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Gupta K, Singh V, Mandal S, Mallya V, Singh M, Khurana N, Sarin YK. Congenital Pulmonary Airway Malformation - A Histomorphological Spectrum of 15 Cases: A 5-Year Study from a Tertiary Care Center. J Indian Assoc Pediatr Surg 2021; 26:409-415. [PMID: 34912138 PMCID: PMC8637997 DOI: 10.4103/jiaps.jiaps_294_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/06/2020] [Accepted: 11/27/2020] [Indexed: 11/19/2022] Open
Abstract
Objective: Congenital pulmonary airway malformation (CPAM) is a rare developmental lung disease. The aim of this study is to analyze the histomorphological spectrum of CPAM in a series of 15 cases. Materials and Methods: A retrospective descriptive study of 15 cases of CPAM was carried out from 2013 to 2018 in our hospital, and cases were classified based on the Stocker's classification. Results: The age ranged from 4 days to 9 years (66.6% were infants). The left lung was most commonly involved (66.6%). The most common lobe was the left upper lobe (60%), followed by right lower lobe (20%). Grossly, cysts measured 0.2–5 cm, filled with mainly serous fluid with few having hemorrhagic and brownish mucoid secretions. On microscopy, single to multiple noncommunicating cysts of size 0.2–5 cm were seen, lined by ciliated columnar epithelium (60%), pseudostratified ciliated columnar epithelium (26.7%), mucin-secreting columnar epithelium (6.7%), and flattened epithelium (6.7%). Few cases showed smooth muscle (20%) and cartilage (13.3%) in the cyst wall. Chronic inflammation (73.3%) with dense histiocytic infiltrate (13.3%) was also seen. Emphysematous changes were also observed (13.3%). Cytomegalovirus inclusions (6.7%), zygomycete fungus (6.7%), and red hepatization (6.7%) were observed. The most common type was type II (60%), followed by type I (33.3%) and type IV (6.7%). Conclusion: Type II was the most common variant in this study. A careful observation should be done to look for fungal hyphae or viral inclusions.
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Affiliation(s)
- Kanika Gupta
- Department of Pathology and Pediatric Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Vishal Singh
- Department of Pathology and Pediatric Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Shramana Mandal
- Department of Pathology and Pediatric Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Varuna Mallya
- Department of Pathology and Pediatric Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Meeta Singh
- Department of Pathology and Pediatric Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Nita Khurana
- Department of Pathology and Pediatric Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Y K Sarin
- Department of Pathology and Pediatric Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
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Wong MCY, Faure Bardon V, Farmakis K, Berteloot L, Lapillonne A, Delacourt C, Sarnacki S, Ville Y, Khen-Dunlop N. Ultrasound detected prenatal hyperechoic lung lesions and concordance with postnatal findings: A common aspect for multiple diagnoses. Prenat Diagn 2020; 41:323-331. [PMID: 33111324 DOI: 10.1002/pd.5854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hyperechoic lung lesions are largely detected prenatally but their underlying etiology is still poorly defined. The aim of the study was to determine the concordance between pre and postnatal diagnosis of hyperechoic lung lesions. METHODS Prenatal ultrasound (US) evaluation was performed by a fetal medicine specialist. Postnatal diagnosis was based on CT-scan. Pre- and postnatal features were retrieved from medical charts. RESULTS Seventy five patients were included from January 2009 to December 2018. Main prenatal diagnoses were bronchopulmonary sequestrations (BPS) (n = 24%-32%), pulmonary cystic malformations (PCM) (n = 19%-25%), congenital lobar emphysemas (CLE) (n = 15%-20%). Mediastinal shift was observed in 18 cases (24%). The prenatal detection of a systemic arterial supply had a diagnostic accuracy of 90%, while the prenatal detection of a cystic component had a diagnostic accuracy of 76.5%. All 16 neonates with prenatal isolated mediastinal shift were asymptomatic at birth. Seven neonates showed respiratory distress that was not predicted prenatally. CONCLUSIONS Hyperechoic lung malformations reflect a heterogeneous group of lesions with a good concordance for bronchopulmonary sequestration, but not a satisfying prediction for cystic lesions.
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Affiliation(s)
- Michela Cing Yu Wong
- Department of Pediatric Surgery, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Valentine Faure Bardon
- Department of Obstetrics, Hôpital Necker-Enfants Malades, AP-HP, Paris, France.,Université de Paris, Paris, France
| | - Konstantinos Farmakis
- Department of Pediatric Surgery, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Laureline Berteloot
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Alexandre Lapillonne
- Université de Paris, Paris, France.,Department of Neonatal Intensive Care, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Christophe Delacourt
- Department of Pediatric Pulmonology, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Hôpital Necker-Enfants Malades, AP-HP, Paris, France.,Université de Paris, Paris, France
| | - Yves Ville
- Department of Obstetrics, Hôpital Necker-Enfants Malades, AP-HP, Paris, France.,Université de Paris, Paris, France
| | - Naziha Khen-Dunlop
- Department of Pediatric Surgery, Hôpital Necker-Enfants Malades, AP-HP, Paris, France.,Université de Paris, Paris, France
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Abstract
Diagnosis and management of congenital lung malformations has evolved dramatically over the past several decades. Advancement in imaging technology has enabled earlier, more definitive diagnoses and, consequently, more timely intervention in utero or after birth, when indicated. These advancements have increased overall survival rates to around 95% from historical rates of 60%. However, further refinement of diagnostic technique and standardization of treatment is needed, particularly as the increased sensitivity of diagnostic imaging results in more frequent diagnoses. In this article, we provide an updated review of the diagnostic strategies, management, and prognosis of congenital lung malformations.
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Affiliation(s)
- Michael Zobel
- Fetal Treatment Center, Department of Surgery, University of California, San Francisco
| | - Rebecca Gologorsky
- Fetal Treatment Center, Department of Surgery, University of California, San Francisco
| | - Hanmin Lee
- Fetal Treatment Center, Department of Surgery, University of California, San Francisco
| | - Lan Vu
- Fetal Treatment Center, Department of Surgery, University of California, San Francisco.
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