Spontaneous Partial Regression of Fetal Lung Interstitial Tumor With A2M::ALK Rearrangement in a Neonate

The differential diagnosis for neonatal primary lung masses includes developmental anomalies and congenital lung tumors. Fetal lung interstitial tumor (FLIT) is a rare benign mesenchymal lesion which presents either antenatally or within the first 3 months of age. FLIT is a circumscribed solid-cystic mass which histologically resembles the fetal lung during the canalicular stage at 20-24 weeks of gestation. It is composed of immature mesenchymal cells expanding the interstitium and irregular airspace-like structures. Of all published cases, only 1 identified an α2-macroglobulin (A2M)::anaplastic lymphoma kinase (ALK) fusion and all cases underwent surgical resection in the neonatal or infancy period. We present the second case of FLIT with an A2M::ALK fusion diagnosed postnatally in a neonate which partially regressed spontaneously during conservative management with interim resection at 39 months of age, and provide a review of the literature.

Surgical intervention for vertebral metastases may benefit lung cancer patients no less than other patients: a retrospective study

BACKGROUND

Spinal metastasis is considered to have a worse prognosis in lung cancer than in other cancers, but recent clinical studies report improved overall survival of lung cancer. We compared the postoperative prognoses of vertebral metastatic tumors from lung with other types of cancer.

METHODS

From 2011 to 2015, 31 Japanese patients (mean age 73 years, range 55-88 years; 19 males, 12 females) underwent surgery for spinal metastasis at our center. We observed patients retrospectively in March 2016, dividing them into groups by cancer type: lung (LK group, n = 10); prostate, breast, or thyroid (PB group, n = 12); and other (OT group, n = 9). We compared survival and revised Tokuhashi score, which provides a basis for choosing a treatment course. Neurologic status was graded before and after surgery using the Frankel system.

RESULTS

Mean follow-up was 16.5 months (range 1-62 months). Only seven of 31 patients (22.6%) were alive at final follow-up. Frankel grade significantly improved postoperatively only in the LK (P = 0.01) and PB (P = 0.048) groups. Revised Tokuhashi score differed across groups (P < 0.0001), and was significantly lower in the LK group than in the PB group (P = 0.00) and OT group (P = 0.02). Postoperative survival was significantly shorter in the LK group than in the PB group (P = 0.01) but did not differ between the LK and OT groups.

CONCLUSIONS

The revised Tokuhashi score may underestimate the survival of lung cancer patients, who may derive the same benefit from surgical intervention as those with vertebral metastasis from other cancer types.

A Congenital Peribronchial Myofibroblastic Tumor Detected in a Premature Infant at 28 Weeks but That Resolved in the Late Stage of Pregnancy: A Case Report

A congenital peribronchial myofibroblastic tumor (CPMT) is a rare benign tumor arising from the lungs. Although CPMT is a benign tumor, it is characterized by rapid growth, and is easily misdiagnosed during the prenatal period when the symptoms are nonspecific. The authors present a rare case of CPMT in a premature infant, which was detected at 28 weeks on ultrasonography (US) but resolved at a later stage of pregnancy. The knowledge concerning the diagnosis and management of CPMT is reviewed. Herein, the authors report of a 30-minute-old premature newborn infant in whom a pulmonary mass was discovered 1 month before delivery. Maternal prenatal US demonstrated a 0.8 × 1 cm well-defined oval-shaped mass in the left hemithorax in the 28th week of gestational age. The pulmonary mass, however, was not apparent on repeat US examination at 32 weeks. The child was delivered by cesarean section at 34 weeks estimated gestational age. Chest radiography and computed tomography revealed a mass-like lesion in the left lower pulmonary lobe. The chest computed tomography characteristics of the tumor included large size (4 cm), an irregular margin, and surrounding ground-glass opacity, which led to misdiagnosis as a malignant tumor. The patient underwent a left inferior lung lobectomy and was pathologically diagnosed with CPMT. He is currently alive 12-month postresection with no evidence of disease recurrence.The authors report this rare case of CPMT, which was detected at 28 weeks and resolved at a later stage of pregnancy. Congenital peribronchial myofibroblastic tumor is an uncommon benign tumor. Lobectomy or pneumonectomy is often required. The prognosis after surgery is good.

