PubMed · 4349926
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J M Lemoine, R Dufat. [Chronic bronchitis and bronchoscopy].. https://pubmed.ncbi.nlm.nih.gov/4349926/
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Lung cysts were observed by chance in the chest radiographs from two women aged 20 and 41. In the surgical specimens the lesions proved to be congenital cystic adenomatoid malformation type 1. The cysts were partially lined by mucous cells. Also near the cysts there were circumscribed tubuloacinar proliferations of mucous cells. In both cases a transition into a bronchioloalveolar carcinoma was seen. Histochemically no sulphomucins could be demonstrated by means of an alcian blue pH 1 reaction in the tumor cells, but was demonstrated in the non-neoplastic cells of the malformation. In both cases CEA was demonstrated in the tumor cells. Some cells in the tubuloacinar proliferations were weakly CEA positive. In one patient the diagnosis of carcinoma was made by intraoperative frozen section and a lobectomy was performed. The other patient had first only a resection of her cystic lesions and had to be reoperated because of the results of the pathological examination. Both patients had no recurrence in the 8 years following the operation. In the literature we found 5 cases of congenital cystic adenomatoid malformation in adults. In 2 cases there was also an associated bronchioloalveolar carcinoma. Several reports exist on the association of different kinds of cystic lung lesions and malignant tumors and their possible pathogenetic relationship. In this paper we draw attention to the development of malignant neoplasia in congenital cystic adenomatoid malformation in adults and its diagnostic problems.
In a series of 57 patients undergoing thoracoscopic pulmonary lobectomy, 2 required expeditious conversion to open thoracotomy when a stapling device (Endo-GIA 30 V3; Autosuture, Ascot, UK) used on the main right lower pulmonary artery in 1 case and on the left superior pulmonary vein in the other cut but failed to staple the vessel involved. In both instances the vessel was successfully controlled while a thoracotomy was performed and the involved vessel was oversewn. Both patients made an uncomplicated postoperative recovery. As the number of thoracoscopic pulmonary resections increases, it is likely that similar episodes will occur in the future. These cases strongly emphasize the fact that patients undergoing this procedure should do so in a center specializing in thoracic surgery where there is the necessary surgical expertise and equipment to deal with such potentially life-threatening vascular complications.
We report on a 42-year-old woman in whom was discovered a symptomless peripheral radiologic excavated lesion of the lung, which actually existed 3 years before. All investigations were negative. A segmentectomy was performed. Histopathologic examination proved a bronchioloalveolar carcinoma in contact with a type I congenital cystic malformation of the lung. Such a malformation can be diagnosed late in adult life. The epithelial cells of the malformation might predispose to slow proliferation and malignancy, enhanced by smoking habits.