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Schultz KAP, Harris AK, Nelson AT, Watson D, Lucas JT, Miniati D, Stewart DR, Hagedorn KN, Mize W, Kamihara J, Mitchell SG, Wilson DB, Gettinger K, Rangaswami AA, Harney LA, Rodriguez Galindo C, Bisogno G, Dehner LP, Hill DA, Messinger YH. Outcomes for Children With Type II and Type III Pleuropulmonary Blastoma Following Chemotherapy: A Report From the International PPB/ DICER1 Registry. J Clin Oncol 2023; 41:778-789. [PMID: 36137255 PMCID: PMC9901992 DOI: 10.1200/jco.21.02925] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/11/2022] [Accepted: 08/08/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Pleuropulmonary blastoma (PPB) is the most common primary lung neoplasm of infancy and early childhood. Type II and type III PPB have historically been associated with a poor prognosis. METHODS Patients with known or suspected PPB were enrolled in the International PPB/DICER1 Registry. Medical records were abstracted with follow-up ascertained annually. All PPB diagnoses were confirmed by central pathology review. Beginning in 2007, the IVADo regimen (ifosfamide, vincristine, actinomycin-D, and doxorubicin) was recommended as a potential treatment regimen for children with type II and type III PPB. This regimen was compared with a historical control cohort. RESULTS From 1987 to 2021, 314 children with centrally confirmed type II and type III PPB who received upfront chemotherapy were enrolled; 132 children (75 with type II and 57 with type III) received IVADo chemotherapy. Adjusted analyses suggest improved overall survival for children treated with IVADo in comparison with historical controls with an estimated hazard ratio of 0.65 (95% CI, 0.39 to 1.08). Compared with localized disease, distant metastasis at diagnosis was associated with worse PPB event-free survival and overall survival with hazard ratio of 4.23 (95% CI, 2.42 to 7.38) and 4.69 (95% CI, 2.50 to 8.80), respectively. CONCLUSION The use of IVADo in children with type II and type III PPB resulted in similar-to-improved outcomes compared with historical controls. Inferior outcomes with metastatic disease suggest the need for novel therapies. This large cohort of uniformly treated children with advanced PPB serves as a benchmark for future multicenter therapeutic studies for this rare pediatric tumor.
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Affiliation(s)
- Kris Ann P. Schultz
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN
| | - Anne K. Harris
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN
| | - Alexander T. Nelson
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN
- University of Minnesota Medical School, Minneapolis, MN
| | - Dave Watson
- Research Institute, Children's Minnesota, Minneapolis, MN
| | - John T. Lucas
- Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Doug Miniati
- Division of Pediatric Surgery, Kaiser Permanente Northern California, Roseville, CA
| | - Douglas R. Stewart
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | | | - William Mize
- Department of Radiology, Children's Minnesota, Minneapolis, MN
| | - Junne Kamihara
- Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | - Sarah G. Mitchell
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - David B. Wilson
- Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO
| | - Katie Gettinger
- Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO
| | - Arun A. Rangaswami
- Division of Pediatric Hematology and Oncology, University of California San Francisco, San Francisco, CA
| | | | | | - Gianni Bisogno
- Hematology, Oncology and Stem Cell Transplant Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Louis P. Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO
| | - D. Ashley Hill
- Division of Pathology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
- ResourcePath LLC, Sterling, VA
| | - Yoav H. Messinger
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN
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Abstract
Pulmonary blastoma (PB) is a very rare malignant lung tumor consisting of classic biphasic PB, well-differentiated fetal adenocarcinoma, and pleuropulmonary blastoma. We herein present an unusual case involving a patient with classic biphasic PB who underwent right upper lobe resection and subsequent treatment. No standard treatment guidelines are available for PB because of its rarity. Our patient received nedaplatin plus paclitaxel as adjuvant chemotherapy. After disease recurrence, the patient received two cycles of etoposide-cisplatin and six cycles of pemetrexed, bevacizumab, and carboplatin. Because of severe adverse effects of the chemotherapy, the patient was finally administered anlotinib, a new oral multikinase inhibitor. Both the tumor size and the serum tumor marker concentration decreased. In conclusion, surgical excision is the treatment of choice for PB. Chemotherapy in the present case resulted in PB activity that was consistent with the literature. Targeted therapies including antiangiogenic agents should be considered as a new treatment option for this rare disease.
