Type III pleuropulmonary blastoma in a 7-month-old female baby with impending respiratory failure: a case report

Abstract

Introduction: Pleuropulmonary blastoma is a very rare, aggressive, embryonal pulmonary neoplasm which mostly affects children under the age of 5. According to the histopathological features, three subtypes of pleuropulmonary blastoma have been recognized: type I (purely cystic), type II (grossly visible cystic and solid elements) and type III (purely solid). Characteristics of type I and type II blastoma allow an earlier diagnosis compared with type III. Here we present a case report of an unusual presentation of type III pleuropulmonary blastoma.

Case presentation: We describe the case of a 7-month-old female baby of Italian mother and Kurdish father who was diagnosed with type III pleuropulmonary blastoma, which entirely occupied her right hemithorax.

Conclusions: The reported case is an unusual presentation because type III pleuropulmonary blastoma typically occurs in older children. The complete re-expansion of her residual, previously totally compressed, right lung observed immediately after the resection of the lesion suggests an atypical rapid growth of this embryonal tumor in the late phase of gestation or after delivery. This case report suggests that, in addition to other childhood tumors, type III pleuropulmonary blastoma should be included in the differential diagnosis of solid nonhomogeneous thoracic large masses, compressing the mediastinal and chest wall structures in infants. This is an original case report of interest for several specialities such us pediatrics, radiology, surgery and oncology.

Figure 1

Computed tomography scanning of the thorax. Demonstrating the presence of an enormous mass, causing a tracheal displacement with complete collapse of the lung parenchyma (A) with structural alteration in the 6th right coastal arc, along the midaxillary line (B) better demonstrated by the three-dimensional reconstruction (C).

Figure 2

Chest radiography after the surgical removal of the intrathoracic tumor demonstrating a complete re-expansion of the right lung.

Figure 3

Light microscopy picture of a specimen of the resected mass. A: the tumor is characterized by myxoid and fibrous-like stroma, showing large areas of necrosis (hematoxylin and eosin staining, original magnification ×100). B: at higher magnification the tumor was constituted by blastomatous areas, containing epithelioid cells, and sarcomatous areas, containing fusiform cells (hematoxylin and eosin staining, original magnification ×250).