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Chen Y, Chen H, Yu R, Zeng X, Tian D, Pu Q, Liu Y. Pulmonary blastoma is successfully treated with immunotherapy and targeted therapy. Lung Cancer 2024; 189:107476. [PMID: 38280290 DOI: 10.1016/j.lungcan.2024.107476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/29/2024]
Abstract
Pulmonary blastomas (PB) are an extremely rare type of lung cancer. Currently, no standard treatment exists for PB. Immunotherapy with checkpoint inhibitors and anti-angiogenesis treatments has been an effective method for lung cancer; however, studies on PB treatment are lacking. Herein, we present a case report of successful conversion therapy with immunotherapy and targeted therapy for PB. After receiving treatment with a PD-1 inhibitor (penpulimab) and a multi-target tyrosine kinase inhibitor (anlotinib) treatment, the patient showed an impressive response and underwent a successful operation. We also summarized and reviewed literature reports on PubMed from January 1, 2000, to December 31, 2022, using the keyword "pulmonary blastoma", discussing the efficacy and specifics of chemotherapy and radiotherapy. Immunotherapy, in combination with targeted therapy, should be considered a potential therapeutic strategy for PB.
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Affiliation(s)
- Yicong Chen
- Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Huijiao Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruixuan Yu
- Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoxiao Zeng
- Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, China; Department of Oncology, The People's Hospital of Jianyang City, Jianyang, Sichuan 641400, China
| | - Dong Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yongmei Liu
- Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
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2
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Yao H, Jiang X, Zeng Y, Wang X, Tang X. Classic biphasic pulmonary blastoma: A case report and review of the literature from 2000 to 2022. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:1103-1116. [PMID: 37772674 PMCID: PMC10632085 DOI: 10.1111/crj.13701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
Classic biphasic pulmonary blastoma (CBPB), a distinct type of lung cancer, is a dual-phasic tumor characterized by the co-existence of low-grade fetal adenocarcinoma and primitive mesenchymal stroma. Accounting for less than 0.1% of surgically removed lung cancers, CBPB commonly presents in individuals during their fourth to fifth decades of life, with smoking as a significant risk factor. The optimal management strategy entails surgical resection, supplemented by chemotherapy to improve prognosis. The frontline chemotherapeutic agents typically include platinum agents and etoposide, with preoperative neoadjuvant chemotherapy potentially enabling operability for initially inoperable cases. In recent years, targeted therapies, such as antiangiogenic agents, have emerged as promising new treatment strategies for CBPB. For patients exhibiting brain metastases or deemed inoperable, radiation therapy proves to be a crucial therapeutic component. CBPB prognosis is adversely affected by factors such as early metastasis, tumor size exceeding 5 cm, and tumor recurrence. In this regard, serological markers have been identified as valuable prognostic indicators. To exemplify, we recount the case of a 44-year-old female patient with CBPB, wherein serum lactate dehydrogenase levels showed significant diagnostic value. This report further incorporates a comprehensive review of CBPB literature from the past 22 years.
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Affiliation(s)
- Hui Yao
- Department of PathologyChongqing General HospitalChongqingChina
| | - Xin Jiang
- Department of PathologyChongqing General HospitalChongqingChina
| | - Ying Zeng
- Department of PathologyChongqing General HospitalChongqingChina
| | - Xue Wang
- Department of PathologyChongqing General HospitalChongqingChina
| | - Xuefeng Tang
- Department of PathologyChongqing General HospitalChongqingChina
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3
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Zang B, Ding L, Liu L, Arun Kumar S, Liu W, Zhou C, Duan Y. The immunotherapy advancement targeting malignant blastomas in early childhood. Front Oncol 2023; 13:1015115. [PMID: 36874100 PMCID: PMC9978522 DOI: 10.3389/fonc.2023.1015115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/12/2023] [Indexed: 02/18/2023] Open
Abstract
Malignant blastomas develop relentlessly in all functional body organs inflicting severe health ailments in younger children. Malignant blastomas exhibit diverse clinical characteristics in compliance with their emergence in functional body organs. Surprisingly, neither of these preferred treatment types (surgery, radiotherapy, and chemotherapy) showed promise or were effective in treating malignant blastomas among child patients. N ew, innovative immunotherapeutic procedures including monoclonal antibodies and chimeric-antigen based receptor (CAR) cell therapy, coupled with the clinical study of reliable therapeutic targets and immune regulatory pathways targeting malignant blastomas, have attracted the attention of clinicians recently.
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Affiliation(s)
- Bolun Zang
- Henan Provincial Key Laboratory of Pediatric Hematology, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Luyue Ding
- Henan Provincial Key Laboratory of Pediatric Hematology, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Linlin Liu
- Henan Provincial Key Laboratory of Pediatric Hematology, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Senthil Arun Kumar
- Henan Provincial Key Laboratory of Pediatric Hematology, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Wei Liu
- Henan Provincial Key Laboratory of Pediatric Hematology, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Chongchen Zhou
- Henan Provincial Key Laboratory of Pediatric Hematology, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Yongtao Duan
- Henan Provincial Key Laboratory of Pediatric Hematology, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou University, Zhengzhou, China
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4
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Xie Y, Su N, Li C, Lei A, Li L, Zou J, Cen W, Hu J. Pulmonary blastoma treatment response to anti-PD-1 therapy: a rare case report and literature review. Front Oncol 2023; 13:1146204. [PMID: 37124510 PMCID: PMC10130361 DOI: 10.3389/fonc.2023.1146204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/28/2023] [Indexed: 05/02/2023] Open
Abstract
Pulmonary blastoma (PB) is a rare and invasive malignancy of the lungs with a poor prognosis. Although the mainstay treatment of PB is surgery, and radiotherapy and chemotherapy have been reported, no standard therapy exists for patients inoperable in advanced stages. Moreover, little is known about driver mutation status and immunotherapy efficacy. This paper presents a male patient diagnosed with classic biphasic PB using CT-guided lung biopsy pathology and immunohistochemistry. The patient's symptoms included cough, chest pain, shortness of breath, hemoptysis, and hypodynamia. The primary focus of this paper is to discuss the impact of anti-PD-1 immunotherapy on PB. The patient experienced progression-free survival (PFS) of over 27 months following sintilimab second-line anti-PD-1 therapy. The patient has currently survived for nearly 40 months with a satisfactory quality of life.
