Case report
Well-differentiated fetal adenocarcinoma: A very uncommon malignant lung tumor
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"apellidos" => "El fassy Fihry" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of pulmonology, Ibn Sina Hospital, Rabat, Morocco" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Thoracic surgery, Ibn Sina Hospital, Rabat, Morocco" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2, 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2v3.jpeg" "Alto" => 1508 "Ancho" => 964 "Tamanyo" => 149794 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A computed tomography scan showing an inhomogenous mass partially cystic, budding at the lingular bronchi and then develops in intrathoracic without mediastinal lymphadenopathy or pleural effusion.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Fetal Adenocarcinoma is a very uncommon malignant tumor originating in the lung, and was first described by Kradin et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> as a subtype of pulmonary blastoma, which resembled the epithelial component of the fetal lung without sarcomatous contingent.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In 1984, the term fetal adenocarcinoma was introduced by Kodama et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> 14 years later Nakatani et al. identified 2 groups: well differentiated occurring in young women and with a good prognosis and poorly differentiated with a similar prognosis to classical non-small cell carcinoma.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Fetal adenocarcinoma has been considered in the WHO classification since 1999 as a solid adenocarcinoma with mucin production. However, a new international multidisciplinary classification, which focused on lung adenocarcinoma to standardize terminology and improve treatment and predict prognosis, does not consider fetal adenocarcinoma as a solid adenocarcinoma with mucin production but as a variant of invasive adenocarcinoma.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We (The authors) report a case of a 38-year-old female patient with WDFA, and discuss the unusual features of this type of tumor.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 38 year old woman presented with a one year history of dyspnea for which she was put on a short-acting bronchodilator with no further testing, in particular no chest X-ray considering she was in the early stages of pregnancy. Two months after delivery, she reported an aggravation of her dyspnea with no other respiratory or extra respiratory signs and was examined two months later. She had no significant past medical history; she had no history of smoking. The physical examination was normal.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A chest X-ray (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) showed a hilar and paracardial left opacity with a well defined border and internal margin which extended into the mediastimum.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">A computed tomography scan (<a class="elsevierStyleCrossRef" href="#fig0010">Figs. 2 and 3</a>) revealed a partially cystic heterogeneous mass, forming at the lingular bronchi and then developing in intrathoracic without mediastinal lymphadenopathy or pleural effusion.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Bronchoscopy confirmed a whitish lingular lesion at the orifice, with total occlusion of the airway lumen.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Microscopic examination of an endobronchial biopsy (<a class="elsevierStyleCrossRef" href="#fig0015">Figs. 4 and 5</a>) showed an obviously malignant tumor process which was extensively ulcerated on the surface. It was made up of malignant glandular cells growing in tubules and papillary structures, sometimes reproducing endometrioid differentiation. These malignant cells had prominent clear cytoplasm, and squamoid morules were present. Some of the lumen of the glands were empty, others contained eosinophilic material. The dividing stroma was fibrous. Large areas of necrosis were observed.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The patient was assessed clinically at stage T3N0M0. Thoracotomy was performed and the patient underwent a superior left lobectomy with lymphadenectomy. The tumor measured 6<span class="elsevierStyleHsp" style=""></span>cm at the widest diameter. Microscopic examination confirmed the description above.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Lung tumors resembling the fetal lung are a very uncommon primitive malignant tumor originating in the lung. They include pulmonary blastoma and fetal adenocarcinoma.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The incidence of this malignant tumor has been estimated at 0.5% of all primary lung tumors.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In the series of Kodama et al., all the patients were elderly males. The majority died of their tumor. Koss et al. reported a series with better survival where almost all the patients were female. In 1990, Natakatani et al. identified subcategories of fetal type adenocarcinoma where the prognosis was good, specifically occurring among woman.