiques. Le bilan hématologique est normal. Depuis sa 1re description en 1984, 4 cas d'HHF de la côte ont été rapportés chez des patients âgés de 24 à 71 ans, sur l'arc antérieur ou postérieur des 3e, 6e et 10e côtes. Toutes étaient asymptomatiques et de découverte fortuite. L'étiopathogénie de cette pseudo-tumeur hématopoïétique, jamais décrite en dehors de la côte, reste indéterminée. Les diagnostics différentiels radiologiques sont la dysplasie fibreuse, le kyste anévrysmal, le chondrosarcome et le plasmocytome. Conclusion. L'HHF est une lésion costale solitaire pseudotumorale rarissime, asymptomatique, ressemblant histologiquement à une « grosse moelle », sans maladie hématologique associée.

BACKGROUND:Determination of tumor clonality has implications for molecular characterization and the optimal treatment of cancer. Allelotyping allows detection of the two alleles, maternal and paternal, and provides additional information regarding clonal genetic defects. The presence of allelic imbalances (AI) in tumors is a general event, but is not necessary at the same allele (alternative AI). The authors' goal was to determine whether the presence of alternative AI (AA) was a marker of heterogeneity and prognosis. METHODS:To further analyze the heterogeneity of lung tumors, tumor DNA released in the plasma was compared with primary tumor DNA from 24 lung carcinoma patients. The comparison was performed by allelotyping using 12 microsatellites targeting 9 chromosomal regions, taking in each case leukocyte DNA as reference. To extend and confirm these observations, 26 primary colorectal carcinomas with paired synchronous liver metastasis were analyzed using an enlarged panel of 33 microsatellites. RESULTS:AA were observed in 40% (20 of 50) of all patients, in 25% (6 of 24) of lung carcinoma patients but at a higher level, and in 54% (14 of 26) of colorectal carcinoma patients. They affected different chromosome localizations and each tumor stage. In both types of cancer, patients with AA had a higher AI mean frequency in their primary tumor. CONCLUSIONS:Detection of AA is an original marker of heterogeneous tumors, demonstrating that independent events occurred on specific genetic sites required for cancer progression.

The majority of lung cancer patients have tumor‐derived genetic alterations in circulating plasma DNA that could be exploited as a diagnostic tool. We used fluorescent microsatellite analysis to detect alterations in plasma and tumor DNA in 34 patients who underwent bronchoscopy for lung cancer, including 11 small cell lung cancer (SCLC) and 23 nonsmall cell lung cancer (NSCLC) (12 adenocarcinomas, 11 squamous cell carcinomas) and 20 controls. Allelotyping was performed with a selected panel of 12 microsatellites from 9 chromosomal regions 3p21, 3p24, 5q, 9p, 9q, 13q, 17p, 17q and 20q. Plasma DNA allelic imbalance (AI) was found in 88% (30 of 34 patients), with a similar sensitivity in SCLC and NSCLC. In the 24 paired available tumor tissues, 83% (20 of 24) presented at least 1 AI. Among these patients, 85% (17 of 20) presented also at least 1 AI in paired plasma DNA, but the location of the allelic alterations in paired plasma and tumor DNA could differ, suggesting the presence of heterogeneous tumor clones. None of the 20 controls displayed plasma or bronchial DNA alteration. A reduced panel of six markers (at 3p, 5q, 9p, 9q) showed a sensitivity of 85%. Moreover, a different panel of microsatellites at 3p and 17p13 in SCLC and at 5q, 9p, 9q and 20q in NSCLC patients could be specifically used. Analysis of plasma DNA using this targeted panel could be a valuable noninvasive test and a useful tool to monitor disease progression without assessing the tumor. © 2003 Wiley‐Liss, Inc.

