Video-assisted anatomical resection for pulmonary blastoma

Pulmonary blastomas (PB) are a rare type of primary lung tumour that significantly differ from other lung malignancies based on their histopathological features and prognosis. Three histological subtypes of PB are described: biphasic PB, pleuropulmonary PB and well-differentiated foetal adenocarcinoma. They are composed of a mixture of immature mesenchymal and epithelial cells resembling foetal lung tissue. Preoperative diagnosis is difficult and the prognosis poor. Surgery is the mainstay of treatment. More than one hundred cases have been described in the literature but none have reported the use of minimally invasive techniques such as video-assisted thoracic surgery (VATS) for surgical excision in the adult. We present two cases of PB in adults who were managed with thoracoscopic surgical resection. The first patient presented with cough and haemoptysis clinical stage was cT3N0M0 and the tumour excised by VATS bilobectomy. The second patient presented with cough, haemoptysis and weight loss and went on to have thoracoscopic resection of a right upper lobe tumour staged pT2bN0. These two cases demonstrate that PB can be resected safely through a minimally invasive approach with good outcomes in the short to medium term.