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Affiliation(s)
- Yalin Xie
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
| | - Ning Su
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
- *Correspondence: Ning Su, ; Jinxing Hu,
| | - Chaoxia Li
- Department of Pathology, Guangzhou Chest Hospital, Guangzhou, China
| | - An Lei
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
| | - Lei Li
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
| | - Jianjun Zou
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
| | - Wencang Cen
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
| | - Jinxing Hu
- Department of Internal Medicine, Guangzhou Chest Hospital, Guangzhou, China
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, China
- *Correspondence: Ning Su, ; Jinxing Hu,
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Budzik MP, Panek G, Bińkowska M, Osuch B, Borkowska E, Badowska-Kozakiewicz AM. Pulmonary blastoma in a pregnant woman: a case report and brief review of the literature. BMC Pulm Med 2022; 22:8. [PMID: 34983474 PMCID: PMC8724745 DOI: 10.1186/s12890-021-01804-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary blastoma (PB) comprises a rare heterogeneous group of lung tumours typically containing immature epithelial and mesenchymal structures that imitate the embryonic lung tissue and extremely rarely occurs during pregnancy. Although cough and haemoptysis are the most common PB symptoms, they usually indicate other serious pregnancy-related complications. CASE PRESENTATION The article presents the unusual case of a 22-year-old pregnant woman diagnosed with PB during pregnancy. CONCLUSIONS PB is characterized by poor prognosis and patients' outcome relies on a rapid diagnosis. Surgery remains the most common and effective treatment. Due to the extreme rarity, the literature contains only single mentions of PB in pregnancy, thus its impact on the course of pregnancy and the developing fetus remains unknown.
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Affiliation(s)
- Michał P Budzik
- Department of Gynaecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, 231 Czerniakowska, 00-416, Warsaw, Poland.
- Department of Cancer Prevention, Medical University of Warsaw, 81 Żwirki i Wigury, 02-091, Warsaw, Poland.
| | - Grzegorz Panek
- Department of Gynaecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, 231 Czerniakowska, 00-416, Warsaw, Poland
| | - Małgorzata Bińkowska
- Department of Gynaecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, 231 Czerniakowska, 00-416, Warsaw, Poland
| | - Beata Osuch
- Department of Gynaecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, 231 Czerniakowska, 00-416, Warsaw, Poland
| | - Ewa Borkowska
- Student Scientific Association, Medical University of Warsaw, 1 Oczki, 02-001, Warsaw, Poland
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6
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Park S, Byun J, Song SW, Kim YH, Hong CK, Kim JH. A Rare Case of Metastatic Brain Tumor From Classic Biphasic Pulmonary Blastoma Presented as Intracerebral Hemorrhage. Brain Tumor Res Treat 2021; 9:81-86. [PMID: 34725989 PMCID: PMC8561219 DOI: 10.14791/btrt.2021.9.e13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/23/2021] [Accepted: 08/06/2021] [Indexed: 11/20/2022] Open
Abstract
Pulmonary blastoma is a rare type of primary lung cancer that accounts for only 0.25%-0.5% of all lung malignancies. Pulmonary blastoma consists of three subgroups: classic biphasic pulmonary blastoma (CBPB), pleuropulmonary blastoma, and well-differentiated fetal adenocarcinoma. Due to the rarity of the tumor, metastatic brain tumor from CBPB is extremely rare, and only 13 cases, including our case, have been reported. A 60-year-old woman who underwent left upper lobectomy of the lung because of pathologically diagnosed as CBPB 5 months ago, suddenly lost consciousness and presented with stupor mental status. The emergent CT scan showed a large, 51 mL, intracerebral hemorrhage on left parieto-occipital lobe with midline shifting. The patient underwent emergent craniotomy, and a hypervascular tumor was identified during the operation. Histopathologic examination reported metastatic pulmonary blastoma, CBPB. The patient has been in a vegetative state, but there has been no evidence of recurrence over a 6-month follow-up period. We report a rare case of brain metastasis from CBPB presenting with altered mentality due to massive tumor bleeding. This is the only reported case of brain metastasis from CBPB presenting with acute intracerebral hemorrhage.
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Affiliation(s)
- Sanghyeok Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joonho Byun
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Sang Woo Song
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hoon Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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7
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Pooniya S, McKinnie A, Taylor T, Will M, Wallace W. Classic biphasic pulmonary blastoma (CBPB): a rare primary pulmonary malignancy. BMJ Case Rep 2021; 14:e244151. [PMID: 34376421 PMCID: PMC8356168 DOI: 10.1136/bcr-2021-244151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/04/2022] Open
Abstract
Classic biphasic pulmonary blastoma (CBPB) is a very rare primary pulmonary malignancy with distinctive clinical and pathological features. Usually CBPB presents with either non specific symptoms or is diagnosed incidentally. Histologically CBPB is composed of a mixture of malignant epithelial and stromal cells resembling fetal lung tissue. Surgical resection is the mainstay of treatment with further chemotherapy or radiotherapy on a case-by-case basis. However, due to its rarity, no definite treatment guidelines are available. CBPB overall has a very poor prognosis with a 5-year survival rate of only 15%. Our patient presented with cough and haemoptysis. Her chest radiograph demonstrated a large right-sided lung mass. Further investigations included CT, CT-guided biopsy and PET CT which were discussed at multidisciplinary team meetings. The patient then underwent complete surgical excision. We report this rare malignancy with radiological and pathological features, comparing them with previously reported cases.
