Tuberc Respir Dis.  2013 May;74(5):226-230. 10.4046/trd.2013.74.5.226.

A Case of Locally Advanced Well-Differentiated Fetal Adenocarcinoma of the Lung Treated with Concurrent Chemoradiation Therapy

Affiliations
  • 1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. YSCHANG@yuhs.ac
  • 2Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.

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.

Keyword

Adenocarcinoma; Drug Therapy; Radiotherapy

MeSH Terms

Adenocarcinoma
Airway Obstruction
Biopsy
Bronchi
Bronchoscopy
Dyspnea
Humans
Lung
Lung Neoplasms
Male
Pulmonary Blastoma
Stents
Taxoids
Thorax
Taxoids

Figure

  • Figure 1 (A) Chest X-ray showed a large mass in the right paratracheal area, causing tracheal deviations to the left, with mild bronchopneumonia in the right lower lobe. (B) Three-month followed-up chest X-ray scans indicated that the airway obstruction and tracheal deviation had been improved.

  • Figure 2 (A) Computed tomography (CT) scans revealed an approximately 7.7×6.4 cm lobulated, heterogeneous, enhancing mass abutting the trachea, carina, and both main bronchi. (B) One-month followed-up CT showed that the size of the mass in the right paratracheal area had decreased (5.8 cm decreased to 4.6 cm), indicating a stable disease.

  • Figure 3 (A) Flexible bronchoscopy allowed for the placement of a stent from the carina to the left main bronchus, extending to the second left carina. (B) Three-month followed-up flexible bronchoscopy showed relief of the airway obstruction of both the right and left main bronchi, which improved the ease of passing the scope.

  • Figure 4 The mass was composed of numerous glands showing endometrioid morphology, occasional squamoid morules, and relatively clear cytoplasm (H&E stain; A, ×100; B-D, ×400).


Reference

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