Congenital peribronchial myofibroblastic tumor: case report of an asymptomatic infant with a rapidly enlarging pulmonary mass and review of the literature

BACKGROUND

Congenital peribronchial myofibroblastic tumor (CPMT) is a rare, benign lung tumor of infants, with only 19 reported cases worldwide. It is often diagnosed by prenatal imaging or in the immediate postnatal period due to co-morbidities like polyhydramnios, fetal hydrops, respiratory distress, and heart failure.

OBSERVATION

We report the oldest known infant (8 weeks old) diagnosed with CPMT, and present his clinical course including the relevant radiographic and histopathologic findings.

CONCLUSIONS

CPMT is a rare tumor that should be considered among other primary lung tumors of infancy (developmental, benign, and malignant) even if not detected prenatally or in the immediate postnatal period.

Congenital pulmonary fibrosarcoma in a newborn with hypoglycemia and respiratory distress: case report

Although primary bronchopulmonary fibrosarcoma is a rare tumor, it may be characterized by the symptoms of acute respiratory distress occurring during the first moments of life in a newborn. It is one of the leading congenital malignant neoplasms of the lung, but is considered a borderline tumor since its biological behavior is much more favorable than that of adult fibrosarcomas. In the absence of metastases, complete resection is curative. Histopathological diagnosis is not simple, as the microscopic characteristics may be confused with benign fibromatosis or malignant mesenchymal neoplasms. In this case report, we present a case of congenital pulmonary spindle cell tumor showing the features of fibrosarcoma, and we discuss the differential diagnosis of spindle cell lesions localized within the thorax.

[Congenital intrapulmonary lymphangioma and pulmonary hemangioma in 5 infants and young children]

OBJECTIVE

To analyze the clinical, imaging and pathological findings of congenital intrapulmonary lymphangioma and hemangioma in 5 infants and young children.

METHOD

Data of 3 cases with congenital intrapulmonary lymphangioma and 2 cases with haemangioma were analyzed.

RESULT

All the 5 cases had cough, difficulty in breathing, cyanosis of lips, and shortness of breath. Imaging study indicated cystic and space occupying changes of partial lung. In the two cases of hemangioma, the blood vessels passing through the hemangioma were observed on CT films. Histochemical studies showed that the cystic pockets from removed tissues were different in size and there was a line of flat endothelial tissue around these pockets. Immunochemical studies indicated D2-40 positive, factor VIII weak positive for lymphangioma cases; while in hemangioma cases, factor VIII was positive, D2-40 was negative or weakly positive, and both of cytokeratin was negative.

CONCLUSION

It is very important to consider and identify congenital intrapulmonary lymphangioma or hemangioma when a patient has cystic pockets and space occupying change in their lung by imaging and pathological studies.

Fetal hydrops associated with congenital pulmonary myofibroblastic tumor

Abstract We report on a fetus with a congenital pulmonary myofibroblastic tumor, the prenatal detection of which with imaging modalities has not been reported up until now. A 32-year-old woman was referred to our hospital at 29 weeks' gestation because of severe fetal hydrops. Sonograms and magnetic resonance imaging showed a large solid tumor in the left thorax. The fetus died in utero the next day. Autopsy confirmed that the tumor was confined to the lower lobe of the left lung, and circulatory insufficiency from compression by the tumor was considered to be the cause of fetal hydrops and demise. Histologic examination revealed that the tumor was composed of uniform short spindle cells with no atypia and a large number of vessels. In addition, with immunohistochemical studies, the tumor cells were stained for calponin but not for cluster differentiation (CD)-31, CD-34, alpha-smooth muscle actin or S-100.

