Pulmonary blastoma in a pregnant woman: a case report and brief review of the literature

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.

Clinical case of pulmonary blastoma in a child as a disguise of community-acquired pneumonia

Currently, the problem of diagnosing pleuropulmonary blastoma in children remains relevant, because this pathology often runs under the guise of other nosologies, including pneumonia, and is extremely difficult to diagnose. Currently there are no pathognomonic clinical symptoms, specific diagnostic criteria for this disease, almost 60% of patients have nonspecific symptoms. This article presents a rare clinical case of biphasic pulmonary blastoma in a child who was examined and treated at the Ivano-Frankivsk Regional Children's Clinikal Hospital Ivano-Frankivsk Regional Council. The main clinical manifestations, diagnosis and treatment of biphasic blastoma of the lungs in a child based on the observation of a 5-year-old girl who was hospitalized for acute abdominal pain, chest pain and cough. After clinical — laboratory and instrumental methods of examination, right-sided pneumonia and exudative pleurisy were diagnosed. The set of treatment measures did not give the expected positive effect, improving the patient's condition. Additional testing is required for suspected breast cancer. It has been established that the best method for verifying the diagnosis of pulmonary blastoma is multislice computed tomography with intravenous bolus contrast and immunohistochemical examination of the biopsy. The methods of treatment used in this case, including anti-inflammatory and polychemotherapy according to the scheme, the use of radical treatment at the National Cancer Institute in Kyiv — surgery right pneumonectomy with pericardial resection. The child is currently in stable remission for 4.5 years. The described clinical case demonstrates the difficulty of diagnosing lung blastoma in children due to the lack of typical clinical manifestations. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: children, pneumonia, blastoma, pulmonology, diagnosis, treatment.

Classic biphasic pulmonary blastoma (CBPB): a rare primary pulmonary malignancy

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.

Pulmonary Adenofibroma in an Elderly Male with Recurrent Soft Tissue Sarcoma

Pulmonary Adenofibroma (PAF) is a rare soft tissue tumour of the lung. It is a benign lesion, having a biphasic pattern with an admixture of epithelial and stromal components and has resemblance to fibroadenoma of the breast and adenofibroma of the female genital tract. The diagnosis can be challenging and it has to be delineated from other entities with biphasic pattern, like pulmonary hamartoma, pulmonary blastoma, intrapulmonary solitary fibrous tumour and metastases from soft tissue and visceral sarcomas, as each tumour has its own therapeutic and prognostic implications. Here, we report a case of a 73-year-old male, a known case of recurrent soft tissue sarcoma of the thigh, who presented with solitary pulmonary lesion. The patient was a non-smoker and did not have any specific respiratory complaints. On staging work-up with a Positron Emission Tomography and Computed Tomography (PET-CT), a hypermetabolic lesion was identified in the anterior segment of right upper lobe of the lung, following which he underwent right lobectomy. The tumour was a solitary lesion located near the hilum and on histology showed a biphasic pattern with scattered glandular spaces lined by columnar epithelium set in a hyalinised spindle cell stroma. The cells showed mild pleomorphism with oval to elongated nuclei and indistinct cytoplasm. On immunohistochemistry, the epithelial component showed positivity for Cytokeratin (CK), Epithelial Membrane Antigen (EMA), Thyroid Transcription Factor-1 (TTF-1) and Napsin-A and the stromal component showed positivity for Vimentin, Desmin, Smooth Muscle Actin (SMA) and H-Caldesmon (High molecular weight isoform-Caldesmon). With the given histological and immunohistochemistry findings, a diagnosis of PAF was rendered.

Unusual Thoracic Tumours- A Concise Imaging Approach

Introduction: There are certain uncommon large thoracic masses sharing overlapping radiological features with commoner ones except few salient characteristic features. Diagnosing these uncommon tumours has practical implications for patient management and prognosis including obviating unnecessary surgeries. Aim: To demonstrate characteristic Computed Tomography (CT) features of large common and certain uncommon intra-thoracic masses Materials and Methods: A retrospective cross-sectional search was done in January 2020, from the archives of patients record in Radiology Department from December 2017 to January 2019 for intra-thoracic tumours. Those tumors or masses meeting inclusion criteria were analysed by two radiologists who were blinded about the histopathologic reports. A probable radiological diagnosis was made and it was later matched-up with the histopathologic reports to reach to a confirmed diagnosis. The unique CT features were separately tabulated and their p-value for a particular diagnosis was calculated using Fisher’s-exact test. Results: Out of total 23 cases studied, 12 bronchogenic carcinomas and 11 uncommon diagnoses including Solitary fibrous tumour, Synovial sarcoma, Pulmonary blastoma, Askin’s tumour, Schwannoma and Metastasis were found. Subtle rib erosion in Askin’s tumour (p-value=0.004), intra-tumoural vessels in Synovial sarcomas (p-value=0.0006) and intense enhancement in some non-bronchogenic tumours (p-value=0.0137) were found to be significantly associated features. Conclusion: When encountering an opaque hemithorax on chest radiograph and a large mass on CT, one should look for certain peculiar features of these unusual lung masses to suggest them as a differential diagnosis, as “Our eyes see only what our mind knows”.

Classic biphasic pulmonary blastoma: a case report and review of the literature

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.