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Hichem Aouina



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    P3.CR - Case Reports (Not CME Accredited Session) (ID 984)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 3
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.CR-33 - Trichoptysis, Hemoptysis and Chest Pain: A Very Rare Presentation of Anterior Mediastinal Teratoma in a Young Patient (ID 11294)

      12:00 - 13:30  |  Author(s): Hichem Aouina

      • Abstract
      • Slides

      Background

      1/Case History:

      A 28-year old patient who presented to the Emergency Department for a 2-week history hemoptysis, right chest pain and intermittent sebaceous expectorations. He had such intermittent chest pain for the last 2 months.

      He had no fever, breathlessness, loss of weight, joint pain or renal symptoms. He had no significant personal or family history of tuberculosis.

      On examination, he was afebrile.Full clinical examination revealed decreased breath sound in the left lung with a dull-percussion note.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      2/Investigations:

      Laboratory investigations were normal.The coagulation tests were normal.

      The Tuberculin skin test was negative.

      The Chest CT-scan revealed a large well-circumscribed anterior mediastinal mass with heterogeneous mixed density (fat, soft tissue and calcifications), in the left hemi-thorax. It also showed intra-tumoral bleeding associated with a left massive hemomediastinum. This radiological aspect suggested a teratoma.

      Preoperative labs showed normal carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), CA-125 and beta-HCG level were normal.

      4c3880bb027f159e801041b1021e88e8 Result

      3/Treatment:

      The multidisciplinary team decision was to perform surgery. A standard posterolateral thoracotomy was performed in the 5th intercostal space. Immediately upon entering the thoracic cavity, a bulky mediastinal mass was found to have a strong adhesion to the upper left lobe. The mass itself was originating from the thymus and extending down to the left lung. A complete thymectomy with a total removal of the tumor was therefore performed. The total amount of bleeding was about 900ml.This was completely evacuated from the thoracic cavity.

      The patient is currently doing well one year from his initial diagnosis.

      Although he had a benign teratoma, he was referred to a medical geneticist for further evaluation and management.

      8eea62084ca7e541d918e823422bd82e Conclusion

      4/Discussion and conclusion:

      Teratomas are germ cell tumors arising from pluripotent cells.

      Most of them are asymptomatic. Hemoptysis is rare. It may result either from communication with tracheobronchial tree or they may result from bronchial bleeding due to the irritation caused by the tumor. In this case, the presence of hypervascularisation depending on the left internal mammary artery in the chest CT-scan suggests that the teratoma developed systemic blood supply which make our case original.

      Another pathognomonic symptom is Trichoptysis which is extremely rare .

      All these symptoms may mimic a pulmonary tuberculosis in young patients especially in our tuberculosis-endemic country. In our case, the tuberculin tests were negative.

      To conclude, it is a rare case of Teratoma of the anterior mediastinum. It should be considered in the differential diagnosis of Hemoptysis..

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      P3.CR-34 - A Giant Ganglioneuroma of the Thoracic Spine (ID 11295)

      12:00 - 13:30  |  Author(s): Hichem Aouina

      • Abstract
      • Slides

      Background

      1/Case History:

      A 9-year old girl presented to our Department for a chronic cough. Her medical history revealed that she had pneumonia at the age of 2 years. The family history was marked by an allergic rhinitis in the father.

      On examination, she was afebrile.Full clinical examination revealed decreased breath sound in the left lung.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      2/Investigations:

      Laboratory investigations were normal.

      The Chest CT-scan revealed a well-circumscribed mediastinal mass measuring 8.6cm*7.8cm*6.8cm. It extended through the neural foramen of T9 and also in the left chest cavity behind the aortic cross and the esophagus.

      Magnetic Resonance imaging showed a long intra-dural extra-medullary tumor extending from T6 to T11 levels. It extended through the left T9 neural foramen into the left thoracic cavity. The intervertebral foramen was enlarged. The thoracic aorta was totally sheathed. The lesion was mildly hypo-intense on T1-weighted imaging and heterogeneously hypo-intense on T2-weighted imaging. This radiological aspect could suggest a ganglioneuroma or a shwannoma.