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Affiliation(s)
- Shashank Pooniya
- Clinical Radiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Angela McKinnie
- Clinical Radiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Thomas Taylor
- Clinical Radiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Malcolm Will
- Consultant Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William Wallace
- Professor Pathology, Royal Infirmary of Edinburgh, Edinburgh, UK
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8
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Gbande P, Abukeshek T, Bensari F, El-Kamel S. Pleuropulmonary blastoma, a rare entity in childhood. BJR Case Rep 2021; 7:20200206. [PMID: 35047198 PMCID: PMC8749406 DOI: 10.1259/bjrcr.20200206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/29/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022] Open
Abstract
Pleuropulmonary blastoma (PPB) is a rare malignant intrathoracic mesenchymal tumour with a variable aggressiveness. It is the most common primary malignancy in the lung during childhood. In this study, we present a case of a 3-year-old male child who complained of persistent dry cough. Radiographs suggested the diagnosis of PPB, which was been confirmed by the histo-pathological examination of a biopsy taken from the tumour under CT guidance. This case was reported to emphasise the importance of radiology, whether diagnotic or interventional, in diagnosing rare cases such as PPB.
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Affiliation(s)
| | | | - Fouad Bensari
- André Grégoire Intercommunal Hospital Center, Medical Imaging Service, Montreuil, France
| | - Safa El-Kamel
- André Grégoire Intercommunal Hospital Center, Medical Imaging Service, Montreuil, France
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9
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Luo Z, Cao C, Xu N, Ying K. Classic biphasic pulmonary blastoma: a case report and review of the literature. J Int Med Res 2020; 48:300060520962394. [PMID: 33107372 PMCID: PMC7645427 DOI: 10.1177/0300060520962394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/01/2020] [Indexed: 11/15/2022] Open
Abstract
Pulmonary blastoma (PB) is a very rare malignant lung tumor consisting of classic biphasic PB, well-differentiated fetal adenocarcinoma, and pleuropulmonary blastoma. We herein present an unusual case involving a patient with classic biphasic PB who underwent right upper lobe resection and subsequent treatment. No standard treatment guidelines are available for PB because of its rarity. Our patient received nedaplatin plus paclitaxel as adjuvant chemotherapy. After disease recurrence, the patient received two cycles of etoposide-cisplatin and six cycles of pemetrexed, bevacizumab, and carboplatin. Because of severe adverse effects of the chemotherapy, the patient was finally administered anlotinib, a new oral multikinase inhibitor. Both the tumor size and the serum tumor marker concentration decreased. In conclusion, surgical excision is the treatment of choice for PB. Chemotherapy in the present case resulted in PB activity that was consistent with the literature. Targeted therapies including antiangiogenic agents should be considered as a new treatment option for this rare disease.
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Affiliation(s)
- Zhuanbo Luo
- Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Respiratory Disease, Ningbo Hospital, Zhejiang University School of Medicine, Zhejiang University, Ningbo, Zhejiang, China
| | - Chao Cao
- Department of Respiratory Disease, Ningbo Hospital, Zhejiang University School of Medicine, Zhejiang University, Ningbo, Zhejiang, China
| | - Ning Xu
- Department of Respiratory Disease, Ningbo Hospital, Zhejiang University School of Medicine, Zhejiang University, Ningbo, Zhejiang, China
| | - Kejing Ying
- Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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10
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Bu X, Liu J, Wei L, Wang X, Chen M. Epidemiological features and survival outcomes in patients with malignant pulmonary blastoma: a US population-based analysis. BMC Cancer 2020; 20:811. [PMID: 32847556 PMCID: PMC7449001 DOI: 10.1186/s12885-020-07323-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 08/19/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Pulmonary blastoma (PB) is a rare lung primary malignancy with poorly understood risk factors and prognosis. We sought to investigate the epidemiologic features and long-term outcomes of PB. METHODS A population-based cohort study was conducted to quantify the death risk of PB patients. All subjects diagnosed with malignant PB from 1988 to 2016 were screened from the Surveillance, Epidemiology and End Results database. Cox regression model of all-cause death and competing risk analysis of cause-specific death were performed. RESULTS We identified 177 PB patients with a median survival of 108 months. The 5 and 10-year survival rate in all PB patients were 58.2 and 48.5%, as well as the 5 and 10-year disease-specific mortality were 33.5 and 38.6%. No sex or race disparities in incidence and prognosis was observed. The death risk of PB was significantly associated with age at diagnosis, clinical stage, histologic subtype and surgery treatment (p<0.01). On multivariable regression analyses, older age, regional stage and no surgery predicted higher risk of both all-cause and disease-specific death in PB patients. CONCLUSION We described the epidemiological characteristics of PB and identified its prognostic factors that were independently associated with worse clinical outcome.
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Affiliation(s)
- Xiang Bu
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Key Laboratory of Molecular Cardiology, Xi'an, Shaanxi Province, China
| | - Jing Liu
- Key Laboratory of Molecular Cardiology, Xi'an, Shaanxi Province, China.,Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Linyan Wei
- Key Laboratory of Molecular Cardiology, Xi'an, Shaanxi Province, China.,Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Xiqiang Wang
- Key Laboratory of Molecular Cardiology, Xi'an, Shaanxi Province, China.,Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Mingwei Chen
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
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11
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Fluid-filled Cystic Lesions of the Lungs. J Thorac Imaging 2020; 36:208-217. [PMID: 32271279 DOI: 10.1097/rti.0000000000000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A pulmonary cyst usually refers to an air-filled space with a smooth, thin wall. Fluid-filled cystic lesions of the lungs include a range of etiologies such as true cysts, congenital malformations, infections, and benign and malignant neoplasms. With relatively little solid component, these lesions often have similar imaging appearances to one another. This article focuses on key imaging features and clinical characteristics that can be used to narrow the differential diagnosis.