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Affiliation(s)
- Zhuanbo Luo
- Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Respiratory Disease, Ningbo Hospital, Zhejiang University School of Medicine, Zhejiang University, Ningbo, Zhejiang, China
| | - Chao Cao
- Department of Respiratory Disease, Ningbo Hospital, Zhejiang University School of Medicine, Zhejiang University, Ningbo, Zhejiang, China
| | - Ning Xu
- Department of Respiratory Disease, Ningbo Hospital, Zhejiang University School of Medicine, Zhejiang University, Ningbo, Zhejiang, China
| | - Kejing Ying
- Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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3
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Abstract
There is an increased risk of cancer after organ transplantation mainly due to the immunosuppressive therapy required in these patients. We report a case of biphasic pulmonary blastoma in an adult male who underwent liver transplant for hepatocellular carcinoma in March 1999, followed by immunosuppressive treatment and adjuvant chemotherapy with epirubicin. Disease-free survival lasted 18 months, then a diagnosis of biphasic pulmonary blastoma was made and the patient underwent a lung lobectomy. Five months after surgical resection a recurrence of this rare tumor was recorded and two cycles of cisplatin + etoposide and ifosfamide + etoposide and one cycle of second-line chemotherapy with vinorelbine were administered. The tolerability and the efficacy of this treatment were poor. The patient died less than one year after diagnosis. To our knowledge this is the first reported case of pulmonary blastoma in a transplant patient. Our findings confirm that organ transplant recipients deserve long-term medical surveillance also in the absence of graft complications, and that pulmonary blastoma is an aggressive tumor with a poor prognosis.
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Affiliation(s)
- Alfredo Tartarone
- Department of Medical Oncology, Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (PZ), Italy.
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4
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Gallo K, Brickman A, Warren WH, Gattuso P, Seder CW. Unresectable Middle Mediastinal Biphasic Pulmonary Blastoma. Anticancer Res 2015; 35:6325-6327. [PMID: 26504071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report a case of a young male who presented with an unresectable, centrally-located classic biphasic pulmonary blastoma (CBPB) involving his bilateral mainstem bronchi and esophagus and a synchronous right testicular seminoma. CBPB is a rare and aggressive tumor that most commonly presents as a solitary mass in the periphery of the lung. Surgical resection is the preferred treatment for CBPB, as chemotherapy and radiation have demonstrated limited effectiveness. In the current case, four cycles of cisplatin, ifosfamide, and etoposide with concurrent radiotherapy resulted in a favorable response at three months. Currently he optimal treatment for unresectable pulmonary blastomas remains undefined.
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Affiliation(s)
- Kelsey Gallo
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, U.S.A
| | - Arlen Brickman
- Department of Pathology, Rush University Medical Center, Chicago, IL, U.S.A
| | - William H Warren
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, U.S.A
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, IL, U.S.A
| | - Christopher W Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, U.S.A.
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5
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Sharma A, O'Gorman K, Aman C, Rassl D, Mohamid W, Polychronis A. A rare occurrence of biphasic pulmonary blastoma in an elderly male. Anticancer Res 2013; 33:3911-3915. [PMID: 24023328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Pulmonary Blastoma (PB) is a rare primary lung malignancy usually occurring in young to middle aged adults. Surgery is the primary mode of treatment, but survival is poor with the mean 5-year survival being approximately 16%. We report on a case of PB arising in a 63-year-old man. Computed tomography, magnetic resonance imaging and positron emission tomography confirmed the mass to be of pulmonary origin. The morphological appearance combined with the immunoprofile of the tumour was consistent with a poorly-differentiated biphasic pulmonary blastoma. Two months after the surgical resection the patient relapsed with multiple sites of metastasis. The patient was treated with four cycles of cyclophosphamide-, doxorubicin- and vincristine-(CAV)-based chemotherapy, achieving a partial response to treatment. He is currently on a two-monthly review and is recovering from chemotherapy-related toxicities.
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Affiliation(s)
- Anand Sharma
- Department of Medical Oncology, Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex, HA6 2RN, U.K.