Perfusion abnormalities in congenital and neoplastic pulmonary disease: comparison of MR perfusion and multislice CT imaging

The aim of this work was to assess magnetic resonance (MR) perfusion patterns of chronic, non-embolic pulmonary diseases of congenital and neoplastic origin and to compare the findings with results obtained with pulmonary, contrast-enhanced multislice computed tomography (CT) imaging to prove that congenital and neoplastic pulmonary conditions require MR imaging over the pulmonary perfusion cycle to successfully and directly detect changes in lung perfusion patterns. Twenty-five patients underwent concurrent CT and MR evaluation of chronic pulmonary diseases of congenital (n=15) or neoplastic (n=10) origin. Analysis of MR perfusion and contrast-enhanced CT datasets was realized by defining pulmonary and vascular regions of interest in corresponding positions. MR perfusion calculated time-to-peak enhancement, maximal enhancement and the area under the perfusion curve. CT datasets provided pulmonary signal-to-noise ratio measurements. Vessel center-lines of bronchial arteries were determined. Underlying perfusion type, such as pulmonary arterial or systemic arterial supply, as well as regions with significant variations in perfusion were determined statistically. Analysis of the pulmonary perfusion pattern detected pulmonary arterial supply in 19 patients; six patients showed systemic arterial supply. In pulmonary arterial perfusion, MR and multislice CT imaging consistently detected the perfusion type and regions with altered perfusion patterns. In bronchial arterial supply, MR perfusion and CT imaging showed significant perfusion differences. Patients with bronchial arterial supply had bronchial arteries ranging from 2.0 to 3.6 mm compared with submillimeter diameters in pulmonary arterial perfusion. Dynamic MR imaging of congenital and neoplastic pulmonary conditions allowed characterization of the pulmonary perfusion type. CT imaging suggested the presence of systemic arterial perfusion by visualizing hypertrophied bronchial arteries.

[Benign and malignant pulmonary tumors in childhood]

Pulmonary tumors in children are rare. Nevertheless, there are besides malign primary neoplasms and metastases also some benign tumors that the radiologist should know. The identification of some tumors is difficult, since some of them may mimic pulmonary inflammation. The first diagnostic tool is chest radiography. After that, a CT with contrast medium should be performed, if possible a multislice-CT (MSCT). Identification of mediastinal structures is best with MRI.

Congenital pulmonary capillary hemangiomatosis: Report of two cases and review of the literature

Pulmonary capillary hemangiomatosis (PCH) is a rare disease characterized by pulmonary hypertension and excessive neovascularization within the pulmonary interstitium, vasculature, and airways. We describe two unusual cases of congenital PCH. Both cases had concurrent anomalies, including renal and urinary bladder agenesis and hypertropic cardiomyopathy. In one case, capillary proliferation caused significant impingement of the proximal bronchial airways. A review of the current literature is described.

Diffuse neonatal haemangiomatosis: a rare cause of haemorrhagic shock and refractory coagulopathy in the newborn

A term newborn infant developed hypovolaemic shock shortly after birth. She was pale with gross hepatomegaly. She required multiple boluses of intravenous fluids, blood products as well as inotropic support. Blood investigations showed persistent thrombocytopenia, anaemia and disseminated intravascular coagulopathy (DIC). She also developed heart failure. She finally succumbed on the eleventh day of life. Autopsy revealed haemangiomatosis involving the liver, lungs, gastrointestinal tract, kidneys and adrenals.

[Congenital pulmonary fibrosarcoma. Differential diagnosis of infantile pulmonary spindle cell tumors]

Primary pulmonary mesenchymal tumors are rare causes of intrathoracic lesions in newborns. We describe a case of pulmonary spindle-cell tumor with features of infantile fibrosarcoma and discuss the differential diagnosis of spindle-cell lesions in this location. In view of further case reports of the literature, this neoplasia can best be categorized in a spectrum of fibroblastic/myofibroblastic differentiated spindle-cell tumors, with excellent prognosis. Especially in congenital lesions a favorable clinical course is to be expected after complete surgical resection. Additional radio- and/or chemotherapy is not recommended.

