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Year : 2010  |  Volume : 53  |  Issue : 4  |  Page : 875-876
Pulmonary blastoma with yolk sac elements


Department of Pathology, T. N. Medical College and B. Y. L. Nair Hospital, Dr. A.L. Nair Road, Mumbai Central, Mumbai - 400 008, Maharashtra, India

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Date of Web Publication27-Oct-2010
 

How to cite this article:
Desai HM, Amonkar GP, Kavishwar VS, Deshpande JR. Pulmonary blastoma with yolk sac elements. Indian J Pathol Microbiol 2010;53:875-6

How to cite this URL:
Desai HM, Amonkar GP, Kavishwar VS, Deshpande JR. Pulmonary blastoma with yolk sac elements. Indian J Pathol Microbiol [serial online] 2010 [cited 2020 Nov 24];53:875-6. Available from: https://www.ijpmonline.org/text.asp?2010/53/4/875/72027


Sir,

Pulmonary blastoma is a rare lung neoplasm comprising 0.25-0.5% of all lung cancers. [1] Pulmonary blastomas form a family of malignant tumors comprising epithelial and mesenchymal elements that resemble fetal lung tissue. [2] The mesenchymal component may show differentiation toward skeletal muscle, cartilage or immature bone. [1],[3] Yolk sac differentiation in pulmonary blastomas has been reported in less than five cases. We present here an unusual case of pulmonary blastoma with yolk sac like elements.

A 35-year-old male patient presented with breathlessness and chest pain since 1 year. Computerized tomography (CT) scan of thorax revealed a large mass in the periphery of the right lung in the right pleural space, measuring 13 × 12 × 9 cm with solid and cystic components. There was moderate pleural effusion on the right side along with mediastinal lymphadenopathy and mild mediastinal shift to left. At surgery, the tumor could not be resected completely as it was infiltrative and very necrotic. Debulking was done and the mass was removed in pieces. On gross examination, the mass was friable with multiple soft tissue bits largest measuring 13 × 10 × 8 cm. On microscopy, the tumor was seen with large areas of necrosis. The tumor had biphasic component - epithelial and mesenchymal [Figure 1] and was accompanied by foci of yolk sac like elements [Figure 2]. On immunohistochemistry, the yolk sac areas showed alpha feto-protein (AFP) positivity. Epithelial component was composed of tumor cells arranged in tubulo-glandular pattern with columnar to cuboidal cells having hyperchromatic nuclei and vacuolated cytoplasm. Squamoid morules were seen. Mesenchymal component consisted of spindle-shaped elongated cells A diagnosis of pulmonary blastoma with yolk sac like elements was made.
Figure 1: Tumor showing biphasic component - epithelial and mesenchymal elements (H and E, ×100)

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Figure 2: Focus of yolk sac element (H and E, ×400)

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Biphasic pulmonary blastoma was first described as embryoma of the lung and latter recategorized as pulmonary blastoma. They are now classified under the group of sarcomatoid carcinoma along with pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma and carcinosarcoma. [3]

Pulmonary blastomas usually develop in the periphery of the lung as a rapidly growing well-demarcated large mass. Most patients are asymptomatic or present with cough, bloody sputum, dyspnea, chest or back pain which is sometimes accompanied by intra-thoracic bleeding. Our case presented with breathlessness, chest pain and moderate pleural effusion. Pre-operative histopathologic diagnosis by either bronchoscopy, needle biopsy or other methods is usually difficult without obtaining a certain amount of specimen, due to the characteristic biphasic pattern. Very few cases have been reported in literature, which have shown features of pulmonary blastoma with yolk sac differentiation. Siegel et al. reported two cases in which the germ cell element was yolk sac tumor. [4] Only one case showed elevated serum AFP levels and both the cases showed weak to absent AFP staining in the blastoma areas. Several possible pathogenetic explanations for the occurrence of mixed blastoma-germ cell malignancies were given by them. They favored germ cell and blastomatous differentiation from a somatic neoplastic cell, but the possibility that the blastomatous area was a teratomatous element of a germ cell tumor of primordial germ cell origin could not be excluded. Yoshiro Oshika et al. reported a case of biphasic pulmonary blastoma with features of yolk sac tumor which showed positive staining for AFP levels and elevated serum AFP levels. [2] Kasuga et al.[5] hypothesize that there is a relation between pulmonary blastomas and yolk sac tumors. Prognosis is stage dependant and these tumors have a very poor prognosis even with stage 1 disease, the 5-year survival rate being only 20%. [3]

 
   References Top

1.Tazelaar HD. Uncommon tumors of the lung. In: Churg AM, Myers JL, Tazelaar HD, Wright JL, editors. Thurlbeck's pathology of lung. New Thurlbeck's pathology of lung. New York: 2005. p. 481-534.   Back to cited text no. 1
    
2.Oshika Y, Matsukuma S, Hashimoto H, Yakeo H, Bato K, Tanaka Y. Biphagic pulmonary blastoma with a lesion of yolk sac tumor. Gen Thorac Cardiovasc Surg 2007;55:243-7.  Back to cited text no. 2
    
3.Corrrin B, Chang YL, Rossi G, Koss MN, Geisinger K, Wick MR, et al. Sarcomatoid carcinoma. In: Travis WT, Brambilla E, Muller-Hermelink HK, Harris CC, editors. Pathologyand genetics of tumors of the lung, pleura and heart. World Health Organisation classification of tumors. Lyon: IARC; 2004. p. 53-8.  Back to cited text no. 3
    
4.Siegel RJ, Bueso-Ramos C, Cohen C, Koss M. Pulmonary blastoma with germ cell (Yolk sac) differentiation: Report of two cases. Mod Pathol 1991;4:566-70.  Back to cited text no. 4
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5.Kasuga I, Miyamoto D, Ichinose Y, Chimangul W, Minemura K, Utsumi K, et al. Alpha - feto protein producing pulmonary blastoma in a patient with systemic sclerosis: Pathogenetic analysis. Eur Respir J 1998;11:1185-7.  Back to cited text no. 5
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Correspondence Address:
Gayathri P Amonkar
Department of Pathology, T. N. Medical College, B.Y. L. Nair Hospital, Dr. A.L. Nair Road, Mumbai Central, Mumbai - 400 008, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.72027

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