1
|
Balaji K, Siddique SS, Khurana U, Goel G, Tandon A, Joshi D, Chaudhary N, Khurana AK, Goyal A. Cytohistological findings and diagnostic challenges in rare pediatric pulmonary mesenchymal malignancies: A report of two cases. Diagn Cytopathol 2024; 52:E88-E94. [PMID: 38235937 DOI: 10.1002/dc.25273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
Pulmonary mesenchymal tumors are uncommon neoplasms and the data available on their clinical, cytohistomorphological, immunohistochemical, and molecular findings are limited, leading to difficulty in timely diagnosis and management. Case 1: A 12-year-old boy presented with a right endobronchial mass. Imprint smears from endobronchial biopsy revealed moderately pleomorphic spindle cell tumor arranged in fascicles and perivascular pattern with attached myxoid material showing occasional mitotic activity suggesting a cytological diagnosis of sarcoma. Biopsy also displayed similar morphology. Extensive immunohistochemistry (IHC) showed diffuse SMA, focal AE1/AE3, and diffuse ALK positivity along with a MIB/Ki67 index of 30%-40% leading to the diagnosis of inflammatory myofibroblastic tumor (IMT; Sarcoma grade). Case 2: A 8-year-old boy presented with a huge left-sided mass replacing the entire lung parenchyma and eroding adjoining ribs. Pleural fluid cytology revealed vague clusters of PAS-positive diastase-sensitive small atypical cells with associated inflammatory cells in the hemorrhagic background, suggesting a diagnosis of malignant small round blue cell tumor. Trucut biopsy from the mass showed spindled to round cells showing diffuse positivity with CD99 and BCL-2. Molecular studies with reverse transcription-PCR (RT-PCR) for SYT-SSX and EWS-FLI1 were negative for synovial sarcoma and Ewing's sarcoma, respectively. Given the clinical setting, PAS positivity, IHC, and molecular studies, the diagnosis of tumors of uncertain differentiation with the possibility of Ewing's sarcoma family of tumors (ESFT) with a translocation between EWS1 and other ETS-family members (ERG, FEV, ETV1, E1AF, etc.) was suggested.
Collapse
Affiliation(s)
| | | | - Ujjawal Khurana
- Department of Pathology and Lab Medicine, AIIMS Bhopal, Bhopal, India
| | - Garima Goel
- Department of Pathology and Lab Medicine, AIIMS Bhopal, Bhopal, India
| | - Ashwani Tandon
- Department of Pathology and Lab Medicine, AIIMS Bhopal, Bhopal, India
| | - Deepti Joshi
- Department of Pathology and Lab Medicine, AIIMS Bhopal, Bhopal, India
| | | | | | - Abhishek Goyal
- Department of Pulmonary Medicine, AIIMS Bhopal, Bhopal, India
| |
Collapse
|
2
|
Ferrara D, Esposito F, Rossi E, Shangolabad PG, D'Onofrio V, Bifano D, Baldari D, Brillantino C, Zeccolini R, Zeccolini M. Type II pleuropulmonary blastoma in a 3-years-old female with dyspnea: a case report and review of literature. Radiol Case Rep 2021; 16:2736-2741. [PMID: 34345335 PMCID: PMC8319522 DOI: 10.1016/j.radcr.2021.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 11/02/2022] Open
Abstract
Pleuropulmonary blastoma (PPB) is a rare but aggressive pediatric tumor originates from either lung or pleura. It was recently linked to the DICER I mutation as a part of predisposition syndrome for different type of tumor. It is characterized histologically by a primitive, variably mixed blastomatous and sarcomatous tissue. PPB is classified into four subtypes: cystic (type I and type Ir); cystic and solid (type II); solid (type III). PPB has no characteristic imaging findings. Integrated imaging can help to make a differential diagnosis and to recognize the subtypes in order to set up therapy. An early recognition and differentiation from congenital airway malformations and other benign cysts are very important. The treatment consists in a multimodal therapy including surgery and chemoterapy. We report a case of 3 years old female admitted at our hospital with fever, non productive cough and dyspnea, who was diagnosed with type II PPB.