Diffuse neonatal haemangiomatosis

A newborn girl with severe diffuse neonatal haemangiomatosis is described. She was treated with high dose systemic corticosteroids and high dose interferon-alpha-2a, but with fatal outcome. A review of the current literature is presented.

Hereditary melanoblastoma in miniature pigs and its successful therapy by devitalization technique

Applying selective breeding for 10 years we established the MeLiM (Melanoblastoma-bearing Libechov Minipigs) strain. Melanoblastoma (MB) in this strain shows a hereditary occurrence. Cutaneous tumours are usually nodular, multiple and distributed on various parts of body. They appear in darkly pigmented animals already at the birth or during two months thereafter (57% of all animals). Numerous organ metastases mainly into the spleen, lymph nodes and lungs are regularly ascertained in animals with cutaneous MB. Tumour cells were surprisingly found also in the inner organs of phenotypically healthy minipigs in which no cutaneous MBs were observed visually (27% of all animals). About 34% of all affected piglets die during the first 2 months of age. These features document a malignancy of this tumour in the MeLiM strain. Original surgical technique was applied in more than 40 affected minipigs at 1-2 months of age. It consists in a devitalization (ischemization) of one of cutaneous tumours by the mattress sutures conducted around the tumour base without any excision of tumour tissue. This simple procedure causes a total destruction of MB cells in all cutaneous tumours as well as in all organ metastases during 4-6 months. Animals treated by this technique were fully healed of tumour cells and no relapses were observed. This technique could bring similar positive results also in therapy of human MB.

[Primary lung tumors in childhood]

The authors give an account of their experience with the treatment of primary lung tumours in children during 1989-1998. Primary lung tumours in children are extremely rare and represent a varied spectrum of pathological conditions (pneumoblastoma, rhabdomyosarcoma, mucoepidermoid carcinoma, pulmonary endodermal tumour and benign tumours). During the mentioned period 10 children were operated on account of primary lung tumours, 5 with malignant tumours and 5 with benign tumours. In these patients during the above period 3 pneumonectomies, 5 lobectomies and 3 segmental resections were made. Chemotherapy was indicated in children with pneumoblastoma and rhabdomyosarcoma. Two patients with pneumoblastoma died, 3 children with malignant and 5 children with benign tumours live without symptoms of the disease.

Congenital hemihypertrophy and epithelioid haemangioendothelioma in a 10-year-old boy: a case report

Epithelioid haemangioendothelioma has not been previously described in a patient with congenital hemihypertrophy and diabetes mellitus. Hepatic nodules were incidentally discovered on a routine US examination searching for known associated abnormalities. Pulmonary nodules were present on chest X-ray and CT of the lungs. The diagnosis was confirmed by open biopsy of a hepatic nodule. Despite significant disease progression the patient remains symptom free.

[Rhabdoid tumor of the kidney arising in a newborn infant: description of a case with ultrastructural observations]

INTRODUCTION

Rhabdoid tumour of the kidney is a new independent entity. Before it was considered a variant of Wilms tumor of the kidney. Now we have enough parametres to define the rhabdoid tumor: immunohistochemistry positive by the vimentin, special histological features and behaviour.

CASE

We report a very aggressive case of rhabdoid tumor found in a two week old infant.

RESULTS

We studied aspects of histology and histochemistry. We found a positivity for vimentin and many cells in apoptosis.

DISCUSSION

The mild positivity for vimentin and the high number of cells in apoptosis suggest a relationship between apoptosis and behaviour.

NICU guidelines for nursing care of the infant with congenital malignancies

Cancer is a rare occurrence among neonates. NICU nurses must have the knowledge base and skills to comfortably and competently care for infants with this disease and their families. This case study provides an overview of neonatal malignancies and a review of clinical management and chemotherapeutic treatments.

Rhabdomyomatosis of the newborn lung unassociated with other malformations

AIMS

To describe a case of rhabdomyomatosis of the lung unassociated with other external or visceral malformations in a newborn infant.