Fibroblast growth factors (FGF), hepatocyte growth factor (HGF) and their receptors, FGFR and c-Met, are essential components of the regulatory networks between the epithelium and mesenchyme in embryonic lung, but their respective roles in tumour growth are not clear. We performed allelotyping at loci containing the candidate genes FGFR-1-2-3-4, FGF-1-2-7-10, c-Met and HGF in 36 non-small cell lung cancer (NSCLC) (20 squamous-cell carcinomas (SQC) and 16 adenocarcinomas (ADC)), by surrounding each locus with two microsatellites (MS), as close as possible to the genes of interest. Unexpectedly, SQC and ADC were frequently altered at all of these loci, and SQC showed more simultaneously altered loci. In ADC, alterations at the 15q13-22 locus (FGF7 candidate gene) were significantly more frequent. Thus, these loci showed different patterns of molecular alterations between SQC and ADC. Finally, alterations at loci containing FGFR and HGF candidate genes were inversely correlated to the lymph node status in SQC and ADC, respectively.

Prenatal DiagnosisVolume 23, Issue 12 p. 1021-1023 Letter to the Editor Mosaic trisomy 13 on chorionic villi in a fetus with body wall complex: fortuitous association or pathogenic hypothesis? Bérénice Doray, Corresponding Author Bérénice Doray Laboratoire de Cytogénétique, Hôpital de Hautepierre, Strasbourg, FranceLaboratoire de Cytogénétique, Hôpital de Hautepierre, Strasbourg, FranceSearch for more papers by this authorBrigitte Viville, Brigitte Viville Fédération de Gynécologie-Obstétrique, Hôpital de Hautepierre, Strasbourg, FranceSearch for more papers by this authorYasmina Touret, Yasmina Touret Fédération de Gynécologie-Obstétrique, Hôpital de Hautepierre, Strasbourg, FranceSearch for more papers by this authorBernard Gasser, Bernard Gasser Service d'Anatomie Pathologique, Hôpital Civil, Strasbourg, FranceSearch for more papers by this authorBrigitte Samama, Brigitte Samama Institut d'Histologie, Faculté de Médecine, Strasbourg, FranceSearch for more papers by this authorNelly Boehm, Nelly Boehm Institut d'Histologie, Faculté de Médecine, Strasbourg, FranceSearch for more papers by this authorFrançoise Girard-Lemaire, Françoise Girard-Lemaire Laboratoire de Cytogénétique, Hôpital de Hautepierre, Strasbourg, FranceSearch for more papers by this authorCaroline Schluth, Caroline Schluth Laboratoire de Cytogénétique, Hôpital de Hautepierre, Strasbourg, FranceSearch for more papers by this authorElisabeth Flori, Elisabeth Flori Laboratoire de Cytogénétique, Hôpital de Hautepierre, Strasbourg, FranceSearch for more papers by this author Bérénice Doray, Corresponding Author Bérénice Doray Laboratoire de Cytogénétique, Hôpital de Hautepierre, Strasbourg, FranceLaboratoire de Cytogénétique, Hôpital de Hautepierre, Strasbourg, FranceSearch for more papers by this authorBrigitte Viville, Brigitte Viville Fédération de Gynécologie-Obstétrique, Hôpital de Hautepierre, Strasbourg, FranceSearch for more papers by this authorYasmina Touret, Yasmina Touret Fédération de Gynécologie-Obstétrique, Hôpital de Hautepierre, Strasbourg, FranceSearch for more papers by this authorBernard Gasser, Bernard Gasser Service d'Anatomie Pathologique, Hôpital Civil, Strasbourg, FranceSearch for more papers by this authorBrigitte Samama, Brigitte Samama Institut d'Histologie, Faculté de Médecine, Strasbourg, FranceSearch for more papers by this authorNelly Boehm, Nelly Boehm