Collapse
Affiliation(s)
- Dolores Ferrara
- Department of Radiology - "AORN Santobono Pausilipon", Pediatric Hospital, Naples, Italy
| | - Francesco Esposito
- Department of Radiology - "AORN Santobono Pausilipon", Pediatric Hospital, Naples, Italy
| | - Eugenio Rossi
- Department of Radiology - "AORN Santobono Pausilipon", Pediatric Hospital, Naples, Italy
| | | | - Vittoria D'Onofrio
- Department of Pathology - "AORN Santobono Pausilipon", Pediatric Hospital, Naples, Italy
| | - Delfina Bifano
- Department of Pathology - "AORN Santobono Pausilipon", Pediatric Hospital, Naples, Italy
| | - Diana Baldari
- Department of Radiology - "AORN Santobono Pausilipon", Pediatric Hospital, Naples, Italy
| | - Carmela Brillantino
- Department of Radiology - "AORN Santobono Pausilipon", Pediatric Hospital, Naples, Italy
| | | | | |
Collapse
|
3
|
Kim JS, Lee JH. Exceptional response to radiotherapy in unresectable pleuropulmonary blastoma of a child. Radiat Oncol J 2020; 38:148-150. [PMID: 33012158 PMCID: PMC7533407 DOI: 10.3857/roj.2020.00290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/12/2020] [Indexed: 11/03/2022] Open
Abstract
Pleuropulmonary blastoma (PPB) is a rare intrathoracic neoplasm in children. Although surgery with or without chemotherapy mainly conducted, the response of radiotherapy (RT) has not been evaluated yet. For unresectable tumor, RT might be considered as one option to decrease tumor extent to relieve obstructing symptoms or to facilitate successive treatment. We report one child in whom PPB with DICER1 mutation recurred after surgery and lead to respiratory distress. She emergently received palliative RT with a relatively low dose (20 Gy), and symptoms sufficiently relieved. Even she showed an 84.3% reduction in diameter and maintained the remission status for 1 year. These might reflect possible radiosensitivity of PPB, and further investigations of RT might be necessary for unresectable PPB.
Collapse
Affiliation(s)
- Jae Sik Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
4
|
Diagnosis and treatment of pleuropulmonary blastoma in children: A single-center report of 41 cases. J Pediatr Surg 2020; 55:1351-1355. [PMID: 31277979 DOI: 10.1016/j.jpedsurg.2019.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study was performed to investigate the age at onset, clinical manifestations, pathological types and features, treatment, and prognosis of pleuropulmonary blastoma (PPB) in children in an attempt to reduce the misdiagnosis rate and achieve early detection and timely intervention. METHODS We retrospectively studied the clinical data of 41 pediatric patients with PPB who were treated in our center from March 2002 to November 2018. The data comprised the age at onset, clinical manifestations, characteristics of familial diseases, pathological types, surgical procedures, and prognosis. RESULTS Twenty male and 21 female patients were included, with a 0.95:1.00 male:female ratio. In total, 51.2% of the patients were misdiagnosed as having nonneoplastic lesions at the first presentation. The interval from symptom onset to surgery/chemotherapy ranged from 5 to 210 days. The pathological types were type I (cystic) PPB (n = 5, 11.9%), for which the median age at diagnosis was 21 months (range, 8-24 months); (solid/cystic) II PPB (n = 12, 28.6%), for which the median age at diagnosis was 37 months (range, 22-112 months); and type III (solid) PPB (n = 23, 54.8%), for which the median age at diagnosis was 39 months (range, 19-156 months). The pathologic type was undefined in one patient (2.4%). The patients were mainly treated by surgery and chemotherapy. The 5-year disease-free survival rate was 69.2%. CONCLUSION The clinical manifestations of PPB are nonspecific, its misdiagnosis rate is high, and it has a poor prognosis. Pediatricians should be aware of the seriousness of PPB. The possibility of PPB should be considered in children with pneumothorax, multiple pulmonary cystic lesions, a family history of pulmonary cysts, a family history of PPB, or space-occupying lesions associated with DICER1 syndromes. The lesion should be closely monitored and surgically removed if necessary. The nature of the lesion should be identified early to minimize the risk of progression of the PPB to worse types because of misdiagnosis and missed diagnosis. Multidisciplinary treatment including surgery, chemotherapy, and/or radiotherapy can be applied to patients with PPB. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE Level III.
