A 25-year-old male patient was admitted to our clinic with complaints of left shoulder pain. Vital findings were stable in physical examination. Her physical examination and medical history did not have a distinctive feature. Laboratory parameters were not abnormal. Thorax computer tomography (CT) and Positron emission tomography (PET/CT) revealed a mass in the lingular segment of the left lung in the upper lobe with a size of 12x7.5 cm (SUDmax 28.8).

Fiberoptic bronchoscopic (FOB) examination revealed no endobronchial lesion and was normal. No signs of malignancy were detected in the aspiration and brush samples taken. Acute bacilli (ARB) was not observed. Transthoracic fine needle aspiration was performed but the diagnosis could not be obtained. In the left upper lobe, a 13 cm diameter pulmonary nodule was palpated in the thoracotomy. The pathological examination of the frozen material was reported as a malignant lesion and left upper lobectomy was performed. The fetal adenocarcinoma of the pathologic lung was reported. Chemotherapy and radiotherapy treatment was performed and no pathology was detected during the 6 months follow-up.

Fetal adenocarcinoma of the lung is a rare, malignant pulmonary tumor, classified as a variable subtype of pulmonary invasive adenocarcinoma. According to the multidisciplinary classification made in 2011 and the World Health Organization (WHO) classification 2015, fetal adenocarcinoma was divided into two subgroups: International Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS /ERS