Plazentoide Malformation der Lunge

Abstract

The differential diagnosis of bullous and cystiform lung alterations comprises a relatively calculable number of various diseases, in which the most important are rare cystic tumors and congenial malformations, such as adenomatoid cystic malformation. We report on a rare clinical picture. In this case, the clinical diagnosis of localized unilateral emphysema caused by local displacement and with subsequent complications had led to "bullectomies" and pneumonectomy. Macroscopically, spongiform solid areas in association with areas of physaliform transformation were seen, corresponding histomorphologically to villous, placentalike formations. The "villous stroma" revealed focally regressive alterations, fatty islets and leiomyomatous areas. So far, the pathogenesis of this lesion, described as "placentoid malformation" due to its pathognomonic histological appearance, remains unclear. In contradiction to the much discussed hypothesis that this lesion may develop from pre-existing lung emphysema, our results suggest that this may be an independent lesion, possibly congenital hamartous malformation with self-developing progression. The clinically predominant emphysematic alterations are considered to be caused by a valve mechanism due to unphysiological traction forces, the lymphatic pathways regularly found in the border areas towards the original lung tissue, possibly playing an important etiological part.

Unexpected Histopathological Diagnosis of Placental Transmogrification of the Lung after Bullectomy for Recurrent Spontaneous Pneumothorax: A Case Report and Literature Review

“…Although PTL is rare, positive-CD10 staining of interstitial cells is specific to PTL, which helps easily differentiate PTL from other cystic diseases, such as alveolar adenoma, congenital lesions, or lymphangioleiomyomatosis. 14) The pathogenesis of the lesion in PTL is still unclear, and there are various theories. PTL is not considered to be associated only with cystic or emphysematous lung lesions but also with pulmonary fibrochondromatous hamartomas and pulmonary lipomatosis.…”

“…Although PTL is rare, positive-CD10 staining of interstitial cells is specific to PTL, which helps easily differentiate PTL from other cystic diseases, such as alveolar adenoma, congenital lesions, or lymphangioleiomyomatosis. 14) …”

Pulmonary placental transmogrification associated with adenocarcinoma of the lung: A case report with a comprehensive review of the literature

“…As most of the reported cases of PT are associated with bullous disease, most researchers believe that PT either develops from bullous emphysema or is a reaction to it. 2 - 4 , 11 Others believe that PT may be related to lymph-vascular malformation, owing to the frequent presence of lymphatic and dilated vascular channels within the stroma of PT. 3 , 4 Yet others are of the opinion that PT is an independent lesion, possibly of congenital hamartomatous origin.…”

“…Microscopically PT is composed of immature placental villi in a myxoid or edematous stroma. The stroma is composed of lymph-vascular channels, 3 , 4 fibroadipose tissue, 5 interstitial clear cells 15 and in rare instances the adipose tissue comprises the major bulk of the stroma. 10…”

“…It is usually diagnosed as an incidental finding, and the exact etiology is still unknown. Some think that it is due to lymphatic or vascular proliferation in emphysematous lung, 2 - 4 while others believe it to be a component of a congenital malformation, 3 or a hamartoma. 1 Xu et al 5 found that PT is frequently associated with pulmonary fibrochondromatous hamartomas and may be induced by or associated with a proliferation of lining epithelial components in the hamartomas.…”