Collapse
|
5
|
Ghosh M, Islam N, Ghosh A, Chaudhuri PM, Saha K, Chatterjee U. Pleuropulmonary Blastoma Developing in a Case of Misinterpreted Congenital Pulmonary Airway Malformation: a Case Report. Fetal Pediatr Pathol 2018; 37:377-386. [PMID: 30358469 DOI: 10.1080/15513815.2018.1520943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Pleuropulmonary blastoma (PPB) is a childhood malignancy known to be associated with congenital pulmonary airway malformation (CPAM). CASE REPORT An 18 months boy presented with respiratory distress. Computed tomography (CT) scans revealed a large right-sided lung mass. Fine needle aspiration cytology (FNAC) showed sheets and clusters of small round to oval cells with scanty cytoplasm. The possibility of PPB was suggested. Trucut biopsy from the mass confirmed the diagnosis of PPB, of at least type II. The child had earlier been diagnosed as CPAM for which he had undergone lobectomy at six months, which on review was diagnosed as PPB I. CONCLUSION We describe the cytological and histological findings of a case of PPBII/III evolving from a PPB I originally thought to be a CPAM type IV. This supports the theory that PPB I may progress to a more aggressive type II with time, and highlights the importance of the adequately treating the PPB I to prevent this transformation.
Collapse
Affiliation(s)
- Moupali Ghosh
- a Dept. of Pathology , Institute of Post Graduate Medical Education and Research and SSKM Hospital (IPGME&R & SSKM) , Kolkata , India
| | - Nelofar Islam
- a Dept. of Pathology , Institute of Post Graduate Medical Education and Research and SSKM Hospital (IPGME&R & SSKM) , Kolkata , India
| | - Arindam Ghosh
- b Department of Pediatric Surgery , Nil Ratan Sircar Medical College and Hospital (NRSMCH) , Kolkata , India
| | - Priyanka Maity Chaudhuri
- a Dept. of Pathology , Institute of Post Graduate Medical Education and Research and SSKM Hospital (IPGME&R & SSKM) , Kolkata , India
| | - Koushik Saha
- b Department of Pediatric Surgery , Nil Ratan Sircar Medical College and Hospital (NRSMCH) , Kolkata , India
| | - Uttara Chatterjee
- a Dept. of Pathology , Institute of Post Graduate Medical Education and Research and SSKM Hospital (IPGME&R & SSKM) , Kolkata , India
| |
Collapse
|
6
|
Das M, Maity Chaudhuri P, Bandyopadhyay A, Chatterjee U. Pulmonary blastoma in a child: Report of a case with cytological findings. Diagn Cytopathol 2017; 46:175-178. [DOI: 10.1002/dc.23811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 08/23/2017] [Accepted: 08/28/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Mou Das
- Department of Pathology; IPGME&R; Kolkata India
| | | | | | | |
Collapse
|
7
|
Chen CC, Yang SF, Lin PC, Luo CW, Chou SH, Dai ZK, Yin HL. Pulmonary Blastoma in Children: Report of a Rare Case and Review of the Literature. Int J Surg Pathol 2017; 25:721-726. [PMID: 28675947 DOI: 10.1177/1066896917718622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pulmonary blastoma is a rare malignant lung tumor with aggressive behavior and dismal prognosis. It is extremely rare in children aged <18 years, and little is known about its genetic alteration and pathogenesis. Although surgical resection and adjuvant chemotherapy or radiotherapy have been applied in several cases, no standard treatment guidelines with sufficient evidence have been established. In this article, we report a case of a large pulmonary blastoma in a 7-year-old girl whose initial presentation was progressive dyspnea and productive cough. We subsequently present a review on cases involving young patients as well as genetic analysis data available in the literature.
