High risk of malignancy in neonates with cystic pulmonary abnormalities and no antenatal findings.

Abstract

Background: The postnatal management of pulmonary malformations is still controversial, especially in terms of indication and timing for surgery. Despite being rare, neonatal lung tumors should be included in the differential diagnosis in case of neonatal pulmonary abnormalities. The aim of this study is to evaluate if the absence of antenatal findings should be considered a risk factor for malignancy in patients with lung abnormalities at postnatal imaging.

Methods: The medical records of neonatal patients undergone surgery for pulmonary abnormalities in our hospital, over a period of 5 years (2017-2021), were retrospectively reviewed. Histological diagnosis and presence of findings at prenatal scans were recorded. A literature review on this topic was also conducted.

Results: Histological diagnosis was pulmonary primary malignancy in 3 cases (2 pulmonary blastomas, 1 fetal lung interstitial tumor), the remaining 20 were diagnosed as pulmonary malformations. We recorded that 100% of our patients affected by lung tumor had no abnormalities at prenatal scans. Three papers reporting similar results were found in literature.

Conclusions: Differential diagnosis among neonatal cystic abnormalities is challenging. When a cystic lung lesion is present in infants who had no abnormalities at standard antenatal scans, a malignancy should be considered.