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6
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Lindet C, Vanhuyse M, Thebaud E, Robin YM, Penel N. Pulmonary blastoma in adult: dramatic but transient response to doxorubicin plus ifosfamide. Acta Oncol 2011; 50:156-7. [PMID: 20670092 DOI: 10.3109/0284186x.2010.491087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Corapçioğlu F, Liman T, Aksu G, Inan N, Deveci M, Gürbüz Y, Topçu S. A case report with type II pleuropulmonary blastoma: successful treatment with surgery and chemotherapy. Turk J Pediatr 2009; 51:78-81. [PMID: 19378898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Pleuropulmonary blastoma (PPB) is a very rare intrathoracic malignancy in childhood. It is an aggressive embryonal or blastemic neoplasm usually occurring in children younger than five years of age. PPB is treated with aggressive multimodal therapies consisting of surgery and chemotherapy. We present a case with PPB type II successfully treated with complete surgical resection following neoadjuvant chemotherapy. She has been free of disease for 33 months of follow-up. Complete surgical resection of the tumor at the time of diagnosis is the cornerstone of PPB management, but in the majority of patients, initial surgery is incomplete because a large tumor may involve vital structures. For this reason, patients with initially unresectable tumors should be treated with neoadjuvant chemotherapy to reduce the lesion to the point that it becomes resectable.
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Affiliation(s)
- Funda Corapçioğlu
- Department of Pediatrics, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
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9
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Abstract
A 3-year-old female presented with a large tumor occupying the right thoracic space. Open biopsy revealed the pathological diagnosis of pleuropulmonary blastoma. After the first-line chemotherapy, the patient underwent surgical resection, then two courses of high-dose chemotherapy. Three years later, follicular carcinoma of the right thyroid lobe was found, so a right hemithyroidectomy was performed. Five months later, the thyroid tumor recurred. The remaining thyroid lobe was completely excised and radioiodine therapy was administered. The patient has remained tumor-free for 3 years. The etiology and treatment of the uncommon combination of pleuropulmonary blastoma and thyroid carcinoma is discussed.
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Affiliation(s)
- Takaharu Oue
- Department of Surgery, Division of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
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10
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Zuker NB, Dietl CA, Kenna S, Fischer EG, Gardner D. Unusual survival of an adult with pleuropulmonary blastoma and neurofibromatosis. J Thorac Cardiovasc Surg 2007; 134:541-2. [PMID: 17662818 DOI: 10.1016/j.jtcvs.2007.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2007] [Accepted: 04/26/2007] [Indexed: 10/23/2022]
Affiliation(s)
- Noah B Zuker
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131-0001, USA
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11
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McMahon CJ, Murchan H, Prendiville T, Burch M. Parvovirus B19 infection associated with dilated cardiomyopathy in patients with previous anthracycline exposure. Pediatr Cardiol 2007; 28:394-5. [PMID: 17632683 DOI: 10.1007/s00246-006-0147-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Accepted: 04/18/2007] [Indexed: 11/24/2022]
Abstract
We describe two children with previous anthracycline exposure for cancer who presented with acute decompensated left ventricular dysfunction. Both patients had evidence of dilated cardiomyopathy and required mechanical ventilation and inotropic support. Parvovirus B19 was detected by polymerase chain reaction of the blood. After several weeks of ventilation and inotropic support, both patients were weaned from ventilation and managed with oral carvedilol, ACE inhibition, and diuretics. Acute left ventricular decompensation in patients following anthracycline exposure may not be solely attributed to drug exposure, and viral etiologies should be considered.
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Affiliation(s)
- C J McMahon
- Department of Paediatric Cardiology, Our Lady's Hospital for Sick Children, Crumlin, Dublin 12, Ireland.
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12
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Indolfi P, Bisogno G, Casale F, Cecchetto G, De Salvo G, Ferrari A, Donfrancesco A, Donofrio V, Martone A, Di Martino M, Di Tullio MT. Prognostic factors in pleuro-pulmonary blastoma. Pediatr Blood Cancer 2007; 48:318-23. [PMID: 16619221 DOI: 10.1002/pbc.20842] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To evaluate the prognostic factors in a series of children affected by pleuropulmonary blastoma (PPB). PATIENTS AND METHODS Clinicopathological findings, treatment, and outcome of 22 PPB cases observed in 13 Italian Associations for Pediatric Hematology and Oncology centers are reported. Clinical data, surgical notes, pathologic findings, and summaries of treatment were taken from the charts and correlated with outcome by standard statistical methods. RESULTS The series included 22 patients (14 males) with a median age of 30.5 months followed up for a median of 22 months (range 2-176 months). In nine patients the PPB developed with lung involvement only. Congenital lung cysts were recorded in five cases. Nine patients had recurrences. Gender, side, tumor size, pre-existing lung cysts, and extent of surgical resection at diagnosis did not significantly affect survival by univariate analysis. Achieving total resection of the tumor at any time of treatment resulted in a significantly better prognosis (P = 0.01), whereas extrapulmonary involvement at diagnosis resulted in a significantly worse prognosis (P = 0.01). Estimated 15-year event-free and overall survival rates were 44 and 49% for all patients, respectively. CONCLUSIONS PPB is an aggressive neoplasm. Total resection of PPB performed at any time of treatment appears to provide a better outcome, whereas extrapulmonary involvement at diagnosis worsens the prognosis.
