Pulmonary blastoma with a good prognosis: a case report and review of the literature

Abstract

Pulmonary blastoma (PB) is a rare, highly malignant tumor prone to distant metastasis and recurrence, and the prognosis of these patients is often poor. We report a case of metastatic PB with a good prognosis with the aim of providing data to support a clinical diagnosis and treatment. In December 2015, a 43-year-old male patient was admitted to our hospital because of a cough and blood-stained sputum. Positron emission-computed tomography showed massive high-density imaging in the lower lobe of the right lung, with a maximum cross-section of 76 × 58 mm. Thoracoscopic-assisted right lower lobectomy with lymph node dissection was performed. After 1 month, computed tomography showed a high possibility of metastasis. The patient then received docetaxel and cisplatin chemotherapy for a total of six courses. After chemotherapy, enhanced computed tomography showed considerable absorption of pleural effusion, and a left lobe pulmonary nodule was not detected. The postoperative pathological diagnosis was PB, and epithelial and mesenchymal differentiation components were observed. The patient continued to visit the hospital regularly for re-examination and imaging examinations. Currently, no signs of recurrence or distant metastasis have been detected.

Keywords: Pulmonary blastoma; chemotherapy; clinicopathological feature; lobectomy; lymph node dissection; metastasis; pleural effusion.

Figure 1.

Preoperative imaging examinations. (a–c) Chest computed tomography shows the possibility of malignancy and (d) positron emission tomography-computed tomography shows massive high-density imaging in the lower lobe of the right lung, with a maximum cross-section of 76 × 58 mm, and increased fluorodeoxyglucose metabolism (maximum standard unit value: 13.8 g/mL).

Figure 2.

One month after surgery (19 January 2016), chest computed tomography shows right pleural effusion and multiple nodules in the left lung. After treatment, the pleural effusion was gradually absorbed. After six courses of chemotherapy (9 August 2016), computed tomography shows effective absorption of pleural effusion, and a left lobe pulmonary nodule was not detected.

Figure 3.

Hematoxylin and eosin and immunohistochemical staining of epithelial components. The epithelial component consists of well-differentiated fetal adenocarcinoma. A single nucleolus and cytoplasmic transparent pseudolamellar columnar cells form branched tubules. Local necrosis was observed. Tumor cells express cytokeratin and thyroid transcription factor-1.