Introduction. - This retrospective study was undertaken to evaluate late results of lung cancer surgery in octogenerians.Methods. - All patients 80 years old or more who underwent a lung resection for cancer from 2000 to 2010 at Lyon University Hospital were included. No patients were treated with video assisted surgery. Wedge resections were excluded.Results. - Sixty-three patients (42 men, 21 women) were operated. The median age was 82 years. Operative mortality was 4.7%. The rate of perioperative complications was 49%. The late survival was 34% at 5 years. Five-year survival by nodal involvement was NO, 36%; N1, 29%; N2 20%, P < 0.05. Patients with a squamous cell carcinoma (24) had a better long-term survival than patients with an adenocarcinoma (30), 33% and 25% respectively at 5 years, P < 0.05. The rate of recurrence was 33.9%.Conclusions. - Surgical treatment of lung cancer in selected population of octogenerians is associated with satisfactory early and long-term results. Survival is influenced by nodal involvement and by the pathologic type of the cancer. (C) 2015 Elsevier Masson SAS. All rights reserved.

OBJECTIVES:To describe the clinical features, treatment, and outcome of autoimmune diseases (AD) in a cohort of patients with thymoma. DESIGN:Pathological records from three university hospitals, between 2005 and 2011, were reviewed to identify patients with thymoma. Patients with thymoma and AD were compared with patients with thymoma without AD. RESULTS:47/85 (55%) cases of thymoma had AD, including myasthenia gravis (MG) (n=33), Hashimoto's thyroiditis (n=4), Isaac's syndrome (n=3), Morvan syndrome (n=2), pure red cell aplasia (n=2), systemic lupus (n=2), lichen planus (n=2), and one case of each following conditions: aplastic anemia, autoimmune hemolytic anemia, Good's syndrome, pemphigus, autoimmune hepatitis, Graves' disease, limbic encephalitis, and inflammatory myopathy. Six patients (7%) presented at least 2 ADs. The median duration of follow-up after surgery was 60 months (40-78 months). In 32 patients, the diagnosis of AD preceded the diagnosis of thymoma, in 9 patients, thymoma was diagnosed at the same time as the AD and 7 patients had been operated on when they developed an AD. We found a significative difference on the Masaoka stage between the MG patients and the patients who present another AD (p=0.028). No risk factor for developing an AD after thymectomy was identified. CONCLUSIONS:We describe here the long-term follow-up of a large series of AD related to thymoma. Our results confirm previous data concerning AD occurrence in patients with thymoma and suggest that preexisting autoimmunity is not a risk factor for developing autoimmune manifestations after thymectomy.

Les traitements par immunoglobulines (Ig) intraveineuses ou sous-cutanées sont utilisés dans un grand nombre de maladies. La tolérance en est habituellement bonne mais des effets indésirables sont décrits, incluant certains potentiellement graves, qui varient selon les préparations commerciales. Ainsi, des complications thrombotiques surviennent dans 0,6 à 13 % des cas et peuvent concerner les territoires artériels ou veineux, rarement les deux. Les thromboses veineuses profondes, plus ou moins associées à des embolies pulmonaires, les accidents vasculaires cérébraux et les infarctus du myocarde représentent les complications les plus décrites. Certains facteurs de risque ont été identifiés, principalement l'âge avancé, l'existence de multiples facteurs de risque cardiovasculaire et les antécédents thrombo-emboliques. Plusieurs mécanismes ont été suggérés pour expliquer ce risque de complications thrombotiques. En effet, les traitements par Ig, d'une part augmentent la viscosité du plasma et le nombre de plaquettes en les activant, et d'autre part peuvent déclencher la cascade de la coagulation en raison de la présence dans certaines préparations d'Ig de facteur XI activé. Elles peuvent également libérer des molécules vasoactives responsables de vasospasmes. L'identification des facteurs de risque doit être faite le plus précocement possible et une surveillance chez les patients concernés est recommandée. La place des antiagrégants plaquettaires ainsi que de l'anticoagulation n'a pas été évaluée mais ils devraient probablement être proposés aux patients à haut risque.Treatments with intravenous or subcutaneous immunoglobulin (Ig) are used in a broad variety of disorders. Tolerance of Ig is usually good but adverse events, including some serious ones, have been reported and may differ among different Ig preparations. Thrombotic complications occur in 0.6 to 13% of cases and can involve arterial or venous circulation, rarely both. Deep venous thrombosis with or without pulmonary embolism, stroke or myocardial infarction remained the most frequent thrombotic complications. Some risk factors have been identified, mainly old age, multiple cardiovascular risk factors, and past history of thrombo-embolic manifestations. Several mechanisms are suggested to explain this increased risk of thrombotic complications. Indeed, Ig treatments increase the plasma viscosity, increase and activate platelets, can trigger the coagulation cascade through the presence of activated factor XI in some Ig preparations, and release vasoactive molecules responsible for vasospasm. Patients have to be carefully monitored and risk factors to be identified as soon as possible. The role of antiplatelets or anticoagulation is not well determined but should probably be proposed to patients with high risk.

