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THORACIC AND CARDIOVASCULAR IMAGING Table of Contents   
Year : 2002  |  Volume : 12  |  Issue : 2  |  Page : 213-214
Case report : Pulmonary blastoma


Dept. of Radiodiagnosis, Pravara Rural Medical College, P.O. Loni BK-413736, Dist. Ahmedanagar, Maharashtra, India

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Keywords: Pulmonary Blastoma, lung malignancy

How to cite this article:
Tara N P, Dubey R B, Agrawal D O. Case report : Pulmonary blastoma. Indian J Radiol Imaging 2002;12:213-4

How to cite this URL:
Tara N P, Dubey R B, Agrawal D O. Case report : Pulmonary blastoma. Indian J Radiol Imaging [serial online] 2002 [cited 2019 Nov 12];12:213-4. Available from: http://www.ijri.org/text.asp?2002/12/2/213/28447

   Introduction Top


Pulmonary Blastoma is a rare primary malignant tumor of lung comprising, of immature mesenchyme and epithelium, that mimics morphologically as an embryonal pulmonary structure. We report a case of pulmonary blastoma in the right lower lobe involving the lateral chest wall.


   Case Report Top


A forty five year old man, chronic bidi smoker reported with complaints of cough with expectoration, hemoptysis, breathlessness and intermittent pain in chest on right side for one year. Chest radiographs (PA and Lateral view) revealed a large, rounded homogenous opacity in the right mid and lower zones having smooth well defined borders. No evidence of calcification, cavitation air bronchogram or underlying bony destruction was seen. An inhomogeneous opacity with air bronchogram in the right upper zone suggested consolidation. A well defined rounded opacity in the left upper zone was suggestive of a metastatic deposit. Considering the above findings, chest ultrasonography and computed tomography of the thorax was advised for further evaluation. [Figure - 1],[Figure - 2]

Ultrasonography of chest revealed a heterogenous mass lesion in the right lower lobe which was indenting the right hemidiaphragm [Figure - 3]. Computed tomography of thorax revealed a 14 x 12 x 8 cm, well defined, heterogenous soft tissue density lesion in the right lower lobe which on contrast administration showed enhancing areas with whorled pattern and some non-enhancing areas suggestive of necrosis. Involvement of the right lateral chest wall along with subcarinal lymphadenopathy was noted. Consolidation in the right upper lobe was confirmed and the rounded opacity in the left apical segment suggested metastasis [Figure - 4],[Figure - 5] and [Figure - 6]. A diagnosis of malignant lung mass involving right lower lobe was considered and CT guided biopsy was performed.

Histopathology report revealed haemorrhagic and necrotic tissue with tumor cells having hyperchromatic nuclei, arranged in acinar, trabecular and sheet like pattern resembling endometrial glands.

Final report of "pulmonary blastoma" was given.


   Discussion Top


Pulmonary blastoma is a rare lung malignancy having incidence of 0.5 % of all primary lung malignancies [1],[2]. Initially it was thought to be analogous to nephroblastoma and some also believed it to be a variant of carcinosarcoma [3]. However, now the entities have been separately classified [4].

Biphasic age distribution is noted in first and seventh decade, with Mean age of occurrence in adults being 43 years [1]. The pediatric variant of pulmonary blastoma is known as pleuropulmonary blastoma [5],[6]. Pulmonary blastoma is common in smokers (82%) [1]. Patients commonly present with hemoptysis, cough, chest pain and dyspnea.

On gross pathology, the tumor is rounded, well circumscribed. In some, it may show lobulated appearance and multiple lesions. Microscopic pathological findings divide these tumors into two groups [1],[4]:

  1. Well differentiated fetal adenocarcinoma
  2. Biphasic blastoma.


Well differentiated fetal adenocarcinomas consist of well ordered neoplastic glands having branching tubules and lined by stratified columnar cells with clear cytoplasm and little nuclear hyperchromasia (endometroid pattern). Biphasic blastomas consist of both neoplastic glands and either adult sarcomatous or embryonic mesenchymal components.

On plain radiographs, pulmonary blastomas appear as well defined homogenous peripherally placed radiopacities [1],[3].

On ultrasound examination, they show heterogenous appearance with solid and few cystic areas which indicate necrotic component.

On computed tomography, heterogenous appearance with typically enhancing whorls of solid tissue and nonenhancing areas of necrosis is seen [3],[6]. Metastases to same or opposite lung as well as involvement of mediastinum and adjacent chest wall can also be seen.


   Conclusion Top


Pulmonary blastoma is a rare primary malignant tumor of the lung with characteristic CT appearance of heterogenous mass with areas of low attenuation and whorls of high attenuation.

 
   References Top

1.Koss MN et al . Cancer 1991; 67: 2368-81  Back to cited text no. 1    
2.Hiroyuki I et al . A Case of Biphasic Pulmonary Blastoma. Japanese Journal of Lung Cancer - 41,2001:131 - 135.  Back to cited text no. 2    
3.Armstrong P. Neoplasms of the Lungs, Airways and Pleura. In: Armstrong P. Wilson AG, Dee P, Hansell DM. Imaging of diseases of the chest; 2nd ed. Mosby - Year Book, 1995:315  Back to cited text no. 3    
4.Rosai J. Respiratory tract - Lung and Pleura. In: Rosai J. Ackerman's Surgical Pathology, Vol. 1; 8th ed. Mosby - Year Book, 1996: 400 - 402.  Back to cited text no. 4    
5.AJR, Feb 96: p-308  Back to cited text no. 5    
6.J Thorac Imag 1995, 10: p. 112 - 116  Back to cited text no. 6    

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Correspondence Address:
N P Tara
Dept. of Radiodiagnosis, Pravara Rural Medical College, P.O. Loni BK-413736, Dist. Ahmedanagar, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]

This article has been cited by
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Güzel, A., Demirkol, D., Çitak, A., Üçsel, R., Karaböcüoǧlu, M., Uzel, N., Toker, A.
Trakya Universitesi Tip Fakultesi Dergisi. 2010; 27(3): 315-317
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2 Pulmonary blastoma
Hussain, M., Baig, F.A., Hussain, S.
Journal of the College of Physicians and Surgeons Pakistan. 2007; 17(7): 438-440
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    Introduction
    Case Report
    Discussion
    Conclusion
    References
    Article Figures

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