Well-differentiated fetal adenocarcinoma presenting with cutaneous metastases

Sir, Pulmonary blastomas are rare lung tumours consisting of malignant embryonic‐appearing glands and fetal‐type stroma.1, 2 Well‐differentiated fetal adenocarcinoma (WDFA), also known as pulmonary endodermal tumour resembling fetal lung3 and well‐differentiated adenocarcinoma simulating fetal lung lobules,4 is a type of pulmonary blastoma lacking a sarcomatous component. The tumour consists of glycogen‐rich, nonciliated tubules simulating those of fetal lung between 10 and 16 weeks' gestation, accompanied by a benign‐appearing mesenchyme.3 WDFA is regarded as a tumour of low‐grade malignancy with a 30% recurrence rate.1, 5 The reported median survival time was 34 months, with 14% of patients with WDFA dying of their tumours.6 Metastasis to lymph nodes and brain occur in fatal cases. Metastasis to the skin has not been documented. We describe the first case of WDFA in which skin metastasis was the presenting manifestation. A 56‐year‐old man was admitted to our hospital in August 1998 because of acute onset of blurred vision of the right eye and right‐sided weakness. He had smoked cigarettes for 20 years and had a 6‐month history of coughing and exertional dyspnoea. Brain computed tomography (CT) showed a 4‐cm tumour in the left occipital area. Chest X‐ray and CT revealed an ill‐defined lesion at the left lower lobe near the mediastinum. A transbronchial lung biopsy revealed the presence of atypical glandular structures consistent with well‐differentiated adenocarcinoma. The patient underwent chemotherapy (gemcitabine, Gemzar, Lilly) and palliative radiotherapy.