Congenital Pulmonary Airway Malformation (CPAM): An Interesting ENT Consultation

Congenital pulmonary airway malformation (CPAM) presenting as spontaneous pneumothorax in young boy

Congenital pulmonary airway malformation (CPAM) is most common congenital lung anomaly of lower respiratory tract accounting for approximately 25% of all congenital pulmonary malformations. It is usually unilateral and involves single lobe of lung. It is usually diagnosed prenatally; rarely found in children and adults. We report a rare case of 14-year-old male presented with sudden onset breathlessness secondary to right sided pneumothorax associated with right lower lobe cystic lesion; successfully managed with multidisciplinary approach involving tube thoracostomy and non-anatomical wedge resection of right lower lobe cystic lesion (using VATS). Adults diagnosed with CPAM usually present with breathlessness, fever, recurrent pulmonary infection, pneumothorax, and haemoptysis. For definitive treatment of symptomatic CPAM cases, surgical resection at the time of diagnosis is recommended in view of possible risk of malignant transformation and recurrent respiratory tract infections. Considering the mild but definitive risk of malignancy, it is advocated to closely monitor the individuals with CPAM even after the surgical resection.

Analysis of miRNA Profiles and the Regulatory Network in Congenital Pulmonary Airway Malformations

Background: Specific diagnostic markers for congenital pulmonary airway malformations (CPAMs) have not yet been discovered. This study intends to detect differentially expressed miRNAs in type I and type II CPAMs by using a miRNA chip and clarify the feasibility of miRNAs as different CPAM typing markers. Methods: Lung tissues of type I and type II CPAMs were collected and used to assess the differentially expressed miRNAs using a miRNA chip after evaluation using hematoxylin-eosin staining and Masson staining. Quantitative reverse transcription-polymerase chain reaction and fluorescence in situ hybridization were used to verify the quality of the miRNA chip. The function and pathways of related differentially expressed miRNAs were analyzed by Gene Ontology Enrichment (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, respectively. Targets of miRNAs were predicted by targetscan7.1 and mirdbV6 and the network between miRNA and mRNA was established using Cystoscope software. Results: In total, 394/34 upregulated and 321/72 downregulated miRNAs were found in type I and type II CPAMs, respectively. GO and KEGG analysis showed that different pathways are involved in the regulation of CPAM, including platelet activation, Ras, MAPK, FoxO, and PI3K-Akt signaling pathways. miRNA-mRNA network analysis confirmed four major miRNAs in CPAM, including miR-4731-5p to complexin 2, miR-3150a-3p to vesicle amine transport 1, miR-32-5p to F-box and WD repeat domain containing 7, and miR-454-3p to SLAIN motif family member 1. Conclusion: In summary, we have identified four candidate miRNAs and pathways related to different pattern CPAMs, which provide a new perspective for CPAM research and treatment.