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

• Kyung C
• Kim SY
• Lim BJ
• Cha JJ
• Kim HJ
• Ahn CM
• Park H
• Cho EN
• Chang YS

• KMID: 2050891
• DOI: http://doi.org/10.4046/trd.2013.74.5.226

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

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  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.

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  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.

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  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.

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  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

1. Kradin RL, Young RH, Dickersin GR, Kirkham SE, Mark EJ. Pulmonary blastoma with argyrophil cells and lacking sarcomatous features (pulmonary endodermal tumor resembling fetal lung). Am J Surg Pathol. 1982; 6:165–172.

2. Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol. 2011; 6:244–285.

3. Kang CU, Cho DG, Jo MS, Cho KD, Moon YK, Park JK. Well-differentiated fetal adenocarcinoma of the lung: 3 cases report. Korean J Thorac Cardiovasc Surg. 2009; 42:388–391.

4. Song DS, Chung WS, Kim H, Kim YH, Kang JH, Lee CB, et al. Surgical treatment of well-differentiated fetal adenocarcinoma: a case report. Korean J Thorac Cardiovasc Surg. 2001; 34:566–568.

5. Nakatani Y, Kitamura H, Inayama Y, Kamijo S, Nagashima Y, Shimoyama K, et al. Pulmonary adenocarcinomas of the fetal lung type: a clinicopathologic study indicating differences in histology, epidemiology, and natural history of low-grade and high-grade forms. Am J Surg Pathol. 1998; 22:399–411.

6. Van Loo S, Boeykens E, Stappaerts I, Rutsaert R. Classic biphasic pulmonary blastoma: a case report and review of the literature. Lung Cancer. 2011; 73:127–132.

7. Sato S, Koike T, Yamato Y, Yoshiya K, Honma K, Tsukada H. Resected well-differentiated fetal pulmonary adenocarcinoma and summary of 25 cases reported in Japan. Jpn J Thorac Cardiovasc Surg. 2006; 54:539–542.

8. Koss MN, Hochholzer L, O'Leary T. Pulmonary blastomas. Cancer. 1991; 67:2368–2381.