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12
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Kojima K, Yoon H, Sakamoto T, Utsumi T, Sakurai T, Takeuchi N, Takeda M, Kasai T, Atagi S, Matsumura A. Adenocarcinoma with fetal features invading the right superior sulcus treated with neoadjuvant chemoradiotherapy followed by complete video-assisted thoracoscopic right upper lobectomy: a case report. Surg Case Rep 2019; 5:165. [PMID: 31664634 PMCID: PMC6820648 DOI: 10.1186/s40792-019-0737-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fetal adenocarcinoma of the lung is a rare lung neoplasm that accounts for only 0.5% of all primary lung cancers. Because of its rarity, effective treatments for the management of the tumor are poorly understood. We herein report a case of adenocarcinoma with fetal features of the lung with invasion of the right superior sulcus that was treated with neoadjuvant chemoradiotherapy followed by surgical resection. CASE PRESENTATION A 54-year-old man was referred to a medical institution due to right inner forearm pain. On computed tomography of the chest, a 56-mm mass with invasion of right superior sulcus was discovered. Bronchoscopic biopsy revealed non-small cell lung carcinoma. We performed concurrent chemotherapy (2 cycles of cisplatin and vinorelbine) and thoracic radiation therapy (40 Gy in 20 fractions). As the result of extreme tumor reduction after neoadjuvant chemoradiotherapy, we could perform right upper lobectomy by complete video-assisted thoracoscopic surgery. Since no viable cancer cells were detected from the pathological examination of the resected tissue, the specimen obtained by bronchoscopic biopsy was reexamined by immunohistochemistry. The analysis supported a pathologic diagnosis of adenocarcinoma with fetal features. CONCLUSIONS We experienced a case of adenocarcinoma with fetal features of the lung in which the patient showed a complete response to neoadjuvant chemoradiotherapy. In addition, the tumor invading the right superior sulcus was completely resected by video-assisted thoracoscopic lobectomy. Neoadjuvant chemoradiotherapy followed by surgery may be also an effective treatment for advanced-stage high-grade fetal adenocarcinoma of the lung, similarly to other subtypes of advanced-stage primary lung cancer.
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Affiliation(s)
- Kensuke Kojima
- Department of General Thoracic Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan.
| | - Hyungeun Yoon
- Department of General Thoracic Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan
| | - Tetsuki Sakamoto
- Department of General Thoracic Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan
| | - Tomoki Utsumi
- Department of General Thoracic Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan
| | - Teiko Sakurai
- Department of General Thoracic Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan
| | - Naoko Takeuchi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan
| | - Maiko Takeda
- Department of Pathology, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan
| | - Takahiko Kasai
- Department of Pathology, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan
| | - Shinji Atagi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan
| | - Akihide Matsumura
- Department of General Thoracic Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka, 591-8555, Japan
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13
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Lewis JA, Petty WJ, Urbanic J, Bernstein ED, Ahmed T. Cure of Oligometastatic Classic Biphasic Pulmonary Blastoma Using Aggressive Tri-modality Treatment: Case Series and Review of the Literature. Cureus 2018; 10:e3586. [PMID: 30656089 PMCID: PMC6333266 DOI: 10.7759/cureus.3586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pulmonary blastoma is a rare lung cancer classified into three subtypes: classic biphasic pulmonary blastoma (CBPB), well-differentiated fetal adenocarcinoma (WDFA), and pleuropulmonary blastoma (PPB) of childhood. Compared to the other subtypes, CPPB is an aggressive tumor with an overall five-year survival of 16% across all stages. We present two cases of biopsy-proven metastatic CBPB, who have been disease-free for over 10 years since treatment completion. Both patients were treated with surgery to the primary tumor followed by an adjuvant cisplatin-based chemotherapy for four cycles and thoracic radiation. One patient relapsed shortly after the completion of thoracic radiation with brain metastases and underwent craniotomy, gamma knife radiosurgery (GKRS), and whole brain radiation therapy. The other patient presented with synchronous pelvic metastases and underwent metastasectomy after the completion of chemotherapy but before the initiation of thoracic radiation. We review the literature regarding surgical, chemotherapeutic, and radiation treatment for patients with metastatic pulmonary blastoma. Based on our experience and review of the existing case reports, aggressive tri-modality treatment including surgery, chemotherapy with a cisplatin backbone, and a definitive treatment of oligometastatic lesions amenable to local therapy including resection or radiosurgery is reasonable to consider for medically fit patients with CBPB.
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Affiliation(s)
| | - William J Petty
- Internal Medicine, Wake Forest School of Medicine, Winston-Salem, USA
| | - James Urbanic
- Radiation Oncology, University of California San Diego Moores Cancer Center, San Diego, USA
| | | | - Tamjeed Ahmed
- Internal Medicine, Wake Forest School of Medicine, Winston-Salem, USA
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14
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Abstract
Pulmonary sarcomatoid carcinomas belong to a group of neoplasms that remain incompletely understood. They are rare tumors of the bronchopulmonary system that incorporate a wide range of neoplasms that by definition contain a sarcomatoid component characterized by spindle or giant cells. Such classification has led to a heterogenous tumor category that includes neoplasms with different clinical, morphologic, and prognostic features. To date, the histopathologic diagnosis of pulmonary sarcomatoid carcinomas does not require the use of ancillary testing and is based on light microscopic criteria alone. However, with recent advances in immunohistochemical and molecular methods, it is becoming increasingly clear that pulmonary sarcomatoid carcinomas represent poorly differentiated or "dedifferentiated" variants of conventional non-small cell carcinomas with similar immunophenotype and molecular signatures. This review summarizes the latest insights and concepts of these unusual tumors and outlines future directions with emphasis on tumor classification and patient management.