      4c3880bb027f159e801041b1021e88e8 Result

      3/Treatment:

      The multidisciplinary team decision was to perform surgery.

      Final histology demonstrated a well-circumscribed ganglioneuroma with negative margins.

      The case was reviewed at the Oncology multidisciplinary team. The decision was made to proceed with active follow-up without any adjuvant therapy given that it’s benign.

      The patient is currently doing well 2 years from her initial diagnosis.

      8eea62084ca7e541d918e823422bd82e Conclusion

      4/Discussion:

      Thoracic intradural extra medullary Ganglioneuromas are very rare benign tumors of the autonomic nerve fibers. Most of them are incidentally discovered.

      In this case, our patient had no significant clinical symptoms apart from a chronic cough. The thoracic location, the potential of growth the large-size of the tumor (extending to the left chest wall with an intra-dural component) and the radiological profile, makes it therefore rare and unusual.

      It also illustrates the complexities of the management of this rare tumor. In fact, surgical treatment is usually safe and efficient. But, it can be more complicated in case of a such large-sized mass. So, a 2-step surgical intervention should be performed.

      Ganglioneuroma has commonly a good prognosis given its low-risk of recurrence and low-metastatic potential. However, it can become cancerous and spread to other organs.

      Conclusion:

      To conclude, it is a rare case of giant Ganglioneuroma of the Thoracic spine with intra-dural extension. It should be considered in the differential diagnosis of a mediastinal mass. We also underline that the surgical treatment is safe and efficient.

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      P3.CR-35 - A Rare Giant Thoracic Desmoid Tumor /A Case Report (ID 11296)

      12:00 - 13:30  |  Author(s): Hichem Aouina

      • Abstract
      • Slides

      Background

      1/Case history:

      A 43-year old lady who presented to the Emergency Department with a 2-month progressively worsening chest pain associated with dyspnea. There was no remarkable past history.

      On examination, she was in significant distress due to pain. She was afebrile,

      Full clinical examination revealed decreased breath sound in the left lung and dull-percussion note of the left hemi-thorax.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      2/Investigations

      A Computed-Tomography Scan (CT) revealed an expansile soft –tissue density mass locating in the left hemi-thorax. The large mass invaded the posterior arches of the 6th and 7th ribs and the 6th and 7th vertebral bodies with an ‘hour-glass’-like extension through the growth foramen including the bone; with partial osteolytic lysis. The left-lung was compressed.

      She had a Transthoracic Needle biopsy of the tumor. The histological aspect can be perfectly fitted with a fibromatosis.

      4c3880bb027f159e801041b1021e88e8 Result

      3/Treatment:

      After a strict work-up and assessment of the prognosis, that results in establishment of an indication for surgery in 2 times.

      Final pathology showed a well-circumscribed, white- pearly, bulky tumoral mass measuring 28*19*12cm.

      The case was reviewed on the Multidisciplinary team. The decision was made to proceed with the second surgical time. The patient is currently doing well 6 months after the initial diagnosis.

      8eea62084ca7e541d918e823422bd82e Conclusion

      4/ Discussion and Conclusion:

      Desmoid Tumors are rare tumors which originate from fibroblasts. They typically arise in the abdominal wall. However, the chest wall is the second location of these rare tumors. Most of them are asymptomatic. Rarely, patients can develop a wide range of symptoms due to tumoral mass effect on surrounding organs that result in cough, dyspnea....

      The thoracic location of the tumor, the pattern of growth, the large-sized tumor, as well as the radiological profile makes this case rare and unusual.

      Surgical excision is considered as the best treatment for most desmoid tumors. In our patient, surgery was therefore necessary to establish the diagnosis and to remove the tumor. However, it can become more complicated in case of a such large-sized mass. So, a 2-step wise surgical intervention should be therefore performed.

      To conclude, this case demonstrates the complexities involved in the presentation and the management of these rare tumors. We also underline that surgical treatment is safe and efficient.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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