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Case Reports
. 2018 Sep 2;12(1):243.
doi: 10.1186/s13256-018-1781-1.

Pediatric lung adenocarcinoma presenting with brain metastasis: a case report

Lucia De Martino  1 , Maria Elena Errico  2 , Serena Ruotolo  3 , Daniele Cascone  4 , Stefano Chiaravalli  5 , Paola Collini  6 , Andrea Ferrari  5 , Paolo Muto  7 , Giuseppe Cinalli  8 , Lucia Quaglietta  3
Affiliations
Case Reports

Pediatric lung adenocarcinoma presenting with brain metastasis: a case report

Lucia De Martino et al. J Med Case Rep. .

Abstract

Background: Diagnosis and treatment of primary lung adenocarcinoma in children remains challenging given its rarity. Here we highlight the clinical history, pathological evaluation, genomic findings, and management of a very young patient with metastatic lung adenocarcinoma.

Case presentation: A 10-year-old white girl presented with brain metastases due to primary pulmonary adenocarcinoma. Next generation sequencing analysis with "Comprehensive Cancer Panel" highlighted the presence of multiple non-targetable mutations in the FLT4, UBR5, ATM, TAF1, and GUCY1A2 genes. She was treated aggressively with chemotherapy, surgery, and radiation therapy for local and distant recurrence. Eventually, therapy with nivolumab was started compassionately, and she died 23 months after diagnosis.

Conclusions: Extremely rare cancers in children such as lung adenocarcinoma need accurate and specific diagnosis in order to develop an optimal plan of treatment. It is also necessary to underline that "children are not little adults," thus implying that an adult-type cancer in the pediatric population might have a different etiopathogenesis. Diagnostic confirmation and primary treatment of such rare conditions should be centralized in reference centers, collaborative networks, or both, with multidisciplinary approaches and very specific expertise.

Keywords: Brain metastasis; Cancer immunotherapy; Lung adenocarcinoma; Nivolumab; Rare tumor; TREP.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the institutional review board at the AORN Santobono-Pausilipon, Naples.

Consent for publication

Written informed consent was obtained from the patient’s legal guardian(s) for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Brain metastasis of lung adenocarcinoma at diagnosis on non-enhanced computed tomography scan (a), post-contrast T1-weighted (b), fluid-attenuated inversion recovery magnetic resonance imaging (c) and after surgical resection on post-contrast T1-weighted (d)
Fig. 2
Fig. 2
Lung adenocarcinoma with micropapillary pattern (hematoxylin and eosin, × 10) (a) and cytological details (hematoxylin and eosin, × 40) (b)
Fig. 3
Fig. 3
Immunoreactivity for thyroid transcription factor 1 (a) and cytokeratin 7 (× 400) (b)
Fig. 4
Fig. 4
Lung adenocarcinoma in the lower lateral basal segment of the right lobe (red arrow) in our 10-year-old white girl on axial (a) and coronal (b) computed tomography scan
Fig. 5
Fig. 5
Thoracic positron emission tomography scan (a) and positron emission tomography/computed tomography scans (b) performed for the staging of lung adenocarcinoma
Fig. 6
Fig. 6
Medical history timeline. CT computed tomography, MRI magnetic resonance imaging, NSCLC non-small cell lung cancer, PET positron emission tomography
See this image and copyright information in PMC

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