Lung Pathology: Fellow Case Report Slide: Lung Pathology |

A New Presentation of Placental Transmogrification of the Lung FREE TO VIEW

Faraz Siddiqui, MBBS; Zulfiqar Ali, MBBS; Amina Saqib, MBBS; Michel Chalhoub, MD
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Staten Island University Hospital, Staten Island, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):784A. doi:10.1016/j.chest.2016.08.880
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SESSION TITLE: Fellow Case Report Slide: Lung Pathology

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Monday, October 24, 2016 at 03:15 PM - 04:15 PM

INTRODUCTION: We report the first ever case of Placental Transmogrification of the lung (PTL) presenting as recurrent exudative pleural effusion.

CASE PRESENTATION: A 70 year old smoker male with PMH of DM, HTN, CABG, presented with 2 month history of SOB and no other complaints. His vitals were stable and exam was only remarkable for decrease breath sounds at right base. CXR showed right sided pleural effusion (fig A). Thoracentesis yielded 800 ml of amber colored fluid. Repeat CXR showed incomplete lung expansion (fig B). Fluid analysis revealed pH 7.3, RBC 646000, WBC 4922 ( 48% lymphocytes, 24% neutrophils, 3% eosinophils, 25% macrophages), LDH 2695, protein 3.0 and glucose <5. Infectious, oncological and rheumatological workup was negative. He was discharged home. Symptoms recurred 3 months later. CT chest showed recurrence of right sided pleural effusion (fig C). 1200 ml of exudative fluid was drained by interventional radiology. Repeat workup was again negative. An out patient PET scan was normal and he refused pleural biopsy. Pleural effusion recurred again in 8 weeks and he was sent for surgery. A 18 x 12 cm fluid filled cyst with adhesive attachments to pericardium and diaphragm was removed. Histopathological analysis showed chorionic villi like structures confirming diagnosis of Placental Transmogrification of the lung (fig D). He remained asymptomatic 6 months post surgery.

DISCUSSION: PTL is a rare disease of unknown pathogenesis discovered in 1979. It resembles, morphologically, to placental villi. Histologically, villi in PTL correspond to alveolar walls enlarged by deposition of adipose tissue containing fibroblast & dilated capillaries. Risk factors are male gender and smoking. It is considered a benign disease with single case of malignant transformation. Differential diagnosis includes bullous emphysema, congenital cystic adenomatoid malformation, bronchogenic cyst and cystic lung tumors1. Most common radiological presentation is bullous emphysema but pneumothorax, nodular and cystic lesions have been reported. CT is the imaging modality of choice but diagnosis requires excision and histopathological examination2. Surgical resection is curative.

CONCLUSIONS: In conclusion, despite being rare, PTL should be considered in the differential diagnosis of exudative lymphocytic pleural effusions.

Reference #1: 1. Hochhegger B, Camargo S et al (2015) Placental Transmogrification of the lung. Lung 193:855-857

Reference #2: 2. Kim JW, Park IH, Kwon W et al (2013) Placental transmogrification of the lung. Korean J Radiol 14(6):977-980

DISCLOSURE: The following authors have nothing to disclose: Faraz Siddiqui, Zulfiqar Ali, Amina Saqib, Michel Chalhoub

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