Brain Tumor Res Treat.  2021 Oct;9(2):81-86. 10.14791/btrt.2021.9.e13.

A Rare Case of Metastatic Brain Tumor From Classic Biphasic Pulmonary Blastoma Presented as Intracerebral Hemorrhage

• Park S
• Byun J
• Song SW
• Kim YH
• Hong CK
• Kim JH

• KMID: 2522224
• DOI: http://doi.org/10.14791/btrt.2021.9.e13

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.

Keyword

Pulmonary blastoma; Cerebral hemorrhage; Neoplasm metastasis; Brain neoplasm

Figure

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  Fig. 1 Radiologic findings of metastatic pulmonary blastoma. A: Brain magnetic resonance image with T1-gadolinium enhancement taken 5 months ago for initial pulmonary blastoma staging. There is no evidence of brain metastasis. B: Brain CT scan at initial diagnosis: hyperacute stage of intracerebral hemorrhage in the left parieto-occipital lobe with 1.4 cm midline shifting. There is a 1.5 cm-sized low-density lesion within the hematoma, indicating tumor bleeding (red arrow). Loss of gyral marking on the left hemisphere also indicates severe brain swelling.

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  Fig. 2 Intraoperative findings of metastatic pulmonary blastoma. A: Intraoperative finding of intracerebral hemorrhage. B and C: After hematoma evacuation, the grayish and hypervascular tumor is identified. Both yellow arrows indicate the tumor. D: Final photo after gross total removal of the tumor and hematoma evacuation.

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  Fig. 3 Post-procedural intraoperative and postoperative CT scan. A: Hematoma and tumor on the left parieto-occipital lobe was removed. B: Newly developed large amount left temporal lobe hematoma was noted. C and D: Postoperative CT scan of left decompressive hemicraniectomy and temporal lobe hematoma removal. Hematoma was totally removed.

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  Fig. 4 Pathologic findings of brain metastasis from pulmonary blastoma. A: Hematoxylin and eosin stain of metastatic brain tumor from pulmonary blastoma (×400). The tumor shows both glandular epithelial components and blastemal stromal component (circle). B: Immunohistochemically, the tumor shows focal nuclear positive for glandular epithelial component and diffuse nuclear positive for the blastemal stromal component (circle) of beta-catenin (×400). C: The tumor is focal immunopositive for thyroid transcription factor-1 (×400). D: The tumor is completely immunonegative for synaptophysin (×400).

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