METHODS AND RESULTS

A 26 weeks gestation newborn male with no relevant medical or family history presented a well-circumscribed solid area in the posterior mediastinum occupying the upper lobe of the right lung. The possibility of neuroblastoma or an extralobar pulmonary sequestration were excluded after laboratory and arteriographic studies. No visceral anomalies were found. At the age of 9 months the patient underwent a partial lobectomy, and he is free of disease 39 months after surgery. Histological examination demonstrated the presence of numerous bundles of striated fibres arranged haphazardly in the pulmonary interstitium in a background of a type-II congenital cystic adenomatoid malformation-like morphology of the resected lung.

CONCLUSION

The presence of striated muscle fibres in the lung not necessarily represents a lethal congenital malformation. As this case shows, rhabdomyomatosis of the lung can affect a single pulmonary lobe, and resection of the affected lung parenchyma may be curative. It is important for pathologists to be aware of this entity, although it is exceptional, and to include it in the differential diagnosis of pulmonary masses in the newborn lung.

[Radiologic appearance of primary anomalies of the lymphatic vessel system of the lung. Review and personal results]

Congenital disorders of the lymphatics of the lung are rare. On the basis of a literature review and our own experiences the disorders are divided into four groups and their radiographic findings are described. Pulmonary lymphangiectasia shows not typical signs. As an expression of the underlying pathophysiologic processes CT shows thickening of interlobular septs, interstitial edema and pleural effusions. Neither architectural distraction nor thickening of intralobular septs was seen. Lymphangioleiomyomatosis shows rather typical findings with multiple thin-walled bullae. In contrast to the opinion that architectural distraction is not seen in LAM we sometimes found signs of fibrosis. Disseminated pulmonary lymphangioma is characterised by proliferation of lymph vessels. CT-findings of this disorder have not been described before. CT shows multiple disseminated nodules of up to 2.5 cm accompanied by multiple bullae of similar distribution and size.

Congenital pulmonary myofibroblastic tumor: a case report with cytogenetic analysis and review of the literature

We report a case of congenital pulmonary myofibroblastic tumor, and review prior reports of this rare neoplasm to demonstrate its clinically benign behavior despite histologic features previously interpreted as sarcoma. The patient, a female neonate, presented with severe respiratory distress after cesarean section delivery. A large radio-opaque mass was detected in the right hemithorax and resected by right bilobectomy. The tumor mass, confined to the lung, was composed of interlacing fascicles of plump spindle cells showing myofibroblastic differentiation and complex cytogenetic abnormalities. Though sarcomatous in appearance, with highly cellular areas and numerous mitoses, there has been neither tumor recurrence nor metastases. The patient remains alive and well 1 year after surgery. Review of the few other reported cases confirms the uniformly benign behavior of this tumor.

Pulmonary blastoma as a unique cause of fatal respiratory distress in a newborn

Pulmonary blastoma is a very rare malignant primary lung neoplasm, especially in the pediatric population. No more than 50 cases have been described in children, with none if these children diagnosed before the age of 1 month. Speculation regarding its congenital nature has been made. Although is has a uniformly poor prognosis, the case presented is that of congenital pulmonary blastoma as a unique cause of fatal respiratory distress in a neonate.

Congenital peribronchial myofibroblastic tumor (so-called "congenital leiomyosarcoma"). A distinct neonatal lung lesion associated with nonimmune hydrops fetalis

An unusual solid tumor composed of myofibroblasts in an infant with nonimmune hydrops fetalis is presented together with a review of previous cases reported under a variety of different names, most notably congenital leiomyosarcoma. Immunocytochemical, ultrastructural, and flow cytometric data plus an analysis of fetal lung specimens from various times during lung development suggest that this tumor arises from the condensed mesenchyme that surrounds those respiratory ducts that go on to form large bronchi. Because of its age of onset, cellular composition, and benign biological behavior we believe that this tumor is analogous to two other congenital myofibroblastic tumors, congenital mesoblastic nephroma, and spindle cell tumor of the intestinal tract. Although the term myofibroblastoma has gained popularity in recent reports describing localized proliferations of myofibroblasts in adults, we would like to emphasize the unique developmental origin of this lesion and suggest the term congenital peribronchial myofibroblastic tumor.

