Pulmonary aspergilloma: A rare differential diagnosis to lung cancer after positive FDG PET scan

Early diagnosis and treatment of lung cancer, one of the leading causes of cancer-related death, is important to improve morbidity and mortality. Therefore any suspect solitary pulmonary nodule should prompt the pursuit for a definitive histological diagnosis. We describe the case of a 55-years-old male ex-smoker, who was admitted to our hospital due to recurrent hemoptysis and dry cough. A CT scan showed an irregular nodule of increasing size (28 mm in diameter) in the left lower lobe (LLL). A whole body PET-CT scan (643 MBq F-18 FDG i.v.) was performed and confirmed an avid FDG uptake of the nodule in the LLL, highly suspicious of lung cancer, without any evidence of lymphogenic or hematogenic metastasis. Bronchoscopy was not diagnostic and due to severe adhesions after prior chest trauma and the central location of the nodule, a lobectomy of the LLL was performed. Surprisingly, histology showed a simple aspergilloma located in a circumscribed bronchiectasis with no evidence of malignancy. This is a report of an informative example of an aspergilloma, which presented with symptoms and radiological features of malignant lung cancer

Syndrome des anticorps antiphospholipides: beaucoup de nouveautés

Recently some key papers and consensus have shed some new light on antiphospholipid syndrome (APS). Concerning the tests the search for lupus anticoagulant is now better defined. A modified antibeta2-glycoprotein I assay has been shown to be more specific for clinical complications. It seems necessary to still perform anticardiolipin antibodies in case of pregnancy morbidity but not in case of thrombosis which raises the question of two separate clinical entities with different pathologic mechanisms. Concerning the pathophysiology, new data emphasize the role of complement and underscore the role of genetic predisposition. The data of some large cohort followed prospectively such as the European cohort (1000 APS patients) as well the data of some registries (APS in children and patients with a catastrophic APS) bring some new important information on the clinical aspects of the syndrome. Finally this review will propose some algorithms to treat patients with APS