Pulmonary blastoma with a topographic transition from blastic to more differentiated areas

Summary

In order to investigate the probable embryonic nature of pulmonary blastoma, immunohistochemical studies were performed using stage-specific embryonic antigens (Le^y, Le^x, sialyl Le^x-i) in a case of pulmonary blastoma with a very wide spectrum of morphological features. The tumour presented a topographic transition from primitive blastic and embryonic areas to more differentiated areas showing diverse differentiation. Blastic areas composed of extremely immature cells were found in most peripheral parts of the tumour. Inside the blastic areas there were “embryonic” areas which morphologically resembled human embryo lungs in the pseudoglandular and canalicular stages. Most central parts of the tumour showed more differentiated features including chondrosarcomatous, leiomyosarcomatous and rhabdomyosarcomatous elements and the common type of adenocarcinomatous element. Electron microscopic observation suggested the blastic and embryonic nature of these immature cell elements. Le^y was expressed in the blastic and pseudoglandular areas. Le^x was expressed in the canalicular areas. These antigens were not expressed in the more differentiated areas. The topographic gradient in the tumour of morphology and antigen expression from the peripheral blastic areas to the central more differentiated areas suggests that the primitive cells gradually differentiated into more mature cells of various directions as the tumour grew in size.