An aggressive childhood tumor mimicking pleural empyema: pleuropulmonary blastoma

Primary lung cancer in children and adolescents: Analysis of a surveillance, epidemiology, and end results database

Background

The incidence of primary lung cancer (LC) in children and adolescence was rare. We analyzed data from a SEER database to better define the incidence, clinical characters, pathology, treatment, and outcomes of rare primary malignant pulmonary tumors in childhood and adolescence.

Methods

Patients were chosen from the SEER database (SEER*Stat 8.4.0 software) from 2000 to 2019 and all patients were pathologically diagnosed with primary malignant tumors of the lung and bronchus. Demographic characteristics of patients (age, gender, race, primary site, laterality, location, differentiation grade, operation methods, histology, and history of radiotherapy and chemotherapy), as well as TNM stage and survival time, were collected.

Results

A total of 301 cases of children ≤19 years of age with a primary malignant pulmonary tumor were reported to the SEER database from 2000 to 2019. There were 143 men (47.5%) and 158 women (52.5%). Whites represented majority of patients (79.7%), followed by Black (13.6%) and others (6.7%). As for the primary site, the main site was the lower lobe (33.2%), followed by the upper lobe (26.9%). Most of the patients (80.4%) underwent surgery. Lobectomy (39.9%) is the main operation method. Only 28 (9.3%) patients received radiotherapy and 112 (37.2) patients received chemotherapy. Carcinoid tumor was the most common histology (29.6%), followed by pulmonary blastoma (PB) (22.3%), mucoepidermoid carcinoma (MEC) (12.3%), adenocarcinoma (10.3%), neuroendocrine tumor (NET) (5.7%), squamous cell carcinoma (SCC) (5.3%), atypical carcinoma (2.3%). The mean follow-up time was 100 months. For the entire group of children and adolescents, the 1-year OS was 89.1%, and the 3-year overall survival (OS) was 79.7%. the 5-year OS was 77.9%, the 10-year OS was 75.7%, and the 15-year OS was 73.9%. And 1-year lung cancer specificity survival (LCSS) was 89.8%, and the 3-year LCSS was 80.4%. the 5-year LCSS was 79.4%, the 10-year LCSS was 77.7%, and the 15-year LCSS was 75.9%. The OS of atypical carcinoma, carcinoid tumor, and MEC were in the top three.

Conclusions

Primary LC in children and adolescent were rare and histopathological diverse. Fortunately, children and adolescents with LC had an overall favorable outcome after treatment. Histology, differentiation grade, surgery, TNM stage, and therapeutic modalities have important influence on OS. The further treatment experience of each pathological type would make better evidence-based practice possible.

Primary lung tumors in children: 24 years of experience at a referral center

PURPOSE

Primary lung tumors are rare during childhood and encompass a wide variety of histological types. Each has a different biology and a different therapeutic approach. The aim of this article is to review the experience of a pediatric referral center with this kind of tumors during the last 24 years.

METHODS

A retrospective chart review was performed for patients with diagnosis of primary lung tumor between the years 1990-2014. The variables analyzed were age, sex, course of the disease, symptoms, localization, surgery, histology and outcome.

RESULTS

Between 1990 and 2014, 38 patients with primary lung tumors were treated at our institution. Age at presentation was 6.6 ± 5.2 years (r 0.91-16.58) and the female:male relationship was 1.37. Inflammatory myofibroblastic lung tumor (n = 13), carcinoid tumor (n = 6) and pleuropulmonary blastoma (n = 6) were the most frequent histological types. Persistent radiographic abnormality was the most frequent presenting sign (34 %). Global mortality was 15.8 % varying according to histology.

CONCLUSION

Although the diagnosis of primary lung tumor is rare, the persistence of a radiographic abnormality in spite of adequate treatment for inflammatory processes forces us to evaluate further. The age of the patient is an important factor in the decision of the diagnostic work-up.

[Pleuropulmonary blastoma: a clinicopathological analysis]

背景与目的

胸膜肺母细胞瘤是一种罕见的且有其独特临床病理特征的恶性肿瘤，本文旨在探讨胸膜肺母细胞瘤的临床病理学特点及鉴别诊断等。

方法

收集5例胸膜肺母细胞瘤，复习患者临床资料，进行组织学及免疫组化观察，并结合文献复习分析。

结果

5例胸膜肺母细胞瘤患者年龄为21个月-47个月，平均为32.8个月；肿瘤主要位于胸腔，4例伴有胸腔积液。组织学观察：Ⅰ型胸膜肺母细胞瘤1例，呈单纯囊性；Ⅱ型胸膜肺母细胞瘤2例，呈囊实性，实性区伴横纹肌分化及灶性软骨样结节；Ⅲ型胸膜肺母细胞瘤2例，完全呈实性，可见间变性未分化肉瘤样成分。免疫组化染色显示肿瘤细胞呈Vimentin（+），部分肿瘤细胞呈Desmin和Myogenin（+），软骨样结节呈S-100（+）；PCK、EMA、CD99等均（-）。

结论

胸膜肺母细胞瘤是一种罕见的主要发生于婴幼儿肺和胸膜的高侵袭性恶性肿瘤，各亚型均有其临床病理学特点。诊断方面应与肺先天性囊性腺瘤样畸形、胚胎性横纹肌肉瘤等良恶性病变鉴别。