Solitary fibrous tumors are relatively rare neoplasms that commonly occur in the pleura, especially visceral pleura. However, an intrapulmonary site of this kind of tumors is even rarer. These tumors can be characterized by a heterogeneous evolution and have a benign or malignant behavior. Wide surgical resection is essential to cure the patient and to avoid recurrence. We present here the clinical, imaging, and histological features of a case with solitary fibrous tumor growing inside the lung.
Original Research ArticleThe production of autoantibodies after a hematopoietic stem cell allograft is a fact observed in hematology and often observed during graft versus host disease (GVHD) following an immune disturbance, however studies have shown the possibility of transferring B cells memory from a donor to the recipient and be responsible for autoimmune manifestations similar to that observed in the donor. We present here an extremely rare case of a manifestation of an isolated anti-phospholipid syndrome, 7 years after allograft in a patient whose donor is always asymptomatic. The appearance of autoantibodies was preceded by the appearance of chronic GVHD and the patient posed a management problem in the face of her persistent thrombocytopenia. The distinction between the manifestation of chronic GVHD and adoptive immunity is necessary due to the prognostic and therapeutic differences between these two entities.
The occurrence of acute leukemia after treated multiple myeloma has long raised concerns and has been the subject of several studies which have been based mainly on the link with treatments, mainly those using alkylating agents, but they remain limited due to the small number of patients, insufficient follow-up and limits for detecting second malignant tumors. Although the underlying biological mechanisms of AML after multiple myeloma are unknown, treatment-related factors are believed to be responsible. Recently, an excessive risk of acute leukemia has been found among 5652 patients with monoclonal gammopathy of undetermined significance IgG / IgA (but not IgM) supporting the role of disease-related factors. In addition, there is evidence to suggest that genetic polymorphisms may contribute to a person's susceptibility to future cancers, while the potential influence of environmental and behavioral factors remains poorly understood. This article discusses, through the observation of our patient, the current knowledge concerning malignant tumors after multiple myeloma and gives future directions for efforts to characterize the underlying biological mechanisms, with the aim of increasing survival and minimize the risk of new malignancies.
Article reçu le 26 juin 2019, accepté le 12 septembre 2019 Résumé. Le syndrome d'activation macrophagique (SAM) est un état d'hyper-inflammation qui résulte d'une sécrétion accrue des cytokines proinflammatoires, responsables de l'activation inappropriée et de la prolifération de cellules issues de la lignée lymphohistiocytaire. Il associe des signes cliniques, des anomalies biologiques et des images d'hémophagocytose. C'est une atteinte rare mais grave, qui peut être « primaire » ou « secondaire » à une infection, une néoplasie, ou une maladie auto-immune. L'étiologie cancéreuse par tumeur solide est exceptionnelle. Nous rapportons ici un cas de SAM ayant révélé un carcinome colique avec métastase médullaire chez un patient de 62 ans. Le SAM peut compliquer ou révéler une tumeur solide dans seulement 1,6 % des cas, notamment lorsqu'il existe des métastases médullaires. Cette association a rarement été rapportée dans la littérature, et ce seulement à travers des cas isolés. Chez notre patient le SAM est associé à un néo colique avec métastases osseuses. Celles-ci sont moins fréquentes que les métastases hépatiques et pulmonaires. Le SAM est une pathologie grave avec une mortalité élevée, liée à une activation inappropriée du système immunitaire. Le traitement à visée étiologique est nécessaire et peut être suffisant.
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