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Affiliation(s)
- Paolo Indolfi
- Pediatric Oncology Service Second University of Naples, Italy.
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13
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Pai S, Eng HL, Lee SY, Hsaio CC, Huang WT, Huang SC, Hill DA, Dehner LP, Priest JR. Correction: Pleuropulmonary blastoma, not rhabdomyosarcoma in a congenital lung cyst. Pediatr Blood Cancer 2007; 48:370-1. [PMID: 16856157 DOI: 10.1002/pbc.20965] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Shyun Pai
- Department of Pathology, Kaohsiung Medical Center, Chang Gung University and Memorial Hospital, Niao-Sung, Kaohsiung, Taiwan
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14
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Abstract
Pleuropulmonary blastoma (PPB) is a rare and aggressive intrathoracic malignant tumor that can be associated with cystic lung lesions in children. This neoplasm is histologically characterized by primitive blastoma and a malignant mesenchymal stroma. The authors describe a 3-year-old boy who presented with a history of fever and cough. Radiological imaging demonstrated a large cystic lesion replacing the left lower lobe. The patient underwent thoracoscopic resection of the lesion. Interestingly, the histopathology demonstrated a type 1 PPB. Type 1 lesions are usually observed in young infants, whereas older infants and children tend to present with type 2 or 3 PPB, which carry a poorer prognosis and higher risk of recurrence. Thus, the presence of large or peripherally based lung cysts should raise the suspicion of PPB. Resection is warranted for all such lesions.
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Affiliation(s)
- Nouf Al-Backer
- Division of Pediatric Respirology, The Montreal Children's Hospital, Montreal, Quebec, Canada H3H 1P3
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15
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Priest JR, Hill DA, Williams GM, Moertel CL, Messinger Y, Finkelstein MJ, Dehner LP. Type I pleuropulmonary blastoma: a report from the International Pleuropulmonary Blastoma Registry. J Clin Oncol 2006; 24:4492-8. [PMID: 16983119 DOI: 10.1200/jco.2005.05.3595] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Type I pleuropulmonary blastoma (PPB) is a rare, cystic lung neoplasm in infants characterized by subtle malignant changes and a good prognosis. Recurrences after type I PPB are usually advanced type II or type III neoplasms with a poor prognosis. This article describes the first collection of type I PPB cases, analyzes outcome based on treatments of surgery or surgery plus chemotherapy, and presents type I PPB management recommendations. PATIENTS AND METHODS Type I PPB cases from the International PPB Registry and literature were evaluated using standard statistical methods for outcomes based on age at diagnosis, sex, thoracic side, surgical extent, length of follow-up, constitutional/familial disease, pre-existing lung cysts, intrathoracic findings, and treatments (surgery or surgery and chemotherapy). RESULTS Thirty-eight type I PPB cases were identified: Registry (n = 30) and literature (n = 8). Twenty children had surgery alone; eight (40%) experienced recurrence; and four died. Eighteen children had surgery and adjuvant chemotherapy; one experienced recurrence and died. All recurrences were type II or III PPB. Recurrence-free survival was higher in the surgery + chemotherapy group (P = .01); overall survival did not differ (P = .18). The improved recurrence-free survival was found only in males. Four of nine children with recurrence survived. CONCLUSION Adjuvant chemotherapy appears to benefit type I PPB patients. Benefit limited to males requires broader substantiation. Salvage after types II and III recurrence is poor (four of nine; 44%). A rigorous surveillance schedule after type I PPB diagnosis might detect early recurrence and be an acceptable alternative to adjuvant chemotherapy.
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Affiliation(s)
- John R Priest
- International Pleuropulmonary Blastoma Registry, Children's Hospitals and Clinics of Minnesota, St Paul, Minnesota 55102, USA.
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16
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Abstract
We report a case of pleuropulmonary blastoma in a child initially diagnosed with encysted pleural empyema. She was treated with combination chemotherapy including ifosfamide, etoposide, vincristine, adriamycin, actinomycin-D, and cyclophosphamide after surgical excision.
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Affiliation(s)
- Mustafa Büyükavci
- Division of Pediatric Oncology, Department of Pathology, Ataturk University School of Medicine, 50/2 Erzurum, Turkey.
