INTRODUCTION: Well differentiated Fetal Adenocarcinoma of the lung is an exceedingly rare form of adenocarcinoma with incidence ranging from 0.25 to 0.5% of all lung tumors. Very few cases have been reported in the literature.
CASE PRESENTATION: The patient is a 50 year old Mexican male with a past medical history of tobacco use referred to our outpatient pulmonary clinic for hemoptysis for the past month. He describes coughing one to two ounces of bright red blood approximately twice daily. There is no associated chest pain, dyspnea, fevers, chills or night sweats. The patient does however report a weight loss of approximately 20 pounds over the past 6 months. Initial PPD done at primary care physician's office was negative and chest x-ray at that time showed large left upper lobe mass with upper lobe collapse. Patient is not currently taking any medications. He has a 30 pk year smoking history and currently works odd jobs. He migrated to the US about 20 years ago and is currently married with 2 children. The patient denies any recent travel history. Upon examination in the office, vital signs were stable, patient was a febrile with an oxygen saturation of 97% on room air. Auscultation of the chest revealed decrease breath sounds on the left with good air entry on the right. A CT scan of the chest with IV contrast showed a 4.6 cm left upper lobe mass with complete collapse of the left upper lobe (fig 1). Patient subsequently underwent bronchoscopy which revealed a partially obstructing left mainstem endobronchial lesion. The lesion was biopsied and pathology revealed atypical cells suggestive of malignancy. Cardiothoracic surgery was consulted and patient underwent medastinoscopy with lymph node sampling. Pathology results revealed pulmonary adenocarcinoma of fetal type with positive inferior and superior bilateral lymph nodes. (fig 2) Subsequent testing revealed no other metastasis and the patient was staged as IIIb.
DISCUSSIONS: Well differentiated fetal adenocarcinoma is a rare lung neoplasm. Initially it was considered a “pulmonary blastoma” of monophasic type, but current WHO classification described it as an adenocarcinoma. The male to female ratio is equal and patients usually present in the 4th decade. The tumor most often less than 5 cm and thoracic adenopathy is associated with a poor prognosis. Standard treatment is surgery, but in advanced inoperable cases such as our patient, radiotherapy along with combined chemotherapy has been described. A review of the literature reveals a mean survival of 14.7 months.
CONCLUSION: Well differentiated Fetal Adenocarcinoma of the lung is a rare form of lung cancer. There are very few publications on this type of lung cancer. More research is needed identification and treatment of this malignancy. as well as diagnosing this difficult pathology.
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