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Righi L, Righi A, Vatrano S, Rapa I, Listì A, Metovic J, Rocca M, Salone M, Giovenali P, Sidoni A, Tabbò F, Dei Tos AP, Volante M, Papotti M. Primary lung adenocarcinoma in three adolescent patients affected by bone sarcomas. Virchows Arch 2021; 478:1125-1134. [PMID: 33420836 DOI: 10.1007/s00428-020-02990-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 01/28/2023]
Abstract
Pediatric primary lung carcinomas are extremely rare. Apart from known associations with congenital adenomatoid malformations, cases of primary lung adenocarcinomas after prolonged treatments of pediatric malignancy have been reported. We describe the morphological and molecular features of three cases of lung adenocarcinoma developed in adolescents aged 8 to 17 years during progression of their bone osteosarcoma or Ewing sarcomas. The morphological features overlapped those of adult lung adenocarcinoma including in situ, minimally invasive, and invasive forms. EGFR gene mutations were found in all three cases by targeted next-generation sequencing. The two patients with Ewing sarcoma had no progression of their lung cancer and no further progression of the metastatic bone tumor after additional chemo- and radio-therapy. Conversely, the osteosarcoma patient refused further treatments after thoracic surgery for metastatic osteosarcoma and locally advanced adenocarcinoma and died 2 years later of widespread distant metastases. Our results indicate that primary lung cancer might originate in pediatric patients during prolonged adjuvant therapies for primary bone neoplasm, and this possibility should be considered in the presence of suspected lung disease progression to correctly monitor the primary tumor evolution and define the appropriate therapeutic strategy at each time point. If appropriately treated, second primary lung cancer may not affect the patients' prognosis. The pathogenetic mechanisms of these rare lung adenocarcinomas are not clear, but the presence of EGFR mutations in all three cases indicates an oncogene addiction of the lung tumor, rather than a direct cancerogenic effect of the sarcoma-related treatment.
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Affiliation(s)
- Luisella Righi
- Department of Oncology, University of Turin, Turin, Italy
| | - Alberto Righi
- Division of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simona Vatrano
- Department of Oncology, University of Turin, Turin, Italy
- Department of Pathology, Cannizzaro Hospital, Catania, Italy
| | - Ida Rapa
- Department of Oncology, University of Turin, Turin, Italy
| | - Angela Listì
- Department of Oncology, University of Turin, Turin, Italy
| | - Jasna Metovic
- Department of Oncology, University of Turin, Turin, Italy
| | - Michele Rocca
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mariacristina Salone
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Giovenali
- Divisions of Pathology, Policlinico Hospital and University of Perugia, Perugia, Italy
| | - Angelo Sidoni
- Divisions of Pathology, Policlinico Hospital and University of Perugia, Perugia, Italy
| | - Fabrizio Tabbò
- Department of Oncology, University of Turin, Turin, Italy
| | | | - Marco Volante
- Department of Oncology, University of Turin, Turin, Italy.
| | - Mauro Papotti
- Department of Oncology, University of Turin, Turin, Italy
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