Metastasizing cervical teratoma of the fetus

We present one case with a metastasizing cervical teratoma in a newborn infant who died of respiratory failure due to extensive cervical tumor masses and multiple pulmonary tumor metastases. This case provides evidence that very rarely malignant behavior may occur in congenital cervical teratomas, the prenatal diagnosis of which may be important for any further therapeutic management.

Surgical treatment of congenital bronchopulmonary disease in children

From 1987 to 1992, 22 children (age 0 days-14 years) were operated for congenital bronchopulmonary disease. One patient had a hamartoma. Four children had a bronchogenic cyst, in 1 patient combined with an esophageal duplication. Intrapulmonary sequestration was diagnosed in 3 children; one of whom had an esophageal duplication as well. Four children had localized emphysema. In 1 patient histology showed rhabdomyosarcoma. A lobectomy was performed following chemotherapy but recurrence was not resectable at a third thoracotomy. Ten patients had cystic adenomatoid malformation, 6 were dependent on artificial ventilation before surgery. Three patients with cystic adenomatoid malformation died in hospital: 2 after pneumonectomy who were shown to have bilateral disease and 1 died after bilobectomy and was shown to have a hypoplastic contralateral lung. Hospital morbidity involved 1 patient with recurrent pneumothorax, 2 with atelectasis of the operated lung and 3 with prolonged artificial ventilation. Late mortality involved 1 patient due to pulmonary rhabdomyosarcoma. After 1-26 months of follow-up there were no late complications. Adequate multidisciplinary treatment allows acceptable mortality and low morbidity in surgery for congenital bronchopulmonary disease in children.

Lymphangioma of the lung associated with respiratory distress in a neonate

Congenital pulmonary lymphangioma involving the entire left lower lobe in a newborn is reported. Respiratory distress was the presenting symptom. Radiography was suggestive of congenital diaphragmatic hernia or congenital cysts of the lung.

[Congenital lymphangioma of the lung]

A congenital lymphangioma of the lung in a newborn is described for the first time. The aetiology and pathogenesis are discussed and various aspects of differential diagnosis considered.

Thoracic hemangiomatosis masquerading as interstitial lung disease

Pulmonary capillary hemangiomatosis is an extremely rare condition, first described by Wagenvoort. In this condition, sheets of thin-walled blood vessels infiltrate the lung parenchyma, bronchioles, and pleura. Three previous cases have been described in the literature. We describe a fourth. It probably represents a congenital abnormality.

[Pulmonary blastoma in childhood--a case report and review of the literature]

The paper deals with a pulmonary blastoma with CNS involvement in a young child 2 years after resection of congenital cysts from the other lung. Further 25 pulmonary blastomas in infants are compiled from the literature serving as the basis for a discussion of epidemiology, pathogenesis, classification, definition and prognosis as well as diagnostic and therapeutic problems involved in these rare malignant lung tumours.

Cystic hamartomata of lung and kidney: a spectrum of developmental abnormalities

We report on a developmental malformation of the lung and kidney which has not been previously described and which we have chosen to call "cystic hamartomata of the lung and kidney" to emphasize the non-malignant nature of these lesions. We also confirm a previous case report by Weinberg and Zumwalt [1977] as a different distinct disorder that results in a multifocal cystic hamartomata of the lung with associated marked parenchymal overgrowth of the kidney (the Weinberg-Zumwalt syndrome). These cases represent a spectrum of abnormal morphogenesis affecting both kidney and lung. Patients 1 and 2 presented during infancy with abdominal masses and hypertension due to bilateral multilocular cysts of the kidney with associated hamartomatous pulmonary cysts; patient 2 also had one area of cellular mesoblastic nephroma. Patient 3 demonstrated markedly hyperplastic renomegaly with medullary dysplasia in association with bilateral cystic hamartomata of the lungs. During the fifth week of gestation, the ureteric bud invades the unsegmented mesoderm that becomes the metanephric system, and the lung bud invades the splanchic mesoderm, which provides the stimulus for its growth. We suggest that the predominant pattern of a congenital kidney or lung hamartoma might reflect the timing of a prenatal neoplastic event affecting these developmental processes.