Purpose. - Superior sulcus non-small cell lung cancer represents less than 5% of all lung cancers and is a challenge for the physicians because of clinical presentation, treatments related toxicities and poor prognosis. The aim of this preliminary retrospective report is to present outcomes of patients affected by a superior sulcus non-small cell lung cancer, treated by high dose radiotherapy (> 60 Gy) with or withour chemotherapy.Patients and methods. - All adult inoperable or unresectable patients (>= 18 years) with a clinical and radiological diagnosis of superior sulcus non-small cell lung cancer treated in our department by radiotherapy with or without chemotherapy were retrospectively analysed. Primary endpoint was the local control. Overall survival, metastasis free survival and toxicity rates were also analysed and reported.Results. - From January 1999 to June 2009, 12 patients were treated by exclusive high-dose radiochemotherapy. Median age was 53 years (range: 33-64 years); mean follow-up time was 20 months (range: 2-75 months). Mean local control, overall survival and metastasis free survival were 20.2, 22 and 20 months, respectively. At the time of this analysis, seven patients died of cancer and three of them presented only a metastatic disease progression. One patient died of acute cardiac failure 36 months after the end of radiochemotherapy and was disease free. Treatment was well tolerated and any acute and/or late G3-4 toxicity was recorded (NCI-CTC v 3.0 score).Conclusion. - This analysis confirms the interest of exclusive high-dose radiochemotherapy in treating inoperable superior sulcus non-small cell lung cancer patients, in achieving good local control and overall survival rates. (c) 2012 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

