Neoadjuvant chemotherapy in well-differentiated fetal adenocarcinoma: a case report

Abstract

BackgroundFetal adenocarcinoma of the lung is a rare subtype of pulmonary adenocarcinoma with a relative estimated incidence of 0.5% or fewer of all lung cancers. Because of its extreme rarity, there have been no controlled clinical trials investigating treatment regimens for fetal adenocarcinoma and, as a result, there are no guidelines for management.Case presentationWe report a case of a well-differentiated fetal adenocarcinoma, which is a variant of pulmonary blastoma, that is a low-grade malignancy and associated with a good prognosis. A 29-year-old Moroccan man presented with a well-differentiated fetal adenocarcinoma staged T3N0M0, who received 3 cycles of neoadjuvant chemotherapy followed by surgery, with no recurrence at 2 years follow-up.ConclusionFetal adenocarcinoma is a rare suptype of adenocarcinoma. Surgical resection is the treatment of choice for resectable disease. The role of chemotherapy in the neoadjuvant setting or adjuvant setting is not well defined.

Comprehensive review of fetal adenocarcinoma of the lung

“…The patient showed a 12% tumor reduction evaluated through computed tomography. 53 Another patient with a T4N0M0-stage disease treated with neoadjuvant chemotherapy (mitomycin, ifosfamide, and cisplatin) showed a downstage prior to tumor resection. 52 Kyung et al reported the case of a patient with locally advanced disease that was treated with concurrent chemotherapy with docetaxel; the patient had a partial response.…”

Well‐differentiated fetal adenocarcinoma of the lung mimicking adenoid cystic carcinoma on fine needle aspiration: A case report

“…The incidence of WDFA is <0.1% of lung cancers; it tends to occur in young smokers with a peak incidence in the third to fourth decades and rarely is seen in the pediatric population . The treatment of choice of fetal adenocarcinoma is surgical resection with an unclear role for adjuvant chemotherapy and radiation treatment . In contrast, management of conventional adenocarcinoma is more established with guidelines for multimodality treatment including surgical resection and neoadjuvant therapy.…”

“…[7][8][9][10][11] The treatment of choice of fetal adenocarcinoma is surgical resection with an unclear role for adjuvant chemotherapy and radiation treatment. 12 In contrast, management of conventional adenocarcinoma is more established with guidelines for multimodality treatment including surgical resection and neoadjuvant 1 therapy. Therefore, distinguishing WDFA from those neoplasms with different prognostic and treatment implications, including, conventional adenocarcinoma and adenoid cystic carcinoma can be critical to disease management.…”

Fetal adenocarcinoma — a rare variant of lung adenocarcinoma with good prognosis

“…The symptoms of fetal adenocarcinoma, once they occur, are not typical and comprise: dry cough, fever, debilitation and fatigue. The more worrying symptoms are haemoptysis and chest pain [2,3,7,13,[15][16][17]. One of the rare causes of chest pain is the presence of fluid in the pleural cavity caused by its involvement with cancer, or secondary lesions connected with emboli in the pulmonary vessels accompanying the adenocarcinoma [15,18].…”

“…Even though there are reports about the benefits in adjuvant chemotherapy and radiotherapy, these are not recommended treatments. The largest number of cases with equivocal results concern the administration of adjuvant chemotherapy containing cisplatin with etoposide [1,16,17].…”