Primary and metastatic lung tumors in the pediatric population: A review and 25-year experience at a large children's hospital

ArticleinArchives of pathology & laboratory medicine 132(7):1079-103 · August 2008with59 Reads
DOI: 10.1043/1543-2165(2008)132[1079:PAMLTI]2.0.CO;2 · Source: PubMed
Primary lung neoplasms are rare in children, but they comprise a broad and interesting spectrum of lesions, some of which are familiar from other tissue sites, and some of which are unique to the pediatric lung. To determine the relative incidence of primary and metastatic lung tumors in children and adolescents through a single-institution case series, to compare these data to reports in the medical literature, to discuss the clinical and pathologic features of primary tumors of the tracheobronchial tree and lung parenchyma in children, and to provide recommendations for handling pediatric lung cysts and tumors. A 25-year single institutional experience with pediatric lung tumors, based on surgical biopsies and resections at Texas Children's Hospital from June 1982 to May 2007, an additional 40 lung tumors referred in consultation, and a review of the medical literature. A total of 204 pediatric lung tumors were diagnosed at our institution, including 20 primary benign lesions (9.8%), 14 primary malignant lesions (6.9%), and 170 secondary lung lesions (83.3%). The ratio of primary benign to primary malignant to secondary malignant neoplasms is 1.4:1:11.6. The common types of lung cancer in adults are exceptional occurrences in the pediatric population. The most common primary lung malignancies in children are pleuropulmonary blastoma and carcinoid tumor. Other primary pediatric lung tumors include congenital peribronchial myofibroblastic tumor and other myofibroblastic lesions, sarcomas, carcinoma, and mesothelioma. Children with primary or acquired immunodeficiency are at risk for Epstein-Barr virus-related smooth muscle tumors, lymphoma, and lymphoproliferative disorders. Metastatic lung tumors are relatively common in children and also comprise a spectrum of neoplasia distinct from the adult population.
    • "Carcinogens may cause cumulative changes to the DNA in the bronchial epithelium of the lungs. As more tissues become damaged, a tumor may develop (Vaporciyan et al., 2000; Dishop and Kuruvilla, 2008). In the present study, the lungs of the MNU induced mice showed histopathological alterations such as hyperchromasia, lymphocyte infiltration, hyperplasia, stroma formation infiltrated with bi-nucleated cells and collapsed alveoli sacs. "
    [Show abstract] [Hide abstract] ABSTRACT: Animal models are important in the study of cancer pathogenesis. N-methyl-N-nitrosourea (MNU) is a potent human carcinogen. Tumor induction by a single intraperitoneal (i.p.) injection of MNU was studied in Swiss albino mice to determine the histo-toxic effects on selected organs of the respiratory, urinary and reproductive systems. Eighty mice, (40 males and 40 females) were randomly divided into four groups of 20 each. The test groups (twenty males and twenty females) were given i.p. injections of 50mg/kg of MNU, while the other two groups served as comparative control. They were monitored for seven months. One mouse from each of the 4 groups was sacrificed monthly over the exposure period. Selected organs (lungs, kidney and connective tissue around the mammary glands) were removed, fixed in 40% formal saline and processed using standard histological techniques. Mortality in the exposed animals was 1.25%. Organs of the exposed groups showed histopathological changes such as hyperplasia, infiltration of lymphocytes and collapsed alveolar sacs in the lungs; while vacuolation, vesicular and pleomorphic nucleation and increased nucleo-cytoplasmic ratio were observed in the kidneys. Lymphocyte infiltration was also observed in the glandular lumen of the connective tissues of the mammary gland, while organs of the control animals showed normal architecture. The degenerative changes observed are illustrative of the progression to cancer (carcinogenesis) that usually follows exposure to carcinogens in the environment. Interaction between the carcinogen and living cells resulted in damage to the organs of the exposed mice as evidenced by the distinct histopathological changes observed.
    Full-text · Article · Jun 2016 · Pediatric Radiology
    • "The ratio of primary benign to primary malignant to metastatic malignant tumors was 1.4:1:11.6 [3]. Cohen and Kaschula [4] reported a ratio of primary tumors to metastatic tumors to non-neoplastic lesions of 1:5:60. "
    [Show abstract] [Hide abstract] ABSTRACT: Atypical adenomatous hyperplasia is a premalignant lesion reflecting a focal proliferation of atypical cells. These lesions are usually observed as incidental findings in lungs that have been resected due to other conditions, such as lung cancer. We report the youngest case of atypical adenomatous hyperplasia on record in a 12-year-old girl. In this patient, the lesion was found in association with pneumothorax. © The Korean Society for Thoracic and Cardiovascular Surgery. 2016. All right reserved.
    Article · Apr 2016
    • "In the most recent review article on pediatric lung cancer [10] , there is no reported initial presentation as an incidental pulmonary nodule — these rare tumors are often aggressive and tend to be symptomatic at the time of diagnosis11121314. Primary bronchogenic carcinoma is extremely rare in children and adolescents, and rare reported cases of squamous cell carcinoma present with a large tumor with a secondary respiratory infection [15]. "
    [Show abstract] [Hide abstract] ABSTRACT: No guidelines are in place for the follow-up and management of incidentally detected pulmonary nodules on CT in the pediatric population. The Fleischner guidelines, which were developed for the older adult population, do not apply to children. This review summarizes the evidence collected by the Society for Pediatric Radiology (SPR) Thoracic Imaging Committee in its attempt to develop pediatric-specific guidelines. Small pulmonary opacities can be characterized as linear or as ground-glass or solid nodules. Linear opacities and ground-glass nodules are extremely unlikely to represent an early primary or metastatic malignancy in a child. In our review, we found a virtual absence of reported cases of a primary pulmonary malignancy presenting as an incidentally detected small lung nodule on CT in a healthy immune-competent child. Because of the lack of definitive information on the clinical significance of incidentally detected small solid lung nodules on CT in children, the management of those that do not have the typical characteristics of an intrapulmonary lymph node should be dictated by the clinical history as to possible exposure to infectious agents, the presence of an occult immunodeficiency, the much higher likelihood that the nodule represents a metastasis than a primary lung tumor, and ultimately the individual preference of the child’s caregiver. Nodules appearing in children with a history of immune deficiency, malignancy or congenital pulmonary airway malformation should not be considered incidental, and their workup should be dictated by the natural history of these underlying conditions.
    Full-text · Article · Feb 2015
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