Comparaison de trois techniques de délinéation des volumes d’irradiation de tumeur pulmonaire afin d’intégrer les mouvements d’organes.Dix-neuf patients, atteints d’une tumeur maligne pulmonaire classée T1-3N0M0 après la TEP réalisée avant la radiothérapie, ont été traités par l’association d’une radiothérapie et d’une chimiothérapie exclusive (14 cas) ou préopératoire (cinq cas). Les doses délivrées étaient respectivement, de 66 et 46 Gy. La scanographie a été faite en respiration libre, en inspiration bloquée non forcée et en expiration bloquée non forcée. Le volume tumoral macroscopique (GTV) a été délinéé sur chaque séquence après fusion des images entre elles. Trois dosimétries ont été effectuées sur trois préparations différentes. La dosimétrie classique a été effectuée à partir du volume tumoral macroscopique en respiration libre à partir duquel a été ajoutée une marge de 5 à 8 mm pour définir le volume-cible anatomoclinique (CTV) et une marge de 7 à 10 mm, intégrant le volume cible interne (ITV) et la marge de repositionnement (set-up margin), pour définir le volume-cible prévisionnel (PTV). Une deuxième, gating-like, a été calculée après avoir intégré le volume tumoral macroscopique en inspiration bloquée, plus la même marge pour le volume-cible anatomoclinique et une de 2 mm pour le volume-cible prévisionnel, correspondant à la marge de repositionnement. La troisième dosimétrie « trois volumes » a été faite à partir du volume tumoral macroscopique incluant les volumes tumoraux macroscopiques des trois séquences de scanographie. La marge entre le volume tumoral macroscopique et le volume-cible anatomoclinique était identique et celle entre les volumes cibles anatomoclinique et prévisonnel de 2 mm. La dosimétrie tentait pour chaque technique d’utiliser le même nombre de faisceaux et la même orientation. Des contraintes dosimétriques étaient imposées pour le volume tumoral et les organes à risque pour conclure à l’acceptabilité de la dosimétrie.Les volumes tumoraux macroscopiques délinéés sur les trois séquences n’étaient pas significativement différents. Le volume-cible prévisionnel obtenu avec la méthode gating-like était significativement plus petit que ceux obtenus avec les deux autres techniques. Les PTV95 % (volumes-cibles prévisionnels recevant 95 % de la dose prescrite) n’étaient pas statistiquement différente entre les trois techniques. Avec les techniques « trois volumes », gating-like et respiration libre, la dosimétrie a répondu à toutes les contraintes, respectivement dans 15, 18 et 15 cas. La comparaison de l’ensemble des valeurs des contraintes a montré que la méthode gating-like donnait les valeurs les meilleures. Dans le cas de traitement préopératoire, la méthode gating-like donnait aussi les meilleurs résultats, y compris pour les valeurs du PTV95 %. Cependant, en l’absence ou dans l’impossibilité d’utiliser le gating, la méthode des « trois volumes » permettait d’obtenir de meilleurs résultats que la méthode classique.La méthode « trois volumes » est intégrable dans la prise en charge des patients. Elle permet de bien appréhender le mouvement d’organe. Cependant la dosimétrie gating-like donne les meilleurs résultats, ce qui conduit à conseiller son usage, y compris dans le traitement préopératoire des tumeurs de l’apex pulmonaire.Comparison of three dosimetric techniques of lung tumor delineation to integrate tumor motion during breathing.Nineteen patients with T1-3N0M0 malignant lung tumor were treated with definitive chemoradiotherapy (14 cases) or pre-surgery chemoradiation. Doses were, respectively, 66 and 46 Gy. CT-scan for delineation was performed during three phases of breathing: free breathing and deep breath-hold inspiration and expiration. GTV (gross tumor volume) was delineated on the three sequences. The classic technique included GTV from the free-breathing sequence plus a CTV (clinical target volume) margin of 5 to 8 mm plus a PTV (planning target volume) margin of 7 to 10 mm (including ITV [internal target volume] margin and set-up margin). The gating-like technique included GTV from the deep breath-hold inspiration sequence plus a CTV margin of 5 to 8 mm plus a PTV margin of 2 mm. The three-volume technique, included GTV as a result of the fusion of GTVs from the three sequences plus a CTV margin of 5 to 8 mm plus a PTV margin of 2 mm. Dosimetry was calculated for the three PTVs, if possible, with the same fields number and position. Dose constraints and rules were imposed to accept dosimetries: firstly spinal cord maximal dose less than 45 Gy, followed by V95 % for PTV greater than or equal to 95 %, and V20 GYGy for lung less than or equal to 30 %, V30 GYGy for lung less than or equal to 20 %.GTVs were not statistically different between the three methods of delineation. PTVs were significantly lower with the gating-like technique. V95% of the PTV were not different between the three techniques. With the classic-, the gating-like- and the 3-volume techniques, dosimetry was considered as acceptable, respectively in 15, 18 and 15 cases. Comparisons of constraint values showed that the gating-like method gave the best results. In the case of pre-operative management, the gating-like method allowed the best results even for the V95% values. However, in the absence of gating device or without the possibility to use it, the 3-volume method allowed to take into account more precisely the organ motion than the classical technique.The 3-volume method can be done. It is a good method to take into account the organ motions. However, the gating-like method gives the best results leading to propose its use even for pre-operative patients with upper tumors.