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17
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Abstract
BACKGROUND/PURPOSE Pleuropulmonary blastoma (PPB) is a rare primary neoplasm of pleuropulmonary mesenchyme. Fewer than 170 children have been reported, and few single institutions have reported more than several cases. Treatment for this condition is primarily surgical resection; however, increasing experience suggests that adjuvant chemotherapy may decrease recurrence and improve outcome. METHODS We reviewed the charts of all children with PPB treated at our institution since 1960. We reviewed the prenatal features, clinical presentation, operation, pathological findings, adjuvant treatment, and outcome. RESULTS Ten children (6 boys and 4 girls) were treated for PPB at a mean age of 3.2 +/- 4.3 years. In 2, a cystic lung mass was diagnosed prenatally, and in 8, a cystic or solid and cystic lung mass was diagnosed postnatally (right lung, 3; left lung, 4; and bilateral, 3). In no patient was PPB considered preoperatively. Surgical resection was performed at 1 day to 11 years (median, 23 months) of age. Seven children had complete resection; 1 had microscopic residual disease, and 2 had gross residual disease. Pathology showed type I PPB in 7, type II in 1, and type III in 2. Five patients received adjuvant chemotherapy with vincristine, actinomycin, and cyclophosphamide-based regimens. At follow-up (mean, 7.7 +/- 11.5 years; range, 1-456 months), children with type I PPB have no evidence of disease (n = 6) or are lost to follow-up (n = 1), whereas all those with type II/III PPB have died of the disease. CONCLUSIONS PPB must be included in the differential diagnosis of a fetus, neonate, or child with a cystic lung mass. This finding supports early resection of these lesions rather than observation or treatment with nonoperative strategies.
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Affiliation(s)
- Douglas N Miniati
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
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18
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Regragui A, Cherradi N, Sefiani S, Malihy A, Khattab M, Alhamany Z. [Pleuropulmonary blastoma: possible interest of neoadjuvant chemotherapy. A case report]. Rev Pneumol Clin 2003; 59:365-370. [PMID: 14745343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Pleuropulmonary blastoma is a very exceptional anatomoclinical and histological entity recently distinguished from adult pneumoblastoma. This tumor, observed in children aged less than 15, can involve the lung, the pleura, or the mediastinum and is characterized by a very poor prognosis. We report the case of a 4-year-old girl who developed pleuropulmonary blastoma which was discovered in a context of respiratory distress. Standard chest x-ray revealed an opacity covering the entire left lung. Histology and immunohistology led to the diagnosis of pleuropulmonary blastoma with several components: blastematous, malignant mesenchymatous with pluridirectional differentiation, and benign epithelial tissue. Treatment consisted in preoperative chemotherapy and radiotherapy to reduce tumor volume. This neoadjuvant treatment is not widely reported and its relatively favorable result allowed tumor resection. This approach might be useful in similar cases.
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Affiliation(s)
- A Regragui
- Service d'Anatomie Pathologique, Hôpital d'Enfants, CHU Ibn Sina, Rabat, Maroc.
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19
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Abstract
Transverse white nail banding can be inherited or caused by various diseases and medications, including cancer chemotherapeutic agents, retinoids, tetracyclines, antimalarials, sulfonamides, pilocarpine, cortisone and zidovudine. Neither a specific drug nor classes of cancer chemotherapeutics were associated more frequently than the other with acquired transverse leukonychia in patients with cancer. Here we report transverse leukonychia in four children with cancer receiving different chemotherapeutic agents.
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Affiliation(s)
- Asim Yoruk
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, SSK Goztepe Educational Hospital, Istanbul, Turkey.
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20
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Abstract
We report a case of pleuropulmonary blastoma with complex cytogenetic abnormalities, including trisomy 2, trisomy 8, dup(7), der(10) t(8; 10)(q13; q22), add(17), and double minutes (dmin). Fluorescence in situ hybridization FISH analysis demonstrated TP53 deletion and amplification of MYCN; the latter has not been reported in PPB.
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Affiliation(s)
- Bo Hong
- Cytogenetics Laboratory, University of Utah School of Medicine, 50 North Medical Drive, Salt Lake City, UT 84132, USA
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21
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Affiliation(s)
- Simone G Ramos
- Department of Pathology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil.
