Pulmonary blastoma in a child

Pulmonary blastoma in a child

Pulmonary By Yoshihiko Kodaira, Hiroshi Blastoma Akiyama, in a Child Masahiko Morikawa, and Koichi Shimizu P ULMONARY BLASTOMA is a very r...

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Pulmonary By Yoshihiko

Kodaira,

Hiroshi

Blastoma

Akiyama,

in a Child

Masahiko

Morikawa,

and

Koichi

Shimizu

P

ULMONARY BLASTOMA is a very rare type of lung tumor. In 1952 Barnard’ described the first report of a rare pulmonary neoplasm which histologically resembled fetal lung tissue. He named it pulmonary embryoma. Spencer’ reported four similar cases which he called pulmonary blastoma because they resembled the histologic pattern of nephroblastoma. Since then there have been 25 reported cases of this type of neoplasm but only two were in children.3,4 We have recently treated a lo-yr-old girl with this neoplasm. CASE A IO-yr-old of a right

girl admitted

pulmonary

monary tuberculosis The patient Examinations angiography,

to the National

REPORT

Children’s

lesion had 6 mo previously (Fig.

I). On admission,

was asymptomatic. included

Blood

tomography,

and lung scintigram.

showed the mass previously

Hospital

received

in Tokyo

medical

in

1973 for treatment

treatment

for possible

pul-

the mass was larger than the film taken 6 mo before.

counts,

sedimentation

bronchography,

rates, and urinalysis

bronchoscopy,

All of these tests were within

sputum

normal

were normal.

cytology,

pulmonary

limits except that the scan

noted by plain film of the chest. A provisional

diagnosis

of benign

tumor was made. Right thoracotomy

was performed

2 wk after

admission.

found in the right upper lobe. There was no evidence There were enlarged

mediastinal

nodes.

Right

upper

Fig. 1. (A) AP and (8) lateml roentgenograms was noted. See p. 240 Fig. 1. (C) and (D) .

that

A mass 3 x 3 cm in diameter it involved

lobectomy

was

the chest wall or pleura.

was performed.

6 me before admission

The pathologic

when right

hilar

mass

From the Departments of Surgery and Pathology, The National Children’s Hospital, Tokyo.

Addressfor reprint requests: Yoshihiko Kodaira, M.D., The Division of Pediatric Surgery, Department of Surgery, Keio University School of Medicine. 35 Shinanotnachi. Shinjuku-ku, Japan.

Tokyo,

0 1976 by Grune & Stratton, Inc. Journal of Pediatric Surgery, Vol. 11, No. 2 (April), 1976

239

KODAIRA

240

Fig. mass.

1.

(C) AP and (D)

lateral

roentgenograms

on admission

showing

enlargement

ET AL

of the

diagnosis of pulmonary blastoma was made by frozen section. Postoperative course was uneventful. She was discharged 2 wk later. Since then there has been no evidence of recurrence or metastasis. The right upper lobe contained a well circumscribed 3 x 3 cm round soft tumor mass the surrounding lung was atelectatic in its midportion. The cut surface was yellow-white, (Fig. 2).

PULMONARY

BLASTOMA

241

Epitheliol cells resemble fetal lung tissue. The connective tissue stromo is scanty; there fig. 3. is no sacromatous proliferation. (A) low power x 100. (B) Higher power x 400.

The tumor ciliated

showed both solid and glandular

epithelial

cells (Fig.

3). The overall

elements with small epithelial appearance

tive tissue stroma was scanned and composed

without sarcomatous proliferation. of the specimen it did not resemble

was similar

of immature

spindle

cells and columnar

to fetal lung. The

connec-

cells at the margin

shaped cells or asteroid

Although there was a small amount of cartilage the appearance of pulmonary hamartoma.

REFERENCES 1. Barnard

WC? Embryoma

of lung.

Thorax

11299, 1952 2. Spencer Bact 82:161,

H: Pulmonary 1961

blastoma.

J Pathol

3. Nazari A, Amer-Mokri E, Sarram A, et al: Pulmonary blastoma. Chest 60: 187, 1971 4. Iverson RE, Straehley CJ: Pulmonary blastoma; Longterm survival ofjuvenile patient. Chest 63:436, 1973