Bronchioalveolar Carcinoma in a 15-Year-Old Girl This report describes a 15-year-oldfemale from Venezuela who has bronchioalveolar carcinoma. She is one of the youngest patients with this particular diagnosis reported in the literature. The postulated age of onset in this case was 13 years, when the first lesion was noted. Bronchioalveolar carcinoma is an extremely rare diagnosis in the pediatric population. The paucity of symptoms in this disease can lead to a delay in diagnosis. Malignancy should be considered in all cases of pediatric pulmonary lesions. Bronchoscopy and transbronchial biopsy in cases of alveolar carcinoma are not particularly useful because of the peripheral location of the lesions.

showed

no

other lesion.

Physical examination revealed a healthy-appearing 70-kg female. There was no lymphadenopathy, but pulmonary findings included bilateral midfield rales and expiratory wheezes. Her abdominal unremarkable. A Mantuberculin skin test was negative with a positive Candida control. Laboratory data showed a white blood cell count of 7.85 K/cu mm (differential of 57% neutrophils, 32% lymphocytes, and 1% eosinophils) ; erythrocyte sedimentation rate was 8 mm/hr. Cultures of bronchial lavage failed to grow aerobic or anaerobic bacteria, fungi, or acid-fast bacilli. A transbronchial biopsy showed no evidence of malignancy. She underwent an open-lung biopsy that revealed well-differentiated mucin-producexam was

toux

bronchioalveolar carcinoma. Since this particular carcinoma is very resistant to chemotherapy and radiation therapy, and the diffuse disease made a surgical option not possible, the patient returned to Venezuela. Unfortunately, at this time there is no other therapeutic regimen available.

ing

Case Report The patient is a 15-year-old female nonsmoker from Venezuela. At age 13 years she had a radiograph of the spine to rule out scoliosis. An incidental finding, which was not followed up until age 15 years, was a cystic lesion in the upper lobe of the left lung. She remained completely asymptomatic until age 15, when she developed a dry cough over a period of four months. She denied any chest pain, hemoptysis, fevers, night sweats, or intestinal complaints. There was no known toxic exposure and no travel outside of Caracas. Her past history was unremarkable. On admission, she had a chest radiograph showing diffuse multiple air- and fluid-filled cysts. A bronchoscopy revealed no endobronchial lesions or compression of the airway. A chest CT scan confirmed the presence of many canitary lesions in the lung parenchyma bilaterally. A body CT scan

Discussion

ated

tumor of mesenchymal and epithelial cell origin.1 The precise diagnosis of pulmonary neoplasms in childhood depends upon the pathology of the lung tissue obtained. The differential classification of bronchogenic

tumors also includes endobronchial tumors, such as carcinoid,2 and bronchial tumors of the salivary gland type, such as mucoepidermoid carcinoma,’ which are tumors that are usually low grade in children

and, therefore, carry a good progIn addition, plasma-cell

nosis.

granuloma is a rare, tumorlike condition of the lung parenchyma and can occasionally obstruct the bronchi.4 In the patient described there no endobronchial lesion, which is typically the finding in bronchioalveolar carcinoma. Squamous-cell and bronchioalveolar carcinoma, within the broad classification of bronchogenic tumors, are quite rare in comparison with other primary lung tumors of childhood. Bronchioalveolar carcinoma, which is the diagnosis in this case, is a variant of adenocarcinoma in which malignant cells demonstrate growth along the walls of bronchioles and alveoli. Mucin-producing cells often fill the airspace with

was

mucus.55 of the

Primary malignancy lung occur in the pediatric age

does

group and should be considered in the evaluation of any child with

pulmonary masses. review of 230 cases of of the lung in chilprimary dren 16 years of age or younger, two thirds were found to be malignant or potentially so. Of the 151 cases of malignant tumors, approximately one third were classified as bronchogenic carcinoma. Other malignant tumors include adenoid In

one

tumors

cystic carcinoma,

a

slow-growing

localized tumor, and pulmonary blastoma, which is an undifferenti-

While alveolar carcinoma acfor about 5% of all lung cancers, the youngest person previously reported to have it was a 15-year-old boy.6,7 The onset of the disease is typically in the sixth decade. The patient described here is perhaps the youngest with alveolar carcinoma in the literature. Predisposing factors and associations are not well-understood, but cigarette-smoking seems to be less associated with frequently bronchioalveolar carcinoma than with squamous-cell carcinoma. Jagziekte, a disease of sheep that occurs in Peru, South Africa, Icecounts