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22
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Surmont VF, van Klaveren RJ, Nowak PJCM, Zondervan PE, Hoogsteden HC, van Meerbeeck JP. Unexpected response of a pulmonary blastoma on radiotherapy: a case report and review of the literature. Lung Cancer 2002; 36:207-11. [PMID: 11955657 DOI: 10.1016/s0169-5002(01)00465-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pulmonary blastoma (PB) is a rare malignant tumor of the lung. Treatment is primarily surgical, although, combination chemotherapy has been reported to result in objective responses in inoperable tumors or after incomplete resections. To our knowledge, this is the first report of a very radiosensitive PB, which showed major tumor reduction after several fractions of radiotherapy without further tumor regression after additional chemotherapy with cisplatin and etoposide. The literature on the treatment of PB is reviewed.
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Affiliation(s)
- Veerle F Surmont
- Department of Pulmonology, Respiratory Oncology Unit, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
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23
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Drebov R, Brankov O, Mikhailova V, Kamenova M, Khristozova I. [Pleuropulmonary blastoma in children: diagnosis and results of surgery and complex treatment]. Khirurgiia (Mosk) 2002; 56:12-5. [PMID: 11692910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
This is a report on a retrospective study of experience had with complex treatment of pleuropulmonary blastoma in ten children aged 2-11 years, covering a 27-year period. In all patients diagnosis is made on the ground of clinical symptomatology, imaging methods and histological findings. All patients undergo surgery, as follows: tumor extirpation (n = 3), lobectomy (n = 2) and pneumonectomy (n = 5). Three deaths occur in the early postoperative period (30%). In the remainder postoperative chemotherapy is conducted. Histologically the solid variant (type 3 according to Dehner's classification) is predominant. There are three recurrences (42.8%) among the cases with simple tumor extirpation (2) and lobectomy (1), followed by successful pneumonectomy (two patients) and atypical pulmonary resection (one patient). At long-term follow-up, five patients (50%) are still alive for periods ranging from 1 to 11 years postoperatively. Pleuropulmonary blastoma is a surgical rarity in children. The most important factors for long-term survivorship are both radical surgery, and adequate chemotherapy.
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Abstract
We report a rare case of pleuropulmonary blastoma arising in a 3-year-old boy and involving the middle and upper lobes of the right lung. Radical resection of the mass was achieved by a bilobectomy. Microscopic examination of the histologic sections showed the typical findings of blastemal and mesenchymal areas with focal zones of rhabdomyoblastic and liposarcomatous differentiation. Monthly cycles of chemotherapy consisting of ifosfamide, vincristine and actinomycin D were given for 10 months after surgical resection. Our patient is presently alive and disease-free two years after diagnosis. As complete tumour ablation is essential to prevent local recurrence and allow any chance of survival, the favourable outcome of our patient is probably due to the radical resection of the neoplasm.
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Affiliation(s)
- C Granata
- Department of Paediatric Surgery, Giannina Gaslini Institute, Genova, Italy.
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25
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Federici S, Domenichelli V, Tani G, Sciutti R, Burnelli R, Zanetti G, Dòmini R. Pleuropulmonary blastoma in congenital cystic adenomatoid malformation: report of a case. Eur J Pediatr Surg 2001; 11:196-9. [PMID: 11475118 DOI: 10.1055/s-2001-15490] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Pulmonary blastoma is a rare malignant tumor seen in both adults and children. Approximately only 25% of cases occur in pediatric patients, many of whom affected by a congenital pulmonary cystic lesion. The clinical features, radiological findings and management of a 3-year-old boy affected by a pulmonary blastoma which arose in a congenital cystic adenomatoid malformation are reported, and an extensive review of the literature is also made. Because of the well-known tendency of cystic pulmonary diseases to develop malignancies, authors recommend the surgical excision of these kind of lesion or at least their close radiological follow-up.
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Affiliation(s)
- S Federici
- Department of Pediatric Surgery, University of Bologna, Italy.
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Walles T, Teebken OE, Bartels M, Fangmann J, Scheumann GF, Pichlmaier MA, Klempnauer J. Pancreatic metastasis of a pleuropulmonary blastoma in an adult. Ann Oncol 2000; 11:1609-11. [PMID: 11205471 DOI: 10.1023/a:1008339425495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pleuropulmonary blastoma (PPB) is a rare dysontogenetic tumor that usually develops in the first decade of life and has been recognized as a distinct clinico-pathological entity different from the ordinary pulmonary blastoma of adulthood. Since the tumor grows aggressively and tends to metastasize early, physicians have to be aware of late onset of symptoms and uncommon manifestations. We report a case of PPB in a young adult and its recurrence in the pancreas after primary surgical treatment and adjuvant chemotherapy. Keeping in mind the moderate prognosis of PPB in children, accurate assessment and treatment of PPB require a team approach of oncology, radiology and surgery to establish new therapeutic guidelines in the future.
