Classic biphasic pulmonary blastoma: importance of early treatment—a case report

Classic biphasic pulmonary blastoma is a very aggressive malignant tumor with very poor prognosis and its overall mortality is very high. It belongs to sarcomatoid neoplasms subgroup in the WHO classification of lung tumors. In the histological analysis shows an immature epithelial and mesenchymal stroma. It is more frequent in middle-age men and can be related with tobacco. Surgery with complete resection is the mainstay of treatment. The role of the chemotherapy or radiotherapy is not very clear because of the rarity and low frequency of this neoplasm. We describe the case of a 63-year-old man that consulted for 2 days history of chest pain and fever. He was diagnosed of a mass of 12 cm [standardized uptake value (SUV) 6.2 g/mL] in the right hemithorax that was complicated with intratumoral bleeding requiring an emergency surgery because of sudden dyspnea, anemia, hypotension and mediastinal shift. Through a median sternotomy and right anterior thoracotomy a right pneumonectomy was performed. Final classification was pT4N1PL2. The patient received adjuvant chemoradiotherapy that was well tolerated. Overall survival was very good (33 months) because of the multimodal treatment. He presented a recurrence manifested by a mass invading the right ventricle in the 28-month post-surgery. After three cycles of chemotherapy he died because of progression of the disease 5 months later. With this case report we want to share our experience in the treatment of this infrequent pathology that must be urgently addressed when intratumoral bleeding occurs.