2 Case Reports in Medicine Figure 1: Posteroanterior radiograph of chest showing (arrow) right-sided circumscribed mass in the upper lobe close to the hilum. Figure 3: Histological features of the lesion containing epithelial and mesenchymal component consistent with pulmonary blastoma (3: HES ×100). Figure 2: CT scan showing hypodensity (arrow) at the right upper lobe with signiﬁcant compression to the superior venacava. lymphadenopathy or pleural eﬀusion. Complete surgical removal of the tumor along with safety margins was done and sent for histopathology examination. The biopsy report revealed ill-deﬁned neoplastic growth showing biphasic pattern comprising epithelial and mesenchymal components consistent with pulmonary blastoma (Figures 3 and 4). The surgical margins were free of tumor. CT abdomen and bone scintigraphy showed no evidence of distant metastasis. The patient was referred to Radiation Oncology Department for possible intervention, but due to lack of established evidence of the role of radiotherapy in controlling local recurrence, the patient did not receive adjuvant radiotherapy. Due to the presence of certain poor prognostic factors like biphasic type and tumor size more than 5 cm, it was decided to proceed with adjuvant platinum-based chemotherapy comprising of ifosfamide, carboplatin, and VP-16 (ICE protocol). The patient received 6 cycles of the ICE protocol every 3 weeks with prophylactic granulocyte colony stimulating factor (G- CSF) from day 5 to day 12 after each cycle. There was one episode of febrile neutropenia after cycle 4 and the patient recovered completely after treatment with intra- venous antibiotics. Reevaluation was done after 3rd and 6th cycle with CT chest which showed no evidence of recurrence. The patient is in complete remission and currently on a 3- month ongoing followup. Figure 4: Histological features of the lesion containing epithelial and mesenchymal component consistent with pulmonary blastoma (H&E ×100). 3. Discussion Pulmonary blastoma is a rare primary lung malignancy, comprising only 0.25–0.5% of all malignant lung neoplasm [1]. In 1952, Barnard described it as “lung embryoma” based on the histological resemblance of the tumor to fetal lung tissue [1]. The term blastoma was introduced later in 1961 by Spencer who described the tumor origin from a pleuripotential pulmonary blastoma analogous to Wilm’s tumor that appears to share the same histological features [1]. More than one hundred cases have been reported in liter- ature highlighting an interesting fact about their distinctive biologic manner from histopathological features [2]. PB is classiﬁed into 3 subtypes based on tissue component such as the monophasic PB, known as the well-diﬀerentiated fetal adenocarcinoma (WDFA) comprising epithelial malignant component only; the classic biphasic pulmonary blastoma (CBPB) characterized by both epithelial and mesenchymal malignant components; pleuropulmonary blastoma (PPB), that is, a childhood tumor showing features of mesenchymal malignant components only. CBPB is the most common of the three subtypes [2]. PB is observed in the fourth decade of life with mean age of occurrence in adults being 43