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In 1998 Natakatani et al. identified 2 groups of fetal adenocarcinoma: WDFA occurring in young women, generally non smokers, which had a good prognosis, also called endodermal tumor resembling the fetal lung, and poorly differentiated fetal adenocarcinoma with a similar prognosis to classical non-small cell carcinoma.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Histologically, the WDFA element characteristically demonstrates glandular elements with tubules composed of glycogen-rich, non-ciliated cells that resemble fetal lung tubules and squamoid morules may be seen with clear nuclei within lumens. The immature mesenchyme and epithelium mimic the embryonic lung at 10–16 weeks gestation. The name WDFA is therefore derived from the histological appearances of the tumor.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> Most are low grade with a favorable outcome. When mixtures occur with other histological subtypes, the tumor should be classified according to the predominant component.</p><p id="par0070" class="elsevierStylePara elsevierViewall">A correct pre-operative diagnosis of endobronchial biopsies is difficult. Although a correct diagnosis may be achieved after resection, thorough sampling is essential, because the tumor may be heterogenic, with components characteristic of WDFA and pulmonary blastoma<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> or components of more conventional adenocarcinoma. In both cases the prognosis is worse. Indeed, the 10-year survival for WDFA is about 75% versus about 15% for pulmonary blastoma. In our case the presence of this latter was excluded by conventional microscopy.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The standard treatment is surgical resection, if technically possible.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0080" class="elsevierStylePara elsevierViewall">This case of well-differentiated fetal adenocarcinoma illustrates the importance of establishing an accurate diagnosis when a pregnant woman presents with respiratory symptoms by carrying out the necessary tests, obviously taking great care, especially when the symptomatic treatment does not provide any improvement. However, report emphasizes how important it is for clinicians to consider and identify this rare variant of adenocarcinoma because of its low grade malignancy associated with good prognosis.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres547625" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec565504" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres547624" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec565505" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-01-19" "fechaAceptado" => "2011-06-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec565504" "palabras" => array:3 [ 0 => "Well-differentiated fetal adenocarcinoma" 1 => "Lung" 2 => "Good prognosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec565505" "palabras" => array:3 [ 0 => "Adenocarcinoma fetal bem diferenciado" 1 => "pulmão" 2 => "bom prognóstico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Well-differentiated fetal adenocarcinoma (WDFA) is a very uncommon malignant tumor originating in the lung. This report describes the case of a 38-year-old woman with a WDFA treated by surgery. The malignancy is low grade and associated with a good prognosis, and so it is important for clinicians to be aware of and to identify this rare variant of adenocarcinoma.</p></span>" ] "es" => array:2 [ "titulo" => "Resumo" "resumen" => "<span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">O adenocarcinoma fetal bem diferenciado (WDFA, de acordo com a sigla em inglês) é um tumor maligno no pulmão muito invulgar que tem origem no pulmão. Este relatório descreve o caso de uma mulher de 38 anos com WDFA tratada através de cirurgia. A malignidade é de baixo grau e está associada a um bom prognóstico e, por isso, é importante que os clínicos estejam atentos e identifiquem esta variante rara de adenocarcinoma.</p></span>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 752 "Ancho" => 900 "Tamanyo" => 53387 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray demonstrating a hilar and paracardial left opacity.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2, 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2v3.jpeg" "Alto" => 1508 "Ancho" => 964 "Tamanyo" => 149794 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A computed tomography scan showing an inhomogenous mass partially cystic, budding at the lingular bronchi and then develops in intrathoracic without mediastinal lymphadenopathy or pleural effusion.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 4, 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4v5.jpeg" "Alto" => 615 "Ancho" => 1600 "Tamanyo" => 278276 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Microscopic examination of an endobronchial biopsy showing malignant glandular cells growing in tubules and papillary structures, reproducing sometimes endometrioid differentiation. These malignant cells have prominent clear cytoplasm, and squamoid morules were present.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary blastoma with argyrophill cells and lacking sarcomatous features (pulmonary endodermal tumor resembling fetal lung)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.L. Kradin" 1 => "S.E. Kirkham" 2 => "E.J. Young" 3 => "G.R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 9 | 20 |