Institut d'Histologie, Faculté de Médecine, Strasbourg, FranceSearch for more papers by this authorFrançoise Girard-Lemaire, Françoise Girard-Lemaire Laboratoire de Cytogénétique, Hôpital de Hautepierre, Strasbourg, FranceSearch for more papers by this authorCaroline Schluth, Caroline Schluth Laboratoire de Cytogénétique, Hôpital de Hautepierre, Strasbourg, FranceSearch for more papers by this authorElisabeth Flori, Elisabeth Flori Laboratoire de Cytogénétique, Hôpital de Hautepierre, Strasbourg, FranceSearch for more papers by this author First published: 02 December 2003 https://doi.org/10.1002/pd.730Citations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES Bamforth JS. 1992. Amniotic band sequence: Streeter's hypothesis reexamined. Am J Med Genet 44: 280–287. Crane JP, Cheung SW. 1988. An embryogenic model to explain cytogenetic inconsistencies observed in chorionic villus versus fetal tissue. Prenat Diagn 8: 119–129. Hartwig NG, Vermeij-Keers CHR, De Vries HE, Kagie M, Kragt H. 1989. Limb body wall malformation complex. Hum Pathol 20: 1071–1077. Herva R, Karkinen-Jääskeläinen M. 1984. Amniotic adhesion malformation syndrome: fetal and placental pathology. Teratology 29: 11–19. Higginbottom MC, Jones KL, Hall BD, Smith DW. 1979. The amniotic band disruption complex: timing of amniotic rupture and variable spectra of consequent defects. J Pediatr 95: 544–549. Johnson A, Wapner RJ, Davis GH, Jackson LG. 1990. Mosaicism in chorionic villus sampling: an association with poor perinatal outcome. Obstet Gynecol 75: 573–577. Kalousek DK, Barrett IJ, McGillivray BC. 1989. Placental mosaicism and intrauterine survival of trisomies 13 and 18. Am J Hum Genet 44: 338–343. Kalousek DK, Dill FJ. 1983. Chromosome mosaicism confined to the placenta in human conceptions. Science 221: 665–667. Kalousek DK, Dill FJ, Pantzar T, McGillivray BC, Li Yong S, Wilson RD. 1987. Hum Genet 77: 163–167. Kalousek DK, Howard-Peebles PN, Olson SB, et al. 1991. Confirmation of CVS mosaicism in term placentae and high frequency of intrauterine growth retardation association with confined placental mosaicism. Prenat Diagn 11: 743–750. Kalousek DK, Vekemans M. 1996. Confined placental mosaicism. J Med Genet 33: 529–533. Miller ME, Graham JM, Higginbottom MC, Smith DW. 1981. Compression-related defects from early amnion rupture: evidence for mechanical teratogenesis. J Pediatr 98: 292–297. Roland B, Lynch L, Berkowitz G, Zinberg R. 1994. Confined placental mosaicism in CVS and pregnancy outcome. Prenat Diagn 14: 589–593. Russo R, D'Armiento M, Angrisani P, Vecchione R. 1993. Limb Body Wall complex: a critical review and a nosological proposal. Am J Med Genet 47: 893–900. Seeds JW, Cefalo RC, Herbert WNP. 1982. Amniotic band syndrome. Am J Obstet Gynecol 144: 243–248. Streeter GL. 1930. Focal deficiencies in fetal tissues and their relation to intra-uterine amputations. Contrib Embryol Carnegie Inst 22: 1–44. Torpin R. 1965. Amniochorioninc mesoblastic fibrous strings and amniotic bands. Am J Obstet Gynecol 91: 65–75. Van Allen MI, Curry C, Gallagher L. 1987. Limb body wall complex: I. Pathogenesis. Am J Med Genet 28: 529–548. Wang BB, Rubin CH, Williams J. 1993. Mosaicism in chorionic villus sampling: an analysis of incidence and chromosomes involved in 2612 consecutive cases. Prenat Diagn 13: 179–190. Citing Literature Volume23, Issue1215 December 2003Pages 1021-1023 ReferencesRelatedInformation