Downloaded from cpj.sagepub.com at PORTLAND STATE UNIV on March 13, 2015

253

land, and the United States,

1973;31:191-208.

causes

pulmonary adenomatosis of viral etiology. Histologically, the findings are similar to those of alveolar carcinoma. There have been associated cases of alveolar carcinoma in sheepherders, but a direct cause-and-effect relationship has not been established.~’° It is of interest that this patient is from South America, but she had no history of travel to rural areas or exposure to sheep, making the diagnosis of jagziekte in this patient less likely. The signs and symptoms of alveolar carcinoma are often minimal. Patients may be asymptomatic at the time of presentation or have symptoms of chest pain, dyspnea, and cough. Alveolar carcinoma is slow-growing, and surgery is the treatment of choice. Unfortunately, alveolar carcinoma in cases of widespread disease is not responsive to chemotherapy or radiation therapy. Surgical removal of the tumor is feasible only in cases of localized disease. This case emphasizes the existence of primary pulmonary tumors in children and the need for early diagnosis, which can lead to the difference between treating localized disease and treating widespread tumor.

5.

Kissane J, ed. Anderson’sPathology. ed. CV Mosby; 1990:1006-1011

6.

Edwards CW. Alveolar carcinoma: view. Thorax. 1984;39:166-174.

7.

Scully R.

8. 9.

10.

9th a re-

Case 4-1976: Case records of Massachusetts General Hospital. N Engl

J Med. 1976;294:211-217. Cowdry EV Studies on the etiology of jagziekte. I. JExp Med. 1925;42:323-334. Bonne C. Morphological resemblance of pulmonary adenomatosis in sheep and certain cases of cancer of the lung in man. Am J Cancer. 1939;35:491-501. Perk K, Hod I. Sheep lung carcinoma: an endemic analogue of a sporadic human neoplasm. J Natl Cancer Inst. 1982;69:747-749.

Recurrent Parotitis in Childhood Recurrent parotitis is characterized by

a

the

cyclic swelling of parotid glands associated with discomfort and/or pain in the absence of external inflammatory changes or progression to frank suppu1 Recurrent parotitis is hardly a ration. common problem, but when it does present itself, it is most perplexing. Its etiology and the pathogenesis remain an enigma and, as a

consequence, consensus on management is still lacking. 2,3

proper

REFERENCES 1.

2.

Hartman G, Shocat S. Primary pulmonary neoplasms of childhood. Ann Thorac Surg. 1983;36:108-119. Lack

E, Harris C, Erakalis A, Vawter G.

bronchial tumors in childhood. Cancer. 1983 ;51 :492-497. Madani MA. Mucoepidermoid bronchial adenoma with an unusual pattern of

Primary 3.

NY State J Med. growth. 1977;77:1283-1285. 4.

254

Bahadori M,

Liebow AA. Plasma cell

granulomas

of

the

lung.

Cancer.

Swelling, gradual or sudden, usually is the first noticeable physical finding. The swelling is usually not so extreme as

The author enced a familial

recently experioccurrence

of re-

parotitis involving two female siblings and their maternal grandmother. The index case was a 4-year-old Hispanic female child who visited our pediatric clinic for right-sided preauricular swelling which had developed over the prior two days. Six months earlier she had experienced right-sided parotid swelling which subsided spontaneously over a few days. Her 11-year-old sibling had experienced recurrent parotitis since age four years. Their maternal grandcurrent

Amrita Dosanjh, M.D. Division of Pulmonary Medicine The Children’s Hospital Boston, Massachusetts

The child’s temperature was 36.5°C. The only pertinent physical finding was diffuse swelling of the right parotid gland with minimal tenderness. No mucus plug or purulentt material was expelled through the Stensen’s duct opening with massage of the affected gland. Peripheral WBC was 12,900/cu mm, with 60% PMNs, 33% lymphocytes, 6% monocytes, and 1% eosinophil. ESR was 2 mm/hr, rheumatoid factor not detected, and serum amylase was 948 units/dL. IgG antiEB VCA (viral capsid antigen) was 1:640, IgM anti-VCA was negative, anti-EA (early antigen) was negative, and anti-EBNA (nuclear antigen) 1:40 (N

Bronchioalveolar carcinoma in a 15-year-old girl.

This report describes a 15-year-old female from Venezuela who has bronchioalveolar carcinoma. She is one of the youngest patients with this particular...
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