Well differentiated fetal adenocarcinoma of the lung in a 38-year-old woman: dynamic computed tomography findings
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CASE REPORT
Well differentiated fetal adenocarcinoma of the lung in a 38-year-old woman: dynamic computed tomography findings Takana Yamakawa • Atsushi Nambu • Satoshi Kato • Masashi Kawamoto • Shozo Fujino • Masato Watanabe Masao Tago
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Received: 14 August 2012 / Accepted: 11 October 2012 / Published online: 31 October 2012 Ó Japan Radiological Society 2012
Abstract We report a case of well-differentiated fetal adenocarcinoma (WDFA) of the lung, with emphasis on dynamic CT (computed tomography) findings. The patient was a 38-year-old woman who was found to have a mass in the left upper lung field in chest radiograph screening. Chest radiograph showed a 5.5 cm well-defined mass in the left upper lung field. CT revealed a well-circumscribed mass measuring 5.5 9 5.5 9 5.0 cm with a lobulated margin in the left upper lobe. Intratumoral enhancing vasculature was noted in the early phase of dynamic CT. In the delayed phase, persistent and plateau enhancement was seen. The tumor also had consistently unenhanced areas, suggesting the presence of necrosis. Left upper lobectomy with mediastinal lymph node dissection was performed. The pathology specimen contained tubular glands consisting of non-ciliated columnar cells with areas of solid nests of epithelial cells with weakly eosinophilic cytoplasm (morule) mimicking fetal lung tissue. The tumor was moderately vascularized with areas of comedo necrosis; the stroma was relatively T. Yamakawa (&) A. Nambu S. Kato M. Tago Department of Radiology, Teikyo University School of Medicine University Hospital, Mizonokuchi, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, Kanagawa 213-8507, Japan e-mail: [email protected] M. Kawamoto Department of Clinical Pathology, Teikyo University School of Medicine University Hospital, Mizonokuchi, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, Kanagawa 213-8507, Japan S. Fujino M. Watanabe Department of Surgery, Teikyo University School of Medicine University Hospital, Mizonokuchi, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, Kanagawa 213-8507, Japan
scanty. Final pathological diagnosis was WDFA with left hilar lymph node metastasis (stage T2bN1M0). This is the first report of dynamic CT findings of WDFA, a rare lung tumor. Although these findings are non-specific, they well reflected the pathological characteristics of this tumor. Keywords Well-differentiated fetal adenocarcinoma Lung carcinoma Dynamic CT Pulmonary blastoma
Introduction Well differentiated fetal adenocarcinoma (WDFA) is a rare malignant pulmonary tumor. It is pathologically characterized by immature epithelium that morphologically mimics that of fetal lung without the sarcomatous component [1–3]. WDFA was originally included in the category pulmonary blastoma. However WDFA was reclassified as a variant of adenocarcinoma by the WHO classification in 1999 [4]; since 2011, in the newest international multidisciplinary classification of lung adenocarcinoma, it has been included in a category which includes variants of invasive adenocarcinoma [5]. WDFA usually appears as an ex
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