INTRODUCTION:Synovial sarcoma is an uncommon tumour and thoracic involvement is rare and of varying location. Clinical characteristics are dominated by pain, with a slow progression over years. Pathological and immuno-histochemical characteristics are helpful in the diagnosis but a specific translocation between chromosomes X and 18 is crucial for confirmation. Extensive surgical resection is required for cure, combined with adjuvant radiotherapy in the presence of adverse prognostic factors. CASE REPORT:We report a case of synovial sarcoma of the chest wall, responsible for chronic local pain for several years, presenting as an acute pleuropneumonitis in a 21-year-old patient. In view of the large size of the tumour, associated with a high proliferation index (Ki-67), a surgical resection was performed, together with local adjuvant radiotherapy. CONCLUSION:This case report reviews synovial sarcoma and underlines the difficulties and requirements of both diagnostic strategy and therapeutic management. Among them, an initial systematic review of prognostic factors (tumour size, mitotic activity, proliferation index, SYT-SSX type fusion, histological grade) is crucial to determine the therapeutic options.

INTRODUCTION:Abrikossoff's tumour or granular cell tumour is usually benign involving multiple anatomical sites, most frequently the head, neck and airways. Occasional observations of aggressive malignant tumours have been reported, associated with a poor prognosis.CASE REPORT:We report the case of a mammary Abrikossoff's tumour, initially considered benign and treated solely by local surgery. Seven years later the tumour was responsible for the development of sub-cutaneous and pulmonary metastases. Local surgery was again the only treatment given in the absence of evidence for the effectiveness of alternative treatment with chemotherapy or radiotherapy.CONCLUSION:This original observation reports the case of a benign granular cell tumour that underwent malignant transformation after an interval of 7 years as indicated by the clinical progress and the cellular proliferation index Ki-67.

Le syndrome de Sweet, appartenant aux dermatoses neutrophiliques, est le plus souvent idiopathique. Dans 10 à 20 % des cas, il est paranéoplasique, accompagnant une tumeur solide ou une hémopathie. L’association à une tumeur maligne bronchique a rarement été décrite. Nous rapportons l’observation d’un patient âgé de 56 ans qui présentait un syndrome de Sweet précédant de deux mois le diagnostic de carcinome bronchique épidermoïde. L’évolution de la dermatose a été favorable sous corticoïdes. L’évolution tumorale est considérée comme favorable avec une stabilisation de la lésion après trois cures de chimiothérapie et radiothérapie locorégionale. Cette observation permet de réactualiser cette association peu fréquente et souligne l’importance de réaliser des explorations thoraciques adaptées en présence de cette dermatose. Une sécrétion paranéoplasique par les cellules tumorales bronchiques d’interleukine-8, de GM-CSF et/ou de GCSF facilitant le recrutement des polynucléaires neutrophiles, en particulier au niveau de la peau pourrait rendre compte de sa physiopathologie. Sweet's syndrome, one of the neutrophilic dermatoses, is ideopathic in most cases. In 10-20% of cases it is paraneoplastic, associated with a solid tumour or haematological malignancy. An association with carcinoma of the bronchus has been only rarely described. We report the case of a 56 year old man who presented with Sweet's syndrome two months before the diagnosis of a squamous cell carcinoma of the bronchus. The dermatosis responded well to corticosteroids. The progress of the tumour was favourable, with stabilisation following 3 courses of chemotherapy and local radiotherapy. This case report updates this rare association and underlines the importance of undertaking appropriate thoracic investigations in the presence of this dermatosis. A paraneoplastic secretion of interleukin-8, GM-CSF and/or G-CSF by the bronchial tumour cells facilitating the recruitment of neutrophils, particularly in the skin, may account for the pathophysiology of this condition.

Abrikossoff's tumour or granular cell tumour is usually benign involving multiple anatomical sites, most frequently the head, neck and airways. Occasional observations of aggressive malignant tumours have been reported, associated with a poor prognosis.We report the case of a mammary Abrikossoff's tumour, initially considered benign and treated solely by local surgery. Seven years later the tumour was responsible for the development of sub-cutaneous and pulmonary metastases. Local surgery was again the only treatment given in the absence of evidence for the effectiveness of alternative treatment with chemotherapy or radiotherapy.This original observation reports the case of a benign granular cell tumour that underwent malignant transformation after an interval of 7 years as indicated by the clinical progress and the cellular proliferation index Ki-67.