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Classic biphasic pulmonary blastoma: A case report and review of the literature. Crit Rev Oncol Hematol 2018; 125:48-50. [PMID: 29650276 DOI: 10.1016/j.critrevonc.2018.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/12/2018] [Accepted: 02/21/2018] [Indexed: 12/20/2022] Open
Abstract
Pulmonary blastomas represent about 0.5% of primary pulmonary malignancies. The prognosis is poor. Standard treatment consists of surgical excision. There are no published series on which to judge the efficacy of chemotherapy or radiation therapy. We describe an unusual case of classic biphasic pulmonary blastoma (CBPC), with long-term survival despite numerous and varied cancer-related events and review the literature. Our 71-year-old Caucasian woman presented with history of blood in sputum in 2009. Right lower lobectomy yielded a diagnosis of sarcomatoid carcinoma (pneumoblastoma). Unusually, our patient is still alive 7 years after initial surgery, despite metastatic first relapse after 2 years. Metastatic progression was confirmed histologically on three separate occasions during the disease course. The patient received a combination of cisplatin (or carboplatin) and etoposide on three separate occasions. Molecular biology studies of CBPC are needed to identify effective treatments, and a patient registry should be created.
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16
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Jenkins TM, Morrissette JJD, Kucharczuk JC, Deshpande CG. ROS1 Rearrangement in a Case of Classic Biphasic Pulmonary Blastoma. Int J Surg Pathol 2018; 26:360-363. [PMID: 29295663 DOI: 10.1177/1066896917749928] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Classic biphasic pulmonary blastoma (CBPB) is a rare and aggressive type of non-small cell lung carcinoma (NSCLC) presenting in adults in the fourth to fifth decade. The prognosis is poor and after surgical resection, therapeutic options are often limited. ROS1 is a proto-oncogene receptor tyrosine kinase that has been identified in some types of NSCLC. We report a case of a 36-year-old woman with CBPB, which was subsequently found to have a ROS1 rearrangement. This is the first reported case of a ROS1-rearranged CBPB. This finding has therapeutic implications as these tumors have the potential to be treated with receptor tyrosine kinase inhibitors.
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Affiliation(s)
- Taylor M Jenkins
- 1 Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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17
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Abstract
RATIONALE Pulmonary blastoma is a rare primary lung cancer that can be categorized into adult type and child type. The clinical symptoms and imaging features of pulmonary blastoma are nonspecific, making it difficult to diagnose preoperatively. Postoperative pathology with immunohistochemical staining can help diagnosis. PATIENT CONCERNS A 53-year-old male had chest tightness and shortness of breath. DIAGNOSES The patient was diagnosed as pleural pulmonary blastoma based on computed tomography (CT) scan, pathology, immunohistochemistry, and molecular pathology. CT examination showed solid mass on the upper lobe of the left lung Intraoperative observation found that tumor tissue was gray with tough texture. The surrounding lung tissue showed AE1/AE3 (+), Vimentin (+), and CD34 (+) staining. No epidermal growth factor receptor gene mutation was detected. INTERVENTIONS The left lobe resection plus mediastinal lymph node dissection were performed. After the operation, patient received paclitaxel combined with nedaplatin chemotherapy for 4 times. OUTCOMES Four months later, left pleural metastasis, and mediastinal lymph node metastasis was found. The patient died 15 months later. LESSONS Pleural pulmonary blastoma is a malignant tumor with rare pathological features that is easy to relapse and metastasis with poor prognosis. Surgical treatment preferably, lobectomy plus mediastinal lymph node dissection, is the first treatment option. The overall prognosis is poor.
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18
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Nemeh F, Kuo AH, Ross J, Restrepo CS. The Radiologic and Pathologic Diagnosis of Biphasic Pulmonary Blastoma. J Radiol Case Rep 2017; 11:10-21. [PMID: 29299105 PMCID: PMC5743140 DOI: 10.3941/jrcr.v11i9.3153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pulmonary blastomas are rare malignancies, representing 0.25% to 0.5% of all primary lung neoplasms with often aggressive progression and poor prognosis. Clinical management of pulmonary blastomas depends on histologic subtype, staging, and presentation, and may consist of surgery, chemotherapy, and radiation. Biphasic pulmonary blastoma is a subtype of pulmonary blastoma that exhibits biphasic histology, with both epithelial and mesenchymal malignant elements. We report a case of biphasic pulmonary blastoma in a 33-year-old female with 1 pack per day history of smoking for approximately 16 years, who presented with left-sided pleuritic chest pain on deep inspiration without otherwise significant pat medical history. Imaging evaluation using chest radiography, computed tomography, and magnetic resonance imaging identified a heterogenous, well-circumscribed, left lower lobe mass with extensive necrosis and hemorrhage. No lymphadenopathy or distant metastasis was detected through imaging evaluation. Surgical resection of the tumor followed by histopathological analysis confirmed a biphasic pulmonary blastoma.
