Recently we correlated histology and computed tomographic imaging of intrapulmonary congenital cystic lesions of the adult, including intrapulmonary cysts and congenital cystic adenomatoid malformation type I. West and colleagues [1] described a carcinoma after a congenital lesion in a young patient. They underlined the possibility of underestimation of these lesions. Then Lantuejoul and colleagues [2] confirmed the relation between carcinoma and this kind of congenital lesions in their study. These two studies unequivocally demonstrate the carcinogenetic potential of type I congenital cystic adenomatoid malformation (CCAM). This finding will radically modify the therapeutic approach to the congenital pulmonary cystic lesions in the adults. Beside CCAM, other pulmonary cystic malformations are: congenital lobar emphysema, pulmonary sequestrions, bronchogenic cysts, and other foregut cysts, including intrapulmonary cysts [3]. The intrapulmonary bronchogenic cysts may be asymptomatic and are identified in the adult on routine imaging. All the other cystic malformations are symptomatic and found in the childhood. In our recent experience when they are intrapulmonary lesions, the bronchogenic cysts are radiologically indistinguishable from large single CCAM type I. Only histologic examination can establish the cystic nature of the lesion. The presence of parietal cartilage islands, bronchial glands, smooth muscle, and occasionally calcifications and ossification is conclusive for intrapulmonary bronchogenic cysts in the differential diagnosis with CCAM type I [4]. Because the differential diagnosis between solitary IBC and type 1 CCAM is not possible by radiologic procedures, generally a complete surgical resection is advisable in solitary cystic congenital intrapulmonary lesions in adults at the time of diagnosis, even if asymptomatic. A delayed or incomplete resection may expose the patient to tumour development in the case of type 1 CCAM.

Resection of Congenital Cystic Intrapulmonary Lesions Is Always Necessary

SCIALPI, Michele;
2009

Abstract

Recently we correlated histology and computed tomographic imaging of intrapulmonary congenital cystic lesions of the adult, including intrapulmonary cysts and congenital cystic adenomatoid malformation type I. West and colleagues [1] described a carcinoma after a congenital lesion in a young patient. They underlined the possibility of underestimation of these lesions. Then Lantuejoul and colleagues [2] confirmed the relation between carcinoma and this kind of congenital lesions in their study. These two studies unequivocally demonstrate the carcinogenetic potential of type I congenital cystic adenomatoid malformation (CCAM). This finding will radically modify the therapeutic approach to the congenital pulmonary cystic lesions in the adults. Beside CCAM, other pulmonary cystic malformations are: congenital lobar emphysema, pulmonary sequestrions, bronchogenic cysts, and other foregut cysts, including intrapulmonary cysts [3]. The intrapulmonary bronchogenic cysts may be asymptomatic and are identified in the adult on routine imaging. All the other cystic malformations are symptomatic and found in the childhood. In our recent experience when they are intrapulmonary lesions, the bronchogenic cysts are radiologically indistinguishable from large single CCAM type I. Only histologic examination can establish the cystic nature of the lesion. The presence of parietal cartilage islands, bronchial glands, smooth muscle, and occasionally calcifications and ossification is conclusive for intrapulmonary bronchogenic cysts in the differential diagnosis with CCAM type I [4]. Because the differential diagnosis between solitary IBC and type 1 CCAM is not possible by radiologic procedures, generally a complete surgical resection is advisable in solitary cystic congenital intrapulmonary lesions in adults at the time of diagnosis, even if asymptomatic. A delayed or incomplete resection may expose the patient to tumour development in the case of type 1 CCAM.
2009
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11391/127020
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