Pulmonary Blastoma: Report of Two Cases

Abstract

Pulmonary blastomas are a group of rare malignant neoplasms subdivided into three categories: classic biphasic pulmonary blastoma (CBPB), well-differentiated fetal adenocarcinoma (WDFA), and pleuropulmonary blastoma (PPB). We report herein the cases of two men with CBPB. Both were heavy smokers and presented with a history of hemoptysis. Physical examination revealed slightly significant findings, chest radiographs showed a large pulmonary mass, confirmed by computed tomography, and bronchoscopic biopsies were not diagnostic. A left and right inferior lobectomy was performed and a diagnosis of CPBP was confirmed by histological examination. In the first patient, local recurrence with multiple bilateral lung metastases was found 6 months later and despite chemotherapy, he died of respiratory failure 1 year after his operation. In the second patient, a subcutaneous metastasis was found in the right subscapular region 2 months later, and a cerebral metastasis in the right posterior parietal lobe 4 months later. Partial remission was achieved by cerebral irradiation, but 6 months later the patient died of cardiac failure while in a coma. We conclude that more aggressive and multidisciplinary treatment should be adopted for CBPB, and because of its low incidence, it is important to unify individual experiences in a central registry to gather as much information as possible regarding the biological and clinical features of this unusual disease.

Solitary Brain Metastasis from Classic Biphasic Pulmonary Blastoma: A Case Report and Review of the Literature

“…Expression of CD 117 in both mesenchymal and epithelial cells suggests a single origin and supports the idea that CBPB arises from a pluripotent cell that can differentiate into both stromal and epithelial morphologies [6]. Multiple distant metastases from CBPB have been reported [7] but brain metastases are extremely rare, and only 5 cases have been reported [5,[7][8][9][10] (table 1). Survival following brain metastasis ranges from 2.5 to 12 months [5,[7][8][9][10].…”

“…The first report of brain metastases from CBPB was by Barson et al in 1968 [9]. To our knowledge, only 4 cases of CBPB with solitary brain metastases [5,[8][9][10] and one with bifocal brain metastases [7] have been reported (table 1). The presence of metastases and a tumor size bigger than 5 cm are signs of poor prognosis [1,2,5].…”

“…However, reports have confirmed the effectiveness of the combination of chemotherapy and RT in inoperable or aggressive tumors [3][4][5]11]. Metastases from CBPB have been reported in bones, pericardium, mediastinum, esophagus, lymph nodes, thyroid, adrenal gland [7], and in the liver [7,9].…”

“…PB is subdivided histopathologically into 3 categories: the classic biphasic pulmonary blastoma (CBPB), the well-differentiated fetal adenocarcinoma and the pleuropulmonary blastoma [1,4,5]. The histological findings reveal two cell patterns Solitary Brain Metastasis from Classic Biphasic Pulmonary Blastoma: A Case Report and Review of the Literature consisting of both epithelial and mesenchymal cells [1,4].…”

“…Multiple distant metastases from CBPB have been reported [7] but brain metastases are extremely rare, and only 5 cases have been reported [5,[7][8][9][10] (table 1). Survival following brain metastasis ranges from 2.5 to 12 months [5,[7][8][9][10].…”