Pulmonary Teratoma with Malignant Transformation

Abstract

A rare case of pulmonary teratoma with malignant transformation that occurred in a 58-year-old man is reported. The patient was treated initially with lobectomy. The tumor was composed of well-differentiated adenocarcinoma and mature teratomatous tissue that included squamous epithelium, sebaceous glands, cartilage, and pancreatic tissue. The patient developed recurrent adenocarcinoma in the lung 3 years later and was also found to have a renal cell carcinoma. Both the renal tumor and recurrent lung tumor were resected and adjuvant chemotherapy was given. He died of brain metastasis and further lung recurrence 9 months later. Int J Surg Pathol 6(2): [89][90][91][92] 1998 Most teratomas arise in ovaries and testicles. For extragonadal teratomas, the most frequent site is the anterior mediastinum; other, less common sites include retroperitoneum, the sacrococcygeal area, and the pineal region [1]. Primary pulmonary teratomas are extremely rare [2]. A case of pulmonary teratoma with malignant transformation (TMT) is herein reported and compared with those reported in the literature. Materials and MethodsFor light microscopic examination, the tissue was fixed in IO/% buffered formalin, routinely processed, and embedded in paraffin. Paraffin sections were stained with hematoxylin and eosin. A mucicarmine stain was performed on representative sections of the tumor.Immunohistochemical staining for chromogranin (dilution 1:200, BioGenex), neuron-specific enolase (dilution 1:150, BioGenex), and synaptophysin (dilution 1:80, BioGenex), with use of the avidin-biotin-peroxidase method was performed on representative sections of the tumor. Clinical HistoryA 58-year-old man presented with fever, chest pain, and dyspnea. A chest roentgenogram showed a large mass in the left lung. A bronchoscopy obtained mucoid material but histologic examination was negative for malignant cells. A left upper lung lobectomy was performed. Histologic examination of the lung mass showed well-differentiated adenocarcinoma arising in a teratoma. There was no clinical or radiographic evidence of extrapulmonary tumor. The testes were normal by palpation and ultrasonography. Three years later he developed hematuria. The chest roentgenograms showed two newly developed masses, 2 cm and 4 cm in size re-89 at Kungl Tekniska Hogskolan / Royal Institute of Technology on July 4, 2015 ijs.sagepub.com Downloaded from