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Resume Nous rapportons le cas d’une femme âgee de 74 ans, qui, dans le cadre du suivi de deux cancers du sein, a presente un nodule pulmonaire de 2 cm de grand axe. L’examen microscopique de la biopsie sous scanner montre une proliferation d’allure epitheliale mais dont le profil immunophenotypique ne permet pas de conclure a un diagnostic precis (negativite de CK7, GATA3, TTF1, recepteurs aux oestrogenes mais positivite des recepteurs a la progesterone). Une chirurgie d’exerese de la lesion par wedge est realisee. L’examen microscopique extemporane et definitif montre une lesion bien limitee faite de lobules de cellules d’allure cohesives dessinant frequemment des enroulements. Les cellules tumorales montrent quelques inclusions intra-nucleaires et quelques psammomes sont observes. L’etude immunohistochimique montre une expression diffuse des marqueurs EMA, SSTR2A et des recepteurs a la progesterone. L’index de proliferation est faible. Le diagnostic de localisation pulmonaire d’un meningiome est alors propose. Le bilan radiologique de l’ensemble du nevraxe ne montre pas d’autre lesion faisant retenir le diagnostic final de meningiome intra-pulmonaire primitif. Il s’agit d’une tumeur exceptionnelle de diagnostic histopathologique difficile sur materiel biopsique, devant etre connue des pathologistes. Elle est associee a un excellent pronostic. Notre observation a pour but d’en illustrer les aspects macroscopiques, microscopiques et de presenter les donnees de la revue de la litterature recente.

Diagnostic updates, an increased precision of tumor sub-type classification and the development of new diagnostic biomarkers (immunohistochemistry (IHC), Fluorescence in situ hybridization (FISH) and other molecular pathology techniques), have a significant impact on pathologists' management of tissue samples. The objective of this work was to test and validate the FISH technique on detached IHC slides. An IHC technique was first performed on 30 tissue samples. After detachment of the lamella, a FISH technique was then performed according to the usual protocol with a centromeric probe. A validation cohort (n=10) with duplicate testing using a traditional FISH technique and an IHC slide with a detached lamella was then carried out. Finally, a cohort of 20 "old" cases (IHC carried out over 2years ago) was also tested. Different types of probes (specific locus, break apart) have been used. All the slides were interpreted by a technician and a pathologist. Evaluation criteria were: the general interpretability of the slide ; the percentage of labeled nuclei; intensity of the signal and the presence or absence of autofluorescence. FISH was interpretable in 100% of recently treated cases and 90% of "old" cases with a satisfactory intensity and a high percentage of labeled nuclei, without autofluorescence. The results of our study show that the reuse of IHC slides for performing FISH is a powerful means of economizing tissue samples, especially for small samples and in the absence of archived representative material.

We report the case of a 74-year-old woman who, as part of the follow-up for two breast cancers, presented a 2cm long lung nodule. A microscopic examination of the biopsy under a scanner showed a proliferation of epithelial appearance but whose immunophenotypic profile did not permit a precise diagnosis (negativity of CK7, GATA3, TTF1, negative estrogen receptors but positive progesterone receptors). Wedge resection surgery was performed. Extemporaneous and definitive microscopic examination showed a well-defined lesion made up of lobules of cohesive-looking cells, frequently forming coils. The tumor cells showed some intranuclear inclusions and a few psammomas while the immunohistochemical study showed diffuse expression of EMA, SSTR2A and progesterone receptor markers and a low proliferation index. A diagnosis of a pulmonary localization of a meningioma was proposed. The radiological assessment of the entire neuraxis did not show any other lesion leading to the final diagnosis of primary intra-pulmonary meningioma. This is an exceptional tumor with a difficult histopathological diagnosis of biopsy material, which must familiar to the pathologists. It is associated with an excellent prognosis. Our observation aims to illustrate the macroscopic and microscopic aspects and to present the data from the recent literature review.