Pulmonary Sequestration With CCAM Type II Appearing as Adrenal Tumor Protruding Through a Bochdalek Hernia

Abstract

A case of a pulmonary sequestration, which almost exclusively consisted of a congenital cystic adenomatoid malformation type II located subdiaphragmatically in the left retroperitoneal area, is reported. This case, in a 24-year-old male patient, is unique in that it appeared as an adrenal incidentaloma and extended through a Bochdalek hernia into the pleural space. It was discovered upon routine ultrasound screening for hepatocellular carcinoma in a patient with a carrier state for hepatitis B. Diagnosis was established only upon histological analysis of the surgically removed tumor after staining with hematoxylin and eosin as well as surfactant A and B. The location of the tumor may indicate that it was formed by an entrapment of a lung bud by the developing diaphragm. This appearance may give us insight into the formation of such tumors. It also highlights the difficulty of diagnosing subdiaphragmatic retroperitoneal tumors without histological examination.

Keywords

pulmonary sequestration CCAM adrenal tumor Bochdalek hernia subdiaphragmatic

Get full access to this article

View all access options for this article.

References

Liang MK , Yee HT , Song JW , Marks JL Subdiaphragmatic bronchogenic cysts: a comprehensive review of the literature . Am Surg. 2005;71:1034-1041.

Gross E. , Chen MK , Lobe TE , Nuchtern JG , Rao BN Infradiaphragmatic extralobar pulmonary sequestration masquerading as an intra-abdominal, suprarenal mass. Pediatr Surg Int. 1997;12:529-531.

van der Zee DC , NMa Bax K. Laparoscopic resection of intra-abdominal extralobar pulmonary sequestration. Pediatr Surg Int. 2005;21:841-842.

Newman B. Congenital bronchopulmonary foregut malformations: concepts and controversies . Pediatr Radiol. 2006;36: 773-791.

Conran RM , Stocker JT Extralobar sequestration with frequently associated congenital cystic adenomatoid malformation, type 2: report of 50 cases. Pediatr Dev Pathol . 1999;2: 454-463.

Stocker JT , Madewell JE , Drake RM Congenital cystic adenomatoid malformation of the lung. Classification and morphologic spectrum. Hum Pathol. 1977;8:155-171.

Berrocal T. , Madrid C. , Novo S. , Gutierrez J. , Arjonilla A. , Gomez-Leon N. Congenital anomalies of the tracheobronchial tree, lung, and mediastinum: embryology, radiology, and pathology. Radiographics. 2004;24:e17.

McManus DT , O’Hara MD Extralobar sequestration and type II congenital cystic adenomatoid malformation in an infant with congenital diaphragmatic hernia. Pediatr Pathol Lab Med. 1996;16:637-642.