INTRODUCTIONSweet's syndrome, one of the neutrophilic dermatoses, is idiopathic in most cases. In 10-20% of cases it is paraneoplastic, associated with a solid tumour or haematological malignancy. An association with carcinoma of the bronchus has been only rarely described.CASE REPORTWe report the case of a 56 year old man who presented with Sweet's syndrome two months before the diagnosis of a squamous cell carcinoma of the bronchus. The dermatosis responded well to corticosteroids. The progress of the tumour was favourable, with stabilisation following 3 courses of chemotherapy and local radiotherapy.DISCUSSIONThis case report updates this rare association and underlines the importance of undertaking appropriate thoracic investigations in the presence of this dermatosis. A paraneoplastic secretion of interleukin-8, GM-CSF and/or G-CSF by the bronchial tumour cells facilitating the recruitment of neutrophils, particularly in the skin, may account for the pathophysiology of this condition.

INTRODUCTION:Gastropleural fistula has only rarely been described in the literature, typically presenting with evidence of left-sided pleural infection.CASE REPORT:The diagnosis may be suggested by the occurrence of chest pain and repeated vomiting with the diagnosis confirmed by microbiological examination of the pleural fluid and appropriate radiological investigations. The fistula occurs most frequently after abdominal or anterior thoracic surgery. Generally, surgical repair should be performed urgently but in the case that we describe occurring during pregnancy, surgery was delayed for 10 weeks until a caesarean section could be performed.CONCLUSION:In the presence of left-sided basal pleuritic chest pain in the context of a possible gap in the diaphragm the diagnosis of gastropleural fistula should be considered. Treatment is usually a medico-surgical emergency.

Introduction Gastropleural fistula has only rarely been described in the literature, typically presenting with evidence of left-sided pleural infection.Case report The diagnosis may be suggested by the occurrence of chest pain and repeated vomiting with the diagnosis confirmed by microbiological examination of the pleural fluid and appropriate, radiological investigations. The fistula occurs most frequently after. abdominal or anterior thoracic surgery. Generally, surgical repair should be performed urgently but in the, case that we describe occurring during pregnancy, surgery was delayed for 10 weeks until a caesarean section could be performed.Conclusion In the presence of left-sided basal pleuritic chest pain in the context of a possible gap in the. diaphragm the diagnosis of gastropleural fistula should be considered. Treatment is usually a medico-surgical emergency.

Background. Neoadjuvant chemotherapy before resection of nonsmall cell lung cancer seems to increase survival, mainly in the early stage. Risks of postoperative complications after chemotherapy and surgery remain controversial. Here we review our experience with patients treated in one thoracic surgery center.Methods. Patients undergoing resection for nonsmall cell lung cancer after induction chemotherapy between January 1993 and March 2002 were reviewed. Data collected included age, sex, preoperative forced expiratory volume in I second (FEW, hemoglobin, and arterial oxygen pressure tension (PaO2). postoperative complications, and global survival. The main objectives were postoperative mortality and morbidity. Postoperative mortality and morbidity were defined as complications or deaths occurring within 30 days after surgery. Predictive morbidity factors were identified by univariate and multivariate analysis and overall survival by the Kaplan-Meier method.Results. In all, 114 patients were reviewed. Different induction chemotherapies were used, mainly cisplatin with vinorelbine or gemicitabine. Postoperative mortality was 2 of 114, 1 of 27 after pneumonectomy, and there were no deaths after lobectomy. Complications occurred in 29% of patients (33 of 114), usually infectious pneumonia and anemia requiring transfusion. Preoperative FEV1, hemoglobin, and PaO2 are not associated with morbidity in univariate or multivariate analysis.Conclusions. Preoperative chemotherapy does not increase postoperative mortality and morbidity after non-small cell lung cancer surgery, performed exclusively by thoracic surgeons.