Cystic lung lesions in the pediatric and adult population: surgical experience at the Brompton hospital

Background. Cystic lung lesions are found in the adult and pediatric populations. We present our 19-year experience with such lesions from a single institution. Methods. We retrospectively reviewed our experience with such lung pathology, comparing the pediatric and adult populations with regard to their spectrum of pathology, presentation, surgical procedures, and postoperative morbidity and mortality. Results. Forty-six operations were performed on 44 patients (24 children and 20 adults). Cystic adenomatoid malformation was the most common pathology in the pediatric group (53.9%), followed equally by simple cysts and sequestrations (15.4%). In three of the pediatric patients malignant features were identified after resection; bronchoalveolar carcinoma in 2 patients with cystic adenomatoid malformation and pleuropulmonary blastoma in 1 patient with bilateral cystic disease. In the adult population the most common pathology was simple cysts in 8 (40%), followed by cystic adenomatoid malformation in 5 (25%) and sequestrations in 2 patients (10%). The majority of the children, 16 (61.5%), required operation because of expanding or infected cysts, recurrent cysts, or chest infections; 4 were operated on as an urgent basis. In contrast, the majority of adults 11 (55%) were asymptomatic or had no specific symptoms, and all operations were elective. A larger number of major resections (65.4% versus 55%) were necessary in the pediatric group, possibly due to differences in the pathology. However, morbidity was comparable in the two groups with no mortality. Conclusions. Operation for cystic lung disease is safe. Asymptomatic cysts in children should be resected to avoid later complications of the cysts, which could make operation more difficult. Patients should be evaluated for associated congenital anomalies. Conservative anatomic resections should be attempted to salvage functional lung tissue. Careful histologic examination of the resection specimen is mandatory to identify occult malignancy.