| 2024 October | 66 | 35 | 101 |
| 2024 September | 70 | 22 | 92 |
| 2024 August | 93 | 34 | 127 |
| 2024 July | 74 | 33 | 107 |
| 2024 June | 58 | 36 | 94 |
| 2024 May | 66 | 38 | 104 |
| 2024 April | 64 | 36 | 100 |
| 2024 March | 57 | 24 | 81 |
| 2024 February | 77 | 28 | 105 |
| 2024 January | 44 | 30 | 74 |
| 2023 December | 35 | 21 | 56 |
| 2023 November | 48 | 28 | 76 |
| 2023 October | 54 | 35 | 89 |
| 2023 September | 54 | 30 | 84 |
| 2023 August | 42 | 26 | 68 |
| 2023 July | 45 | 29 | 74 |
| 2023 June | 48 | 14 | 62 |
| 2023 May | 57 | 26 | 83 |
| 2023 April | 48 | 15 | 63 |
| 2023 March | 88 | 26 | 114 |
| 2023 February | 54 | 18 | 72 |
| 2023 January | 55 | 17 | 72 |
| 2022 December | 72 | 19 | 91 |
| 2022 November | 65 | 36 | 101 |
| 2022 October | 56 | 29 | 85 |
| 2022 September | 44 | 29 | 73 |
| 2022 August | 57 | 39 | 96 |
| 2022 July | 51 | 46 | 97 |
| 2022 June | 42 | 30 | 72 |
| 2022 May | 56 | 39 | 95 |
| 2022 April | 57 | 33 | 90 |
| 2022 March | 55 | 53 | 108 |
| 2022 February | 56 | 35 | 91 |
| 2022 January | 39 | 27 | 66 |
| 2021 December | 33 | 37 | 70 |
| 2021 November | 45 | 36 | 81 |
| 2021 October | 38 | 46 | 84 |
| 2021 September | 47 | 36 | 83 |
| 2021 August | 45 | 20 | 65 |
| 2021 July | 35 | 24 | 59 |
| 2021 June | 33 | 21 | 54 |
| 2021 May | 62 | 24 | 86 |
| 2021 April | 149 | 41 | 190 |
| 2021 March | 83 | 23 | 106 |
| 2021 February | 66 | 22 | 88 |
| 2021 January | 53 | 22 | 75 |
| 2020 December | 56 | 15 | 71 |
| 2020 November | 62 | 31 | 93 |
| 2020 October | 57 | 15 | 72 |
| 2020 September | 79 | 29 | 108 |
| 2020 August | 107 | 30 | 137 |
| 2020 July | 140 | 27 | 167 |
| 2020 June | 133 | 21 | 154 |
| 2020 May | 108 | 16 | 124 |
| 2020 April | 88 | 9 | 97 |
| 2020 March | 81 | 18 | 99 |
| 2020 February | 88 | 15 | 103 |
| 2020 January | 84 | 18 | 102 |
| 2019 December | 82 | 19 | 101 |
| 2019 November | 74 | 17 | 91 |
| 2019 October | 88 | 19 | 107 |
| 2019 September | 103 | 22 | 125 |
| 2019 August | 159 | 21 | 180 |
| 2019 July | 189 | 16 | 205 |
| 2019 June | 164 | 11 | 175 |
| 2019 May | 183 | 17 | 200 |
| 2019 April | 181 | 35 | 216 |
| 2019 March | 254 | 12 | 266 |
| 2019 February | 224 | 7 | 231 |
| 2019 January | 222 | 25 | 247 |
| 2018 December | 129 | 5 | 134 |
| 2018 November | 36 | 0 | 36 |
| 2018 October | 31 | 12 | 43 |
| 2018 September | 45 | 6 | 51 |
| 2018 August | 53 | 28 | 81 |
| 2018 July | 53 | 21 | 74 |
| 2018 June | 75 | 17 | 92 |
| 2018 May | 66 | 16 | 82 |
| 2018 April | 112 | 19 | 131 |
| 2018 March | 104 | 21 | 125 |
| 2018 February | 47 | 10 | 57 |
| 2018 January | 76 | 17 | 93 |
| 2017 December | 89 | 12 | 101 |
| 2017 November | 54 | 22 | 76 |
| 2017 October | 32 | 19 | 51 |
| 2017 September | 46 | 12 | 58 |
| 2017 August | 51 | 21 | 72 |
| 2017 July | 54 | 12 | 66 |
| 2017 June | 60 | 30 | 90 |
| 2017 May | 55 | 21 | 76 |
| 2017 April | 43 | 3 | 46 |
| 2017 March | 41 | 5 | 46 |
| 2017 February | 22 | 5 | 27 |
| 2017 January | 36 | 3 | 39 |
| 2016 December | 34 | 12 | 46 |
| 2016 November | 35 | 9 | 44 |
| 2016 October | 44 | 8 | 52 |
| 2016 September | 111 | 5 | 116 |
| 2016 August | 26 | 3 | 29 |
| 2016 July | 11 | 6 | 17 |
| 2016 June | 0 | 4 | 4 |
| 2016 May | 0 | 6 | 6 |
| 2016 April | 49 | 2 | 51 |
| 2016 March | 74 | 16 | 90 |
| 2016 February | 94 | 18 | 112 |
| 2016 January | 77 | 7 | 84 |
| 2015 December | 76 | 7 | 83 |
| 2015 November | 54 | 12 | 66 |
| 2015 October | 71 | 10 | 81 |
| 2015 September | 74 | 13 | 87 |
| 2015 August | 57 | 14 | 71 |
| 2015 July | 80 | 8 | 88 |
| 2015 June | 54 | 5 | 59 |
| 2015 May | 66 | 12 | 78 |
| 2015 April | 93 | 12 | 105 |
| 2015 March | 84 | 8 | 92 |
| 2015 February | 60 | 4 | 64 |
| 2015 January | 70 | 13 | 83 |
| 2014 December | 100 | 9 | 109 |
| 2014 November | 73 | 9 | 82 |
| 2014 October | 96 | 12 | 108 |
| 2014 September | 89 | 16 | 105 |
| 2014 August | 88 | 11 | 99 |
| 2014 July | 85 | 9 | 94 |
| 2014 June | 78 | 8 | 86 |
| 2014 May | 93 | 8 | 101 |
| 2014 April | 95 | 13 | 108 |
| 2014 March | 111 | 15 | 126 |
| 2014 February | 143 | 11 | 154 |
| 2014 January | 141 | 20 | 161 |
| 2013 December | 93 | 11 | 104 |
| 2013 November | 93 | 16 | 109 |
| 2013 October | 76 | 13 | 89 |
| 2013 September | 67 | 18 | 85 |
| 2013 August | 79 | 20 | 99 |
| 2013 July | 79 | 22 | 101 |
| 2013 June | 64 | 15 | 79 |
| 2013 May | 73 | 19 | 92 |
| 2013 April | 77 | 24 | 101 |
| 2013 March | 79 | 15 | 94 |
| 2013 February | 62 | 26 | 88 |
| 2013 January | 78 | 26 | 104 |
| 2012 December | 61 | 17 | 78 |
| 2012 November | 70 | 24 | 94 |
| 2012 October | 52 | 68 | 120 |
| 2012 September | 24 | 7 | 31 |
| 2012 January | 361 | 0 | 361 |
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