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Affiliation(s)
- T Walles
- Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany
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27
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Lallier M, Bouchard S, Di Lorenzo M, Youssef S, Blanchard H, Lapierre JG, Vischoff D, Tucci M, Brochu P. Pleuropulmonary blastoma: a rare pathology with an even rarer presentation. J Pediatr Surg 1999; 34:1057-9. [PMID: 10442587 DOI: 10.1016/s0022-3468(99)90563-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pleuropulmonary blastoma is among the rarest tumors of childhood. Three types have been described: cystic, solid, and mixed. To date, bilateral disease has not been documented. METHODS AND RESULTS A 5-week-old girl presented with a history of fever. Chest x-ray showed bilateral diffuse cystic lesions. Bowel obstruction developed that required laparotomy. Multiple small bowel polyps were resected. The patient was readmitted 4 months later with deteriorating respiratory status. She underwent sequential thoracotomies for resection of multiple bullae under high-frequency oscillatory ventilation. Small bowel polypectomies were again required because of obstruction. Lung lesions were compatible with pulmonary blastoma but could not be correlated with intestinal polyposis. Bilateral cystic renal lesions were seen on ultrasound scan. Her disease progressed, despite chemotherapy, with the appearance of metastatic iris lesions. She again underwent laparotomies for multiple recurrent generalized small bowel polyps that were causing obstruction. Expanding renal cysts affected kidney function, and she died at 14 months of age. CONCLUSIONS The rare association between pleuropulmonary blastoma and Wilms' tumor or nephroblastomatosis is known but rarely reported. Lacking pathological evidence, we can only speculate that this was the case. We have been unable to demonstrate any histological association between the renopulmonary and digestive lesions. Despite many unanswered questions, we are likely dealing with a "syndrome" of sorts with a dire outcome, despite aggressive treatments.
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Affiliation(s)
- M Lallier
- Department of Pediatrics, Hôpital Sainte-Justine, Montreal, Quebec, Canada
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28
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Benouachane T, el Khorassani M, Nachef MN, Khattab M, Alhamany Z, Barahioui M, Msefer Alaoui F. [Pleuro-pulmonary blastoma. Report of 4 cases]. Rev Mal Respir 1999; 16:390-4. [PMID: 10472650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Pleuropulmonary blastoma is an uncommon malignant lung tumor observed in children. Outcome is often unfavorable. Two boys and two girls, mean age 4.5 years, were admitted for nonspecific respiratory signs. Oriented by radiology findings, the diagnosis of pleuropulmonary blastoma was confirmed at pathology examination of a pneumonectomy specimen. Three of the children were given postoperative adjuvant chemotherapy. There were three deaths and one child was lost to follow-up. We discuss the clinical features of pleuropulmonary blastoma. No optimal treatment has been defined for this often fatal tumor.
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Affiliation(s)
- T Benouachane
- Service de Pédiatrie II Hémato-Oncologie, Hôpital d'Enfants Rabat, Maroc
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29
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Abstract
We herein describe a 27-year-old male presenting with a pulmonary blastoma. The patient was admitted to our hospital with the chief complaints of fever and left back pain. Chest roentgenograms showed a tumor measuring 10 cm in diameter in a lower lobe of the left lung. Computed tomography and magnetic resonance imaging revealed a well demarcated and heterogeneously enhanced tumor. Although a histological diagnosis could not be obtained by a transbronchial biopsy, image analyses led us to suspect it to be malignant. The patient underwent a left lower lobectomy with lymph node dissection. A histopathological examination revealed the tumor to be a biphasic type of pulmonary blastoma. Because of the rapid progress of the tumor and the difficulty in making a preoperative diagnosis in such cases, an immediate surgical resection is therefore recommended in cases with even the slightest suspicion of malignancy.
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Affiliation(s)
- N Ohara
- Department of Surgery, Kanbara Municipal Hospital, Shizuoka, Japan
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30
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Köseoğlu V, Zeybek C, Kürekçi AE, Yildiz FR, Ozcan O. Pleuropulmonary blastoma in a child. Pediatr Int 1999; 41:195-7. [PMID: 10221028 DOI: 10.1046/j.1442-200x.1999.4121030.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- V Köseoğlu
- Department of Pediatric Oncology, Gülhane Military Medical Academy, Ankara, Turkey.
