Gallbladder small-cell carcinoma (SCC) is an extremely rare cancer characterized by early metastases and associated with poor survival outcomes. The therapeutic options are limited in this indication and dedicated prospective trials are difficult to achieve.Maintenance chemotherapy is an evolving concept in medical oncology whose goal is to prolong chemotherapy-induced response. The role of maintenance therapy has been demonstrated especially in many cancers but the results remain controversial in small cell cancer.We report a case of a 49-year-old woman admitted in our institution with biliary colic, postprandial bilious vomiting, right hypochondrial mass, and deteriorated general condition. Abdominal computed tomography (CT) revealed a mass of the gallbladder with lymphadenopathy in the hepatic hilum and multiple liver metastases. CT-guided biopsy was performed that showed small, round cells with high nuclear-to-cytoplasmic ratio, and frequent atypical mitosis, which is consistent with high-grade small cell neuroendocrine carcinoma. Tumor cells were positive for chromogranin A, synaptophysin, and CD56. Ki-67 shows a high proliferation rate with 90% tumor cell staining and the diagnosis of gallbladder SCC was confirmed. The treatment used a combination of carboplatin and etoposide, interrupted by the generalized discomfort and shortness of breath during the second course of the etoposide. Repeated CT scan showed a partial radiological response in the order of 35% and carboplatin monotherapy was maintained with good tolerance and stability of the disease until the 11th cure. Thrombocytopenia at 70,000 per mm3 appeared, and its persistence forced the cessation of this treatment. Five months later, the disease progressed and second-line chemotherapy by irinotecan was given weekly. The death occurred 18 months after initiation of medical treatment due to hepatocellular insufficiency. Maintenance therapy in SCC should be considered as a promising therapeutic option when it is well tolerated.

Background: Hepatic tuberculosis (TB) is a rare entity, poorly described in the literature. It presents with nonspecific clinical manifestation and imaging findings mimicking other liver disease making diagnosis challenge. We report a case of isolated hepatic tuberculosis in asymptomatic cabin crew member diagnosed accidentally by investigating a liver chemistry test disorder. Case Report: A 28 year-old Moroccan cabin crew attendant came to the aeromedical expertise center to perform her periodical medical assessment. She had no medical history. Physical examination was unremarkable. Liver chemistry test values were elevated. Imaging studies of the liver suggested malignant disease. Histological examination showed isolated hepatic tuberculosis. Discussion: Isolated hepatic TB is very uncommon, lacks typical clinical manifestation and radiological features, but remains an important differential diagnosis of hepatic nodules especially in endemic areas. This observation highlights the benefit of liver chemistry test evaluation realized systematically for periodical aeromedical fitness to diagnose some pathology in asymptomatic stage avoiding complications. Hepatic TB is a cause of temporarily unfitness because it’s not compatible with flight safety conditions. Aircrew with hepatic TB will need to be assessed for both complete disease control and full resolution of any iatrogenic side effect of anti-tubercular drugs before returning to fly under some restrictions.

Introduction: 35% of pheochromocytomas are malignant and generally have a poor prognosis.Visceral metastases are associated with shorter survival. Treatments for advanced pheochromocytomas are essentially palliative. Surgery is potentially curative; however, tumor extension limits the chance for a curative resection. Case Presentation: A 21-year-old women presented to our hospital with severe hypertension associated with Ménard's triad and heaviness of the left flank.The abdominal CT scan discovered a left adrenal mass with liver metastases. The diagnosis of pheochromocytoma was confirmed biochemically by the elevated catecholamine and metanephrine levels in the blood and urine. After preparation by the alpha-adrenergic blockade, she underwent left adrenalectomy and resection of left liver metastases followed by right hepatectomy. A pathology examination was performed and the final report was a metastatic pheochromocytoma with negative margins. She was discharged on postoperative without complications, and no evidence of recurrence occurred 48 months postoperatively. Conclusion: complete resection of liver metastases from metastatic pheochromocytoma can improve survival and should also be considered in the event of predominant secreting symptoms.

Narcolepsy is a rare chronic neurological hypersomnia, differentiated into two independent nosological entities: Type 1 and type 2 narcolepsy. Through clinical observation, the authors recall the diagnostic criteria of narcolepsy and the role of the aeronautical physician in the screening of this pathology.