A rare case of lung adenocarcinoma producing alpha-fetoprotein and consisting mainly of clear cells (high-grade adenocarcinoma of fetal lung type)

Abstract

Background. Pulmonary adenocarcinoma producing alpha-fetoprotein (AFP) is rare and has a poor prognosis. We report a case of pulmonary adenocarcinoma consisting mainly of clear cells, high-grade adenocarcinoma of the fetal lung type (H-FLAC). Case. An annual check-up revealed an abnormal shadow in the right lower lung field of a 69-year-old man. Chest CT showed a solid, nodular mass with a distinct margin measuring 46 x 28 mm. A transbronchial lung biopsy revealed non small cell carcinoma. Right lower lobectomy and ND2a dissection was performed. Histologically, the tumor was adenocarcinoma, showing features similar to those of fetal lung. The tumor consisted mainly of tall columnar clear cells, and no morules were found. Immunohistochemically, the tumor was positive for AFP. Accordingly, we made the diagnosis of H-FLAC, pT2N1M0, stage IIB. Two courses of adjuvant chemotherapy (CBDCA + PAC) were administered, but the patient succumbed to recurrence of cancer 9 months after surgery. Conclusion. This was a rare case in which the clinicopathology was not established. Further study is needed to determine a better therapeutic approach. © 2009 The Japan Lung Cancer Society.