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31
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Abstract
BACKGROUND Pulmonary blastoma is a rare malignant neoplasm for which there currently are no treatment guidelines. METHODS A patient with locally advanced pulmonary blastoma is described. The treatment modality is discussed and the world literature is reviewed with respect to the use of chemotherapy. RESULTS A 54-year-old man had a 7-year disease free survival despite subtotal resection. He was treated with adjuvant radiotherapy and combination chemotherapy. Three cycles of cisplatin and etoposide were administered. The world literature was reviewed with regard to the use of adjuvant chemotherapy in the treatment of pulmonary blastoma. CONCLUSIONS Surgery, adjuvant radiotherapy, and combination chemotherapy with cisplatin and etoposide should be considered in the treatment of patients with this rare pulmonary neoplasm.
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Affiliation(s)
- C S Cutler
- Department of Medical Oncology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada
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32
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Pistevou-Gompaki K, Gompakis N, Trachana M, Kostopoulou E, Koliouskas DE. "Bad-risk childhood pleuropulmonary blastoma: does chemoradiotherapy help?". Med Pediatr Oncol 1997; 29:236. [PMID: 9212853 DOI: 10.1002/(sici)1096-911x(199709)29:3<236::aid-mpo15>3.0.co;2-b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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33
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Békássy AN, Garwicz S, Wiebe T, Hagerstrand I. Uncertain role of high dose chemotherapy with autologous stem cell support in pediatric pleuro-pulmonary blastoma (PPB). Med Pediatr Oncol 1997; 28:75-6. [PMID: 8950342 DOI: 10.1002/(sici)1096-911x(199701)28:1<75::aid-mpo15>3.0.co;2-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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34
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Abstract
Pleuropulmonary blastoma, although rare, should be considered in the differential diagnosis of children who present with a pleural effusion and symptoms of respiratory tract infection when the empyema fails to respond to medical management. A case of a 2-year-old boy with this rapidly growing tumor is reported. The treatment and outcome of pleuropulmonary blastoma in children is reviewed.
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Affiliation(s)
- T E Merriman
- Royal Children's Hospital, Melbourne, Victoria, Australia
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35
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Abstract
Pulmonary blastoma (PB) is a rare primary malignancy of the lung, with about 54 cases reported in children. The tumor consists of mesenchymal and epithelial components resembling the fetal lung. It has been treated primarily with surgery and the effect of combination chemotherapy has not been systematically investigated. A 15-year-old girl with PB with metastases to bone and regional lymph node, and high levels of alphafetoprotein, is reported. A preoperative combination chemotherapy consisting of cisplatinum, etoposide alternating with iphosphamide with mesna, vincristine and epirubicine resulted in an objective response that permitted subsequent safe surgical excision of the primary tumor. This intensive combination chemotherapy should be tested in the management of advanced PB in children, as initial therapy as well as an adjuvant to surgery.
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Affiliation(s)
- F Lobo-Sanahuja
- Oncology Department, Hospital Nacional de Niños, Costa Rica, San José, Costa Rica
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36
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Abstract
BACKGROUND Pulmonary blastoma is a rare malignancy treated primarily with surgery. Chemotherapy has proven effective in some cases, and has been used in adjuvant fashion in pediatric patients. METHOD This is a case report of a 40 year-old woman treated with surgical resection, and because of the high risk of recurrence, adjuvant chemotherapy was also given. RESULTS At the time of this writing, the patient has been in continued remission since surgery in October, 1993. CONCLUSION This rare entity is difficult to diagnose noninvasively. The limited number of case reports makes therapeutic decisions difficult. To the authors' knowledge, this case is the first reported adult treated with adjuvant chemotherapy. A central registry of cases would be helpful to physicians treating patients with this disease.
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37
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Büchel H, Casella R, Müller W, Martinelli G, Cavalli F, Luscieti P. [Blastoma of the lung--a rare malignancy. Case report]. Helv Chir Acta 1993; 60:21-5. [PMID: 8226058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Pulmonary blastoma--so called because of its histological resemblance to fetal lung--is a rare malignant neoplasm, which tends to relapse locally and metastasize mainly in the first years, has a poor 5-year prognosis, and shows a potential radio-chemosensitivity. We report our findings and therapeutic approach in a case of a 64-year-old male.
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Affiliation(s)
- H Büchel
- Divisione di Chirurgia, Ospedale San Giovanni, Bellinzona
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