Pulmonary blastoma: Report of two cases

Pulmonary blastomas are a group of rare malignant neoplasms subdivided into three categories: classic biphasic pulmonary blastoma (CBPB), well-differe ntiated fetal adenocarcinoma (WDFA), and pleuropulmonary blastoma (PPB). We report herein the cases of two men with CBPB. Both were heavy smokers and presented with a history of hemoptysis. Physical examination revealed sligh tly significant findings, chest radiographs showed a large pulmonary mass, confirmed by computed tomography, and bronchoscopic biopsies were not diagn ostic. A left and right inferior lobectomy was performed and a diagnosis of CPBP was confirmed by histological examination. In the first patient, loca l recurrence with multiple bilateral lung metastases was found 6 months lat er and despite chemotherapy, he died of respiratory failure 1 year after hi s operation. In the second patient, a subcutaneous metastasis was found in the right subscapular region 2 months later, and a cerebral metastasis in t he right posterior parietal lobe 4 months later. Partial remission was achi eved by cerebral irradiation, but 6 months later the patient died of cardia c failure while in a coma. We conclude that more aggressive and multidiscip linary treatment should be adopted for CBPB, and because of its low inciden ce, it is important to unify individual experiences in a central registry t o gather as much information as possible regarding the biological and clini cal features of this unusual disease.