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Affiliation(s)
- Fadi Nemeh
- Department of Radiology, University of Texas Health and Science Center, San Antonio, Texas, USA
| | - Anderson H Kuo
- Department of Radiology, University of Texas Health and Science Center, San Antonio, Texas, USA
| | - Jenny Ross
- Department of Pathology, University of Texas Health and Science Center, San Antonio, Texas, USA
| | - Carlos S Restrepo
- Department of Radiology, University of Texas Health and Science Center, San Antonio, Texas, USA
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19
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Chen CC, Yang SF, Lin PC, Luo CW, Chou SH, Dai ZK, Yin HL. Pulmonary Blastoma in Children: Report of a Rare Case and Review of the Literature. Int J Surg Pathol 2017; 25:721-726. [PMID: 28675947 DOI: 10.1177/1066896917718622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pulmonary blastoma is a rare malignant lung tumor with aggressive behavior and dismal prognosis. It is extremely rare in children aged <18 years, and little is known about its genetic alteration and pathogenesis. Although surgical resection and adjuvant chemotherapy or radiotherapy have been applied in several cases, no standard treatment guidelines with sufficient evidence have been established. In this article, we report a case of a large pulmonary blastoma in a 7-year-old girl whose initial presentation was progressive dyspnea and productive cough. We subsequently present a review on cases involving young patients as well as genetic analysis data available in the literature.
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Affiliation(s)
- Chia-Chi Chen
- 1 Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheau-Fang Yang
- 1 Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,2 Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Chin Lin
- 1 Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Wen Luo
- 1 Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Hua Chou
- 1 Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zen-Kong Dai
- 1 Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Ling Yin
- 1 Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,2 Kaohsiung Medical University, Kaohsiung, Taiwan
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20
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A 34-Year-Old Pregnant Woman With Cough, Chest Pain, and a Left Upper Lobe Mass. Chest 2017; 150:e87-91. [PMID: 27613995 DOI: 10.1016/j.chest.2016.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 02/28/2016] [Accepted: 03/07/2016] [Indexed: 11/22/2022] Open
Abstract
A 34-year-old white woman who was 30 weeks' pregnant initially presented to her primary care physician with a cough for which she was given antibiotics, but she had persistent symptoms. These were followed by chest pain, as a result of which she was referred to our department. She had a past medical history of hypertension, and currently was in her sixth pregnancy, with no reported complications in the previous pregnancies. Review of systems was otherwise negative. She had a three-pack-year smoking history, but denied smoking during her current pregnancy.
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21
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Brodowska-Kania D, Kotwica E, Paturej A, Sośnicki W, Patera J, Giżewska A, Niemczyk S. What do we know about pulmonary blastoma?: review of literature and clinical case report. NAGOYA JOURNAL OF MEDICAL SCIENCE 2016; 78:507-516. [PMID: 28008207 PMCID: PMC5159477 DOI: 10.18999/nagjms.78.4.507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/06/2016] [Indexed: 11/30/2022]
Abstract
Pulmonary blastoma (PB) is a rare form of lung tumour and is accountable for 0.25-0.5% of primary pulmonary malignancies. Initially pulmonary blastoma was divided into three subtypes: biphasic pulmonary blastoma (BPB) consisting of an epithelial and mesenchymal component, well differentiated fetal adenocarcinoma (WDFA) built of well differentiated epithelium and a mesenchymal component and malignant pleuropulmonary blastoma (PPB). Prognosis in this type of cancer is really poor. We present a current review of literature and a clinical case report. Treatment of PB is very difficult. Data and recommendations about the treatment of pulmonary blastoma are still available therefore we should use only observations and clinical case reports.
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Affiliation(s)
- Dorota Brodowska-Kania
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Ewa Kotwica
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Aleksandra Paturej
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Witold Sośnicki
- Department of General Surgery, Oncology, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Janusz Patera
- Department of Pathology, Military Institute of Medicine, Warsaw, Poland
| | - Agnieszka Giżewska
- Department of Nuclear Medicine, Military Institute of Medicine, Warsaw, Poland
| | - Stanisław Niemczyk
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
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22
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Zhao YY, Liu L, Zhou T, Zhou NN, Yang YP, Hou X, Li Y, Zhao HY, Huang Y, Zhang L. A retrospective analysis of the clinicopathological and molecular characteristics of pulmonary blastoma. Onco Targets Ther 2016; 9:6915-6920. [PMID: 27877056 PMCID: PMC5108598 DOI: 10.2147/ott.s117097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to analyze and summarize the clinicopathological and molecular characteristics of classic biphasic pulmonary blastoma (PB) to improve its diagnosis and treatment. Patients and methods A retrospective analysis was performed in patients who were diagnosed with PB at Sun Yat-Sen University Cancer Center from March 1995 to March 2015. Genomic DNA was profiled using a capture-based targeted sequencing panel. Results Sixteen patients with an average age of 40 years were included in this study. Accurate preoperative diagnosis was very challenging as surgically resected tissues with immunohistochemical staining were required for the diagnosis. Surgery was the optimal treatment for localized disease and there was no standard management for metastatic disease. Mutations were detected among 9 out of the 56 genes profiled, including BRCA2, ERBB4, ALK, MET, BRAF, RAF1, PTEN, EGFR, and PIK3CA. Conclusion Due to the low incidence rate and the reclassification of PB, no standard treatment is available. Although the numbers of cases are few with varying individual experiences, it is important to improve our understanding regarding this rare lung cancer. Targeted DNA sequencing may be of clinical use for molecular testing and the effects of targeted therapy need to be confirmed.
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Affiliation(s)
- Yuan-Yuan Zhao
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou
| | - Lin Liu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou; Department of Medical Oncology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong
| | - Ting Zhou
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou
| | - Ning-Ning Zhou
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou
| | - Yun-Peng Yang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou
| | - Xue Hou
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou
| | - Yong Li
- Department of Pathology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Hong-Yun Zhao
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou
| | - Yan Huang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou
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23
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A rare occurrence of well-differentiated fetal adenocarcinoma lung in a patient with history of bullet injury to lung and retained pellets in the pleura. Indian J Thorac Cardiovasc Surg 2016. [DOI: 10.1007/s12055-016-0450-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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25
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Abstract
A 75-year-old nonsmoker woman was referred for the evaluation of a nonsecretory left adrenal lesion. An abdominal contrast-enhanced CT showed an incidental left lower lobe mass, which was confirmed on a chest contrast-enhanced CT. A 18F-FDG PET/CT showed a hypermetabolic tumor without nodal or distant metastasis. She underwent a lobectomy, and the final pathology reported a classic biphasic pulmonary blastoma, which is an uncommon histological form of malignant lung neoplasm. This case highlighted the glucose avidity of this rare and aggressive cancer.