The 49,XXXXY syndrome is a rare sex chromosome anomaly with an approximate incidence of 1 in 85,000 male live births. The diagnosis is usually ascertained postnatally by the association of mental retardation, variable growth deficiency, Down syndrome-like facial dysmorphy, hypogenitalism and other malformations, especially involving the heart and skeleton. Prenatal diagnosis of the pentasomy 49,XXXXY is generally fortuitous and sonographic features have rarely been described in the literature. We report here on two cases of 49,XXXXY syndrome diagnosed prenatally because of sonographic abnormalities. In the first, amniocentesis was performed at 26 weeks' gestation for polyhydramnios, unilateral clubfoot and micropenis. In the second, a karyotype was carried out on chorionic villi at 13 weeks' gestation for cystic hygroma. These observations and the six previously reported cases demonstrate that cystic hygroma in first or second trimester of pregnancy may be associated with sex chromosome aneuploidy other than Turner syndrome. Moreover, they emphasize the importance of detailed sonographic examination in the second trimester, as small penis and abnormal posturing of the lower extremities are very suggestive of the 49,XXXXY syndrome.

The first prenatal diagnosis of Pallister‐Killian syndrome (PKS) was reported by Gilgenkrantz et al . in 1985 . Since this report, about 60 prenatal cases have been reported but both sonographic and cytogenetic diagnoses remain difficult. Although ultrasound anomalies such as congenital diaphragmatic hernia, polyhydramnios and rhizomelic micromelia in association with fetal overgrowth are very suggestive of the syndrome, they are inconstant and they may even be absent. The mosaic distribution of the supernumerary isochromosome 12p greatly increases these difficulties. No prenatal cytogenetic technique is sensitive enough to ensure prenatal diagnosis and false‐negative results have been described on fetal blood, chorionic villi and amniocentesis. We report here two prenatal cases of PKS which illustrate the great variability of the fetal phenotype. In reviewing the 63 reported cases, we attempt to determine ultrasound indicators of the syndrome and to define a cytogenetic strategy. In cases where ultrasound indicators are present, our proposal is first to perform chorionic villus or placental sampling and then amniocentesis when the first cytogenetic result is normal. Fetal blood sampling is the least indicated method because of the low frequency of the isochromosome in lymphocytes. In this cytogenetic strategy, fluorescent in situ hybridization (FISH) and especially interphase FISH on non‐cultured cells increases the probability or identifying the isochromosome. A misdiagnosis remains possible when ultrasound is not contributory; the identification of new discriminating ultrasound indicators would be very helpful in this context. Copyright © 2002 John Wiley & Sons, Ltd.

Objective: This retrospective study evaluates probability of survival and mode of recurrence in patients with a microscopically positive bronchial resection margin following resection for primary bronchogenic carcinoma, as well as influence of radiotherapy on survival. Methods: From January 1986 to July 1997, 40 patients had a microscopically positive bronchial resection margin following a macroscopically complete resection (17 lobectomies, three bilobectomies, four sleeve-lobectomies, and 16 pneumonectomies). Tissue diagnosis was squamous cell carcinoma in 32 patients, adenocarcinoma in four, adenosquamous carcinoma in two and neuroendocrine carcinoma in two. Lymph node status was N0 in 14 patients, N1 in 10, and N2 in 16. The bronchial margin contained carcinoma in situ in 20 patients, invasive mucosal carcinoma in five, and peribronchial infiltration in 15. All patients except the three most recent underwent adjuvant radiation therapy. Results: At the conclusion of the study (January 31st, 1999), 30 patients had died: two with post-operative complications, 17 with progressive disease, ten without relation to cancer, and one under undefined circumstances. Six of 10 unrelated deaths were interpreted as respiratory complications of radiotherapy. Recurrent disease appeared in 24 patients (60%). Nineteen had progression of initial disease (47.5%): metastatic spread in 12 (30%), isolated local recurrence in four (10%), and combined local recurrence and metastases in three (7.5%). Five patients developed metachronous cancer, with bronchial location in four (10%) and laryngeal in one (2.5%). 5-year survival (Kaplan-Meier) in 20 patients with carcinoma in situ was 38.7 +/- 13.7% (median 31 months), but rose to 55.0 +/- 16.6% when excluding seven deaths not related to cancer (five of whom were secondary to radiotherapy) (chi(2) = 3.080; P = 0.0792). Survival in 13 patients classified NO was 51.3 +/- 16.3% (median 61 months), and 71.1 +/- 18.0% following exclusion of unrelated deaths (chi(2) = 3.939; P = 0.0472). Adverse prognosis of peribronchial infiltration was correlated to a positive N status (13 N2 and 2 N1), 5-year survival being 20.0 +/- 10.3% (median: 18 months). Conclusions: Prognosis of peribronchial infiltration is similar to N2 disease. In situ carcinoma does not influence survival per se. Local control of disease is probably in part due to radiotherapy. However, the high prevalence of unrelated late deaths suggests an adverse impact of radiotherapy on survival. (C) 2000 Elsevier Science B.V. All rights reserved.