[Congenital generalized fibromatosis. Presentation of a case and review of the literature]

We report a case of congenital generalized fibromatosis in a newborn who presented with a solitary subcutaneous tumour, developing subsequently a widespread generalization (soft tissues, bone and lung). The tumours were found to be fibromatosis pathological on study. A review of the literature related to the clinic aspects and to the prognosis is made.

Pulmonary sequestration and congenital cystic adenomatoid malformation in an infant

Pulmonary sequestration and congenital cystic adenomatoid malformation (CCAM) are individually well known but infrequent congenital malformations of the lung. We report a rare case of pulmonary sequestration and CCAM occurring concurrently in the same infant.

Neurofibromatosis and associated neuroectodermal tumors: a congenital neurocristopathy

The synchronous occurrence of neurofibromatosis and neuroblastoma has been labeled in the recent literature as a chance event. We report 2 cases of newborn infants with congenital neurofibromatosis and a similar midline pattern of multiple Schwann cell and neuroblastic tumors; other types of ectomesenchymal tumor differentiation are documented, along with supportive ultrastructural and immunohistochemical studies. The tumors may take an aggressive, fatal course despite maximal multimodality antitumor therapy. These 2 cases are reported, with additional literature review, to document a clinically recognizable neurocristopathy that links neuroblastic tumors and neurofibromatosis.

Congenital adrenal tissue in the lung with adrenal cytomegaly. Case report and review of the literature

Adrenal cytomegaly is a cellular abnormality found in the fetal and neonatal adrenal gland. It is characterized by large polyhedral cells with granular eosinophilic cytoplasm and irregular pleomorphic nuclei. A case of bilateral adrenal cytomegaly in five-day-old infant with two foci of pulmonary involvement is reported with a review of the literature. The question of whether the pulmonary lesion represents metastasis or cytomegalic change in ectopic adrenal tissue is discussed.

Pulmonary blastoma, a true congenital neoplasm

An infant, after a difficult delivery, had X-ray shadowing in the right lung. After 32 days sudden death occurred, a pulmonary blastoma being found at autopsy. The controversy over whether this tumour is a blastoma or a carcinosarcoma is discussed and arguments are advanced for acceptance of the designation pulmonary blastoma when the tumour occurs in infancy and childhood. When the equivalent tumour occurs in adults with or without the addition of areas of carcinoma and/or sarcoma, the title 'mixed tumour of lung' should replace the term carcinosarcoma.

Rhabdomyomatous dysplasia of lung and congenital diaphragmatic hernia

A previously unrecognized association of pulmonary rhabdomyomatous dysplasia and congenital posterolateral diaphragmatic hernia is reported. The authors subscribe to the concept of ectopia and postulate an anomalous migration of cervical "diaphragmatic" rhabdomyoblasts as the most probable origin of the pulmonary muscle fibers.

Diffuse striated muscle heteroplasia of the lung. An autopsy case

We studied a diffuse, striated muscle heteroplasia in the lungs in a 20-week-old stillborn fetus. The lung was small, but retained normal shape. There was no tumefaction. Histologically, a massive and diffuse distribution of the striated muscle cells was found among the interstitia of the dysplastic lung, representing solid adenomatoid malformation. Based on the findings in this case and the cases of others, we believe that the presence of the striated muscle and adenomatoid malformation are causally related, and the striated muscle cells arise from the heteroplastic transformation of the pluripotential embryonal mesenchymal cells.