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26
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Wang YX, Zhang J, Chu XY, Liu Y, Li F, Wang ZB, Wei LX. Diagnosis and multi-modality treatment of adult pulmonary plastoma: Analysis of 18 cases and review of literature. ASIAN PAC J TROP MED 2014; 7:164-8. [PMID: 24461533 DOI: 10.1016/s1995-7645(14)60015-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 10/15/2013] [Accepted: 12/15/2013] [Indexed: 12/14/2022] Open
Abstract
The clinical data of 18 patients with PB from April 1989 to April 2013 was analyzed retrospectively, including 11 men and 7 women, aged 45 and 76 years old (mean 53 years). There were 12 cases of PB occurring in right lung and other cases in left lung. Among them, 3 patients had no symptoms, and 15 patients displayed symptoms of cough, chest pain, asthenia or minor haemoptysis. Overall, 11 patients had a preoperative diagnosis of lung cancer, 7 patients were preoperatively diagnosed as the other diseases, which included lung benign tumor (n=5) and mediastinal mass (n=2). All patients received a radical resection. Six patients received postoperative cisplatin-based chemotherapy, and two patients received postoperative irradiation with the dose of 55 Gy. Histologically, 14 cases of 18 patients had biphasic pulmonary blastoma and four cases had well differentiated fetal adenocarcinoma. A total of 12 patients died in a period of 6-36 months after operation, and 1 case was lost after 2 years of follow up. The median survival time was 19 months. PB is a rare primary lung malignant embryonal neoplasm. Despite its assumed embyonal origin, the tumor has a predilection for adults. A preoperative correct diagnosis is very difficult in spite of modern diagnostic imaging and biopsy techniques. Surgical resection is the main method for diagnosis and treatment. Postoperative chemotherapy or irradiation can help eliminate tumor remnants. Its prognosis is very poor, especially for the biphasic type.
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Affiliation(s)
- Yun-Xi Wang
- Department of Thoracic Surgery, General Hospital of PLA, Beijing 100853, China
| | - Jing Zhang
- Department of Thoracic Surgery, General Hospital of PLA, Beijing 100853, China.
| | - Xiang-Yang Chu
- Department of Thoracic Surgery, General Hospital of PLA, Beijing 100853, China
| | - Yi Liu
- Department of Thoracic Surgery, General Hospital of PLA, Beijing 100853, China
| | - Fang Li
- Department of Oncology, General Hospital of PLA, Beijing 100853, China
| | - Zhan-Bo Wang
- Department of Pathology, General Hospital of PLA, Beijing 100853, China
| | - Li-Xin Wei
- Department of Pathology, General Hospital of PLA, Beijing 100853, China
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27
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Kawasaki K, Yamamoto K, Suzuki Y, Saito H. Surgery and radiation therapy for brain metastases from classic biphasic pulmonary blastoma. BMJ Case Rep 2014; 2014:bcr-2014-203990. [PMID: 24895392 DOI: 10.1136/bcr-2014-203990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pulmonary blastoma, a rare malignant lung tumour, can metastasise to the brain. However, there is no evidence for any effective treatment. The aim of this report is to discuss the treatment options for pulmonary blastoma and confirm the necessity for a pathological diagnosis. A 75-year-old man was admitted with progressive right-sided hemiplegia and aphasia. MRI showed multiple brain tumours. A left frontal lobe lesion was surgically resected, after which he underwent whole brain radiation (30 Gy/10 fractions). He died of an acute exacerbation of interstitial pneumonia. On performing autopsy, partial responses in the brain metastases that had been irradiated were confirmed pathologically. Thus, we present pathological confirmation that surgery and radiation therapy have therapeutic effects on brain metastases from pulmonary blastoma.
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Affiliation(s)
- Kenta Kawasaki
- Department of Internal Medicine, Keio University Hospital, Shinjuku-ku, Tokyo, Japan Department of Internal Medicine, Asahi General Hospital, Asahi, Japan
| | | | - Yoshio Suzuki
- Department of Pathology, Asahi General Hospital, Asahi, Japan
| | - Hirohisa Saito
- Department of Internal Medicine, Asahi General Hospital, Asahi, Japan
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28
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Lkhoyaali S, Boutayeb S, Ismaili N, Aitelhaj M, Ouchen F, Benosman A, Errihani H. Neoadjuvant chemotherapy in well-differentiated fetal adenocarcinoma: a case report. BMC Res Notes 2014; 7:283. [PMID: 24886749 PMCID: PMC4017811 DOI: 10.1186/1756-0500-7-283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 04/28/2014] [Indexed: 01/15/2023] Open
Abstract
Background Fetal adenocarcinoma of the lung is a rare subtype of pulmonary adenocarcinoma with a relative estimated incidence of 0.5% or fewer of all lung cancers. Because of its extreme rarity, there have been no controlled clinical trials investigating treatment regimens for fetal adenocarcinoma and, as a result, there are no guidelines for management. Case presentation We report a case of a well-differentiated fetal adenocarcinoma, which is a variant of pulmonary blastoma, that is a low-grade malignancy and associated with a good prognosis. A 29-year-old Moroccan man presented with a well-differentiated fetal adenocarcinoma staged T3N0M0, who received 3 cycles of neoadjuvant chemotherapy followed by surgery, with no recurrence at 2 years follow-up. Conclusion Fetal adenocarcinoma is a rare suptype of adenocarcinoma. Surgical resection is the treatment of choice for resectable disease. The role of chemotherapy in the neoadjuvant setting or adjuvant setting is not well defined.
