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Ann Thorac Surg 2009;87:1323-1324. doi:10.1016/j.athoracsur.2009.01.004
© 2009 The Society of Thoracic Surgeons
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Correspondence

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Douglas West, MRCSa, Andrew G. Nicholson, FRCPathb, Ian Colquhoun, FRCSc, James Pollock, FRCSd

a Department of Thoracic Surgery, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario, M5G 2C4 Canada
b Department of Histopathology, The Royal Brompton Hospital, Sydney St, London, SW3 6NP UK
c Department of Cardiothoracic Surgery, The Golden Jubilee Hospital, Clydebank, Glasgow, G81 4HX UK
d The Department of Cardiothoracic Surgery, The Royal Hospital for Sick Children, Dalnair St, Glasgow, G3 8SJ UK

(Email: dgwest{at}rcsed.ac.uk; a.nicholson{at}rbht.nhs.uk; ian.colquhoun{at}gjnh.scot.nhs.uk; jim.pollock{at}yorkhill.scot.nhs.uk).

To the Editor:

We read with interest Dr Pusiol and colleagues' [1] letter on congenital cystic intrapulmonary lesions.

Malignant transformation in Stocker type 1 congenital cystic adenomatoid malformation (CCAM) had been well described [2] prior to our report [3]. As few cases have been reported, it may still be premature to describe this relationship as "unequivocal." In addition to its association with bronchioloalveolar carcinoma, CCAM may be a source of recurrent pulmonary sepsis.

Congenital cystic adenomatoid malformation causing respiratory distress can mandate resection in the neonatal period. Debate exists as to the optimal management of asymptomatic CCAM. Conservative management has been reported [4]. However, long-term follow-up of this strategy has not been performed. Therefore, the risk of progression to malignancy and the burden of recurrent sepsis cannot be quantified. The patient in our report suffered recurrent episodes of sepsis until resection by lobectomy.

Surgical resection in these patients can be performed at low risk [5]. On the basis of current evidence, we support Dr Pusiol and colleagues' [1] recommendation that complete surgical resection should remain the treatment of choice for CCAM.


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 References
 

  1. Pusiol T, Franceschetti I, Scialpi M, Piscioli I. Resection of congenital cystic intrapulmonary lesions is always necessary Ann Thorac Surg 2009;87:1323.[Free Full Text]
  2. Luck SR, Reynolds M, Raffensperger JG. Congenital bronchopulmonary malformations Curr Probl Surg 1986;23:245.[Medline]
  3. West D, Nicholson AG, Colquhoun I, Pollock J. Bronchioloalveolar carcinoma in congenital cystic adenomatoid malformation of lung Ann Thorac Surg 2007;83:687-689.[Abstract/Free Full Text]
  4. Aziz D, Langer JC, Tuuha SE, Ryan G, Ein SH, Kim PC. Perinatally diagnosed asymptomatic congenital cystic adenomatoid malformation: to resect or not? J Pediatr Surg 2004;39:329-334.[Medline]
  5. Papagiannopoulos K, Hughes S, Nicholson AG, Goldstraw P. Cystic lung lesions in the paediatric and adult population: surgical experience at the Brompton hospital Ann Thorac Surg 2002;73:1594-1598.[Abstract/Free Full Text]

Related Article

Resection of Congenital Cystic Intrapulmonary Lesions Is Always Necessary
Teresa Pusiol, Ilaria Franceschetti, Michele Scialpi, and Irene Piscioli
Ann. Thorac. Surg. 2009 87: 1323. [Extract] [Full Text] [PDF]




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