A child presenting with bullous emphysema

Abstract

Background. Placental transmogrification of the lung (PTL) is a clinical spectrum varying from asymptomatic to severe pulmonary impairment; such as recurrent pneumothorax, bronchopneumonia, respiratory distress syndrome and chronic obstructive airway disease. PTL usually presents as a bullous lesion, and rarely can appear in nodule or cyst formation on chest imaging. PTL with giant bullous emphysema has a male preference, is more commonly unilateral and mostly affects one lobe, but can rarely involve more than one lobe. Case. Here we report a 13-year-old boy presenting with bullous emphysema and coexisting with a borderline testicular tumor. He had no complaints of cough, sputum, or shortness of breath. He had a past medical history of pneumonia five years ago. In order to elucidate the underlying lung pathology, a wedge lung biopsy was performed and the patient was diagnosed with PTL. Scrotum ultrasonography was performed because of hydrocele in both testes, and bilateral epididymal cysts with papillary solid projections were reported. Pathological examination of the epididymal tumor revealed a `Mullerian type borderline epithelial neoplasm` which is an analogue of the ovarian serous borderline tumor. Conclusions. In conclusion, we reported the youngest PTL case in the literature, a rare disease with unknown pathophysiology, presenting as bullous emphysema and coincidental Mullerian type borderline epithelial neoplasm. It is important to diagnose placental transmogrification of the lung in a child with bullous emphysema because compared to other cystic lung diseases it is a benign disease and if no additional malignity exists, lobectomy or pneumonectomy is the cure for the disease.

Pulmonary placental transmogrification: a difficult pattern in differential diagnosis of pulmonary hamartomas from a tertiary care hospital in Turkey

“…This increase in the epithelial clefting may explain the papillary pattern of PT. Although it was frequently noted in PT cases associated with bullous emphysema in the literature [12,16,17], any lymphatic or vascular channel formation and dilation were not observed in our sections. Therefore, the origin and pathogenesis of PT associated with the pulmonary hamartomas may differ from PT associated with bullous emphysema [9,10].…”

“…Until now, approximately 50 reported cases of pulmonary PT in the English literature [11][12][13][14][15][16][17][18][19][20][21][22][23]. To our best knowledge, there is no study reporting that PT was histopathologically diagnosed in a hamartoma, and presented more than one case in a single center.…”

Placental Transmogrification of the Lung Presenting as Cystic‐Solid Mass: A Case Report

“…The age of presentation varied from 13 to 72 years, but PTL is most common in men between 20 to 50 years of age [5,6]. Clinically, PTL is either asymptomatic or presented with cough, hemoptysis, chest pain, dyspnea, pneumothorax (possibly tension pneumothorax), or a of all of the above.…”