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Affiliation(s)
- Sihame Lkhoyaali
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco.
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29
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Abstract
(18)F-FDG PET/CT scanning plays an important role in the management of thoracic malignancy. The authors would like to present FDG PET/CT images of a rare thoracic malignancy, pulmonary blastoma in adulthood. The patient had recurrent metastatic disease of previously resected primary pulmonary blastoma. The foci of recurrent metastases in lung, mediastinum, and subcutaneous tissue are intensely FDG-avid.
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30
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Giusti R, Iacono D, Ida P, Ruco L, Marchetti P. Multidisciplinary approach to fetal adenocarcinoma of the lung: A case report. Thorac Cancer 2014; 5:97-100. [PMID: 26766982 DOI: 10.1111/1759-7714.12022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 12/10/2012] [Indexed: 11/26/2022] Open
Abstract
This paper reports a case of high-grade fetal lung adenocarcinoma with particularly aggressive clinical and biological features in a 57-year-old man. Our patient first underwent neoadjuvant chemotherapy followed by surgery, and was then treated with adjuvant chemotherapy. Next, he had radiotherapy on the mediastinal region and prophylactic whole brain radiation therapy (WBRT). Following radiotherapy treatment, the patient started maintenance therapy with a somatostatin analogue. After 58 months of follow-up he is asymptomatic and disease free.
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Affiliation(s)
- Raffaele Giusti
- Medical Oncology, S. Andrea Hospital, Sapienza University II Faculty Rome, Italy
| | - Daniela Iacono
- Medical Oncology, S. Andrea Hospital, Sapienza University II Faculty Rome, Italy
| | - Paris Ida
- Medical Oncology, S. Andrea Hospital, Sapienza University II Faculty Rome, Italy
| | - Luigi Ruco
- Pathology, Department of Clinical and Molecular Medicine, S. Andrea Hospital, Sapienza University II Faculty Rome, Italy
| | - Paolo Marchetti
- Medical Oncology, S. Andrea Hospital, Sapienza University II Faculty Rome, Italy
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31
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Revannasiddaiah S, Bhardwaj B, Susheela SP, Hiremath SB. Radiographic illusion of cardiomegaly resulting from a pulmonary blastoma in a patient imaged for evaluation of chronic bronchitis. BMJ Case Rep 2013; 2013:bcr-2013-010179. [PMID: 23887987 DOI: 10.1136/bcr-2013-010179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Swaroop Revannasiddaiah
- Department of Radiotherapy & Clinical Oncology, Swami Rama Cancer Hospital & Research, Institute, Haldwani, Uttarakhand, India.
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32
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Kyung C, Kim SY, Lim BJ, Cha JJ, Kim HJ, Ahn CM, Park H, Cho EN, Chang YS. A case of locally advanced well-differentiated fetal adenocarcinoma of the lung treated with concurrent chemoradiation therapy. Tuberc Respir Dis (Seoul) 2013; 74:226-30. [PMID: 23750171 PMCID: PMC3672415 DOI: 10.4046/trd.2013.74.5.226] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 09/03/2012] [Accepted: 09/28/2012] [Indexed: 01/15/2023] Open
Abstract
Fetal adenocarcinoma is a rare adenocarcinoma subtype of pulmonary blastoma. A 48-year-old male patient is being referred to our hospital due to progressive dyspnea. A chest X-ray showed a lung mass of unknown origin that was obstructing the right main bronchus. After relieving the airway obstruction with stent insertion via bronchoscopy, a diagnosis of fetal adenocarcinoma is being confirmed through thoracoscopic biopsy. Due to the locally advanced state of the lung cancer, it seemed to be inoperable, and concurrent chemo-radiation therapy was being administered with docetaxel. The stent was removed after improvements in the airway obstruction followed by a lung mass shrinkage. Comparing to other contexts which describe fetal adenocarcinoma as lower grade malignancy with low-associated mortality, herein, we describe a case of locally-advanced fetal adenocarcinoma (T4N3M0). This is the first documented case being treated with concurrent chemoradiation therapy. The followed-up image studies represent a partial response and the patient is currently under further observations.
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Affiliation(s)
- Chanhee Kyung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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33
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Luo CQ, Yeung SCJ, Liu ZG, Meng J, Zhong FT, Cheng C. Pulmonary well-differentiated fetal adenocarcinoma with platelet-derived growth factor receptor (PDGFR)α expression. Cancer Biol Ther 2012; 13:1384-9. [PMID: 22986233 DOI: 10.4161/cbt.22253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Well-differentiated fetal adenocarcinoma (WDFA) is a rare pulmonary malignancy. Biomarkers of tumor biology has rarely been studied in WDFA. Here, we report two WDFA patients. Both patients had blood-streaked sputum or mild hemoptysis at presentation. They underwent lobectomy and systematic mediastinal lymphadenectomy. Expression of PDGFRα on the plasma membrane was demonstrated by immunohistochemistry (IHC) in the resected tumor specimens. Further IHC examination showed intense immunostaining of β-catenin in both patients but negative staining for TP53, CEA, CD56, EGFR, CK5/6, HER2, S-100, ER, PR, BCL2, and NSE. Both patients had no recurrence to date after more than 3 years of follow up. Herein, we reviewed this rare disease with special emphasis on the clinico-pathological features, treatment and potential role of PDGFRα.
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Affiliation(s)
- Can-Qiao Luo
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
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