Collapse
Affiliation(s)
- Chia-Chi Chen
- 1 Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheau-Fang Yang
- 1 Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,2 Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Chin Lin
- 1 Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Wen Luo
- 1 Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Hua Chou
- 1 Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zen-Kong Dai
- 1 Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Ling Yin
- 1 Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,2 Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
8
|
Christosova IR, Avramova BE, Drebov RS, Shivachev HI, Kamenova MA, Bobev DG, Brankov OG. Diagnosis and treatment of pleuropulmonary blastoma-single center experience. Pediatr Pulmonol 2015; 50:698-703. [PMID: 24692196 DOI: 10.1002/ppul.23047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 01/14/2014] [Indexed: 01/15/2023]
Abstract
Pleuropulmonary blastoma (PPB) is a rare and potentially aggressive intrathoracic disembryonic neoplasm typically occurring in children less than 6 years of age. We assessed the relative incidence, clinical characteristics, treatment outcome, and the prognostic factors for long-term survival in patients with PPB treated at our institution over a 25-year period, and compared these data with reports in the literature. From 1985 to 2010, 11 children (4 males and 7 females), with a median age of 5.4 years (range, 1-12 years) were treated at our hospital. Here we described the main characteristics of these patients, the diagnostic methods, and treatment modalities used. During a median follow-up period of 80, 9 months, the overall survival (OS) and disease-free survival (DFS) rates were 54, 6% and 45, 5%, respectively. Two patients survived for more than 20 years. The main prognostic factors for long-term survival were the diseases type I and II and treatment with radical surgery. Our results show that in order to improve the prognosis of patients with PPB a timely in our opinion and accurate diagnosis needs to be established and treatment should be offered according to the disease type and extend of dissemination.
Collapse
Affiliation(s)
| | - Boryana E Avramova
- Specialized Hospital for Pediatric Oncohematology, Sofia, Sofia, Bulgaria
| | - Rosen S Drebov
- University Hospital for Emergency Medicine "Pirogov," Sofia, Clinic of Pediatric Surgery, Sofia, Bulgaria
| | - Hristo I Shivachev
- University Hospital for Emergency Medicine "Pirogov," Sofia, Clinic of Pediatric Surgery, Sofia, Bulgaria
| | - Margarita A Kamenova
- Section of Pathology, University Hospital for Emergency Medicine "Pirogov," Sofia, Sofia, Bulgaria
| | - Dragan G Bobev
- Specialized Hospital for Pediatric Oncohematology, Sofia, Sofia, Bulgaria
| | - Ognyan G Brankov
- University Hospital for Emergency Medicine "Pirogov," Sofia, Clinic of Pediatric Surgery, Sofia, Bulgaria
| |
Collapse
|
9
|
Inflammatory myofibroblastic tumour in a 5-year-old child - a case report and review of the literature. Wideochir Inne Tech Maloinwazyjne 2015; 9:658-61. [PMID: 25562011 PMCID: PMC4280424 DOI: 10.5114/wiitm.2014.45885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/11/2014] [Accepted: 09/01/2014] [Indexed: 11/17/2022] Open
Abstract
Inflammatory myofibroblastic tumour is an uncommon tumour of intermediate malignant potential. Its aetiology is still unclear. It occurs predominantly in children and young adults. This report presents a case of pulmonary inflammatory myofibroblastic tumour in a 5-year-old girl. The patient had a history of recurrent respiratory tract infections. A chest radiograph and computed tomography chest scan showed a round mass in the lower lobe of her left lung. Thoracoscopic marginal excision of the tumour with an Endo-GIA stapler device (TYCO healthcare) was performed. Histological examination confirmed the final diagnosis of inflammatory myofibroblastic tumour. Postoperative recovery was uncomplicated and the patient was discharged 6 days after surgery. Round masses located in the lungs are very rare in children and the possibility of myofibroblastic tumour as well as metastatic lesions should be taken into consideration in such cases. Thoracoscopic excision is the best option in distally located lesions.
Collapse
|
10
|
Abstract
(18)F-FDG PET/CT scanning plays an important role in the management of thoracic malignancy. The authors would like to present FDG PET/CT images of a rare thoracic malignancy, pulmonary blastoma in adulthood. The patient had recurrent metastatic disease of previously resected primary pulmonary blastoma. The foci of recurrent metastases in lung, mediastinum, and subcutaneous tissue are intensely FDG-avid.
Collapse
|