Crohn’s disease can be associated with several respiratory manifestations. We report here a case of pulmonary migratory infiltrates associated with bilateral pleural thickening and peripheral eosinophilia. The histopathological findings show an association of necrotizing nodules, eosinophilic infiltration in the non-abscessed lung tissue, areas of non-caseating epithelioid granulomas, and an extensive pleural fibrosis. The different histopathological findings are detailed and the responsibility of either Crohn’s disease or treatment by mesalazine is discussed.

Pathologic processes that may involve the chest wall include congenital and developmental anomalies, inflammatory and infectious diseases, and soft-tissue and bone tumors, Many of these processes have characteristic radiologic appearances that allow definitive diagnosis, Sternal deformities can be visualized at radiography and their severity quantified with computed tomography (CT), In cervical rib, CT with multiplanar reconstruction may demonstrate relevant anatomic detail and the relationship between bone deformity and arterial compression, In Poland syndrome, radiography reveals an area of hyperlucency on the affected side, whereas CT demonstrates the absence of the greater pectoral muscle and clearly depicts associated musculoskeletal anomalies, Tuberculosis typically manifests at radiography and CT as osseous and cartilaginous destruction and soft-tissue masses with calcification and rim enhancement, Aspergillosis involving the chest wall manifests as pulmonary consolidations and permeative osteolytic changes of the rib and spine at CT and as an area of increased signal intensity at T2-weighted magnetic resonance (MR) imaging, Neurogenic tumors and hemangiomas also typically have high signal intensity at T2-weighted MR imaging, Apparent mass extension or unequivocal bone destruction seen at CT or MR imaging may indicate chest wall involvement by lymphoma, Radiologically, soft-tissue sarcomas typically appear as areas of soft-tissue density or attenuation, often associated with necrotic areas of low density or attenuation. At radiography, plasmacytoma typically manifests as well-defined, "punched-out" lytic lesions with associated extrapleural soft-tissue masses. Chondrosarcoma frequently appears as a large, lobulated excrescent mass arising from a rib with scattered flocculent calcifications characteristic of its cartilaginous mix, Familiarity with these radiologic features facilitates accurate diagnosis and optimal patient treatment.

Background: This study was designed to determine whether bronchoplastic resection could be an alternative to pneumonectomy in patients with operable primary lung cancer. Methods: From 1980 to 1996, 63 patients (59 males and four females; mean age 62 +/- 7 years) underwent a bronchoplastic lobectomy for non-small cell lung cancer, indicated because of a disabled respiratory function in 34 patients, and performed electively in 29 patients. There were 38 right upper lobectomies, four bilobectomies, one middle lobectomy combined with lower lobe apical segmentectomy, ten left upper and ten left lower lobectomies. The bronchoplasty was a full sleeve in 24 patients, and a bronchial wedge resection in 39. Results: A single patient died post-operatively (1.6%). Specific procedure-related complications are summarized as follows: six anastomotic complications managed conservatively (9.5%), 15 space problems (23.8%), nine sputum retentions (14.2%). Pathologic staging classified 30 patients in stage I, 21 patients in stage II, and 12 in stage IIIA. Estimated 5-year survival was 69.7 +/- 9.8% in stage I, 37.1 +/- 12.1% in stage II, and 8.3 +/- 8.0% in stage IIIA. Fourteen patients (22.2%) developed locoregional recurrence. Three of them died with local recurrence alone, whereas 10 developed metastatic progression; a single patient is alive following completion pneumonectomy. According to stage, three recurrences occurred in stage I (10%), six in stage IT (28%), and five in stage IIIA (38%). Actuarial freedom from local recurrence was significantly higher after elective procedures (P = 0.019); there was a trend towards improved outcome following right-sided procedures (P = 0.079) and following wedge bronchoplasty (P = 0.055). Five patients experienced a second primary cancer (7.9%), which was resected in four. Conclusion: Bronchoplastic resections achieve local control and long-term survival comparable to standard resections in patients with stage I or II disease, and may be considered as a valuable alternative to pneumonectomy. (C) 1999 Elsevier Science B.V. All rights reserved.

Le carcino-sarcome bronchopulmonaire est une tumeur maligne rare qui associe un contingent de cellules carcinomateuses et un contingent de cellules sarcomateuses. Nous présentons un cas de carcino-sarcome bronchopulmonaire chez un homme de 62 ans. Cette observation illustre bien quelques aspects particuliers de cette tumeur de pronostic sombre dont l'histogenèse reste encore non élucidée. Le carcino-sarcome bronchopulmonaire est une tumeur dont la présentation clinique et radiologique est commune aux autres tumeurs bronchopulmonaires. Sur le plan histogénétique, l'hypothèse d'une cellules totipotente à l'origine d'une tumeur «mixte semble être privilégiée par la plupart des auteurs. Si neuf carcino-sarcomes bronchopulmonaires sur dix sont opérables, leur pronostic est néanmoins moins bon que celui des autres cancers bronchopulmonaires, avec une médiane de survie de 6 mois. Bronchopulmonary carcinosarcoma is an uncommon neoplasm consisting of mixed malignant epithelial and mesenchymal cells. We report a case of bronchopulmonary carcinosarcoma in a 62-year-old man illustrating some characteristics of this tumor of poor prognosis and unknown histogenesis. Bronchopulmonary carcinosarcoma has clinical and X rays features identical to those of bronchopulmonary epithelial malignant tumors. Most of the authors consider that a totipotential cell might be at the origin of this “mixed” tumor. Althoug 90% of bronchopulmonary carcinosarcomas are resectable, their prognosis is worse than that of other lung cancers, with a 6-month median survival.

Laser energy is able to ablate, coagulate, and vaporize tissues. Its transmissibility in thin optical fibers makes it an ideal tool for use in percutaneous procedures. This article describes two applications in interventional musculoskeletal radiology. In percutaneous laser disc decompression the laser source is used to vaporize a small portion of the nucleus pulposus. In interstitial laser photocoagulation of osteoid osteoma the laser energy is used to coagulate and destroy the tumor by direct heating.

INTRODUCTION:Bronchopulmonary carcinosarcoma is an uncommon neoplasm consisting of mixed malignant epithelial and mesenchymal cells.EXEGESIS:We report a case of bronchopulmonary carcinosarcoma in a 62-year-old man illustrating some characteristics of this tumor of poor prognosis and unknown histogenesis.CONCLUSION:Bronchopulmonary carcinosarcoma has clinical and X rays features identical to those of bronchopulmonary epithelial malignant tumors. Most of the authors consider that a totipotential cell might be at the origin of this "mixed" tumor. Although 90% of bronchopulmonary carcinosarcomas are resectable, their prognosis is worse than that of other lung cancers, with a 6-month median survival.

Apres une serie d'experimentation animale (photocoagulation osseuse), 15 patients (8 a 48 ans) atteints d'osteome osteoide ont ete traites par photocoagulation. La localisation la plus frequente etait la tete femorale. Sous neuroleptanalgesie et/ou anesthesie generale, une aiguille de 18 Gauge permettant le passage d'une fibre optique de 400 μ est introduite dans le nidus sous controle scanographique. Dans 3 cas, la perforation corticale a necessite l'utilisation d'une chignole. Un laser portable a diode etait utilise. 400 a 100 joules d'energie sont delivres au nidus selon sa taille. Dans tous les cas, la douleur retrocede dans les 48 heures. Apres 3 a 6 semaines, les douleurs ont repris dans deux cas (lesion de plus de 10 mm). Un des patients a ete repris avec un bon resultat. La duree de suivi maximum etait de 40 mois (moyenne 16 mois). Une sclerose osseuse est observee 6 a 12 mois apres le traitement. Une algodystrophie est survenue apres le traitement d'un osteome osteoide du poignet. La photocoagulation au laser de l'osteome osteoide est une technique peu invasive sans fragilisation osseuse et les resultats obtenus semblent tres encourageants.