Online Images in the Medical Sciences| Volume 364, ISSUE 4, e1, October 2022

Congenital cystic adenomatoid malformation in an adult

      A 68-year-old woman presented with an asymptomatic mass in the lung that had been detected on computed tomography (CT) during a physical screening. She had no history of hemoptysis and was otherwise well. Tumor markers were normal, including carcino-embryonic antigen (CEA), squamous cell carcinoma antigen (SCC-Ag), neuron-specific enolase (NSE) and cytokeratin 19 fragment antigen 21-1 (CYFRA21-1). Chest CT demonstrated an irregular mass with internal punctate air in the right inferior lobe, with a maximum diameter of 3.3 cm (Fig. 1A). Contrast enhancement CT showed slightly enhancement, with microvessels passing through the lesion (Fig. 1B). Thoracoscopic wedge resection of the right inferior lobe was performed, and abundant bronchus-like structures were found in the mass. Histopathology (Fig. 1C) indicated congenital cystic adenomatoid malformation (CCAM), with the following immunohistochemistry results (Fig. 1D): CK7 (+), TTF-1 (+), NapsinA (+), EMA (+), Ki-67 (10% +), P63 (+), CK5/6 (+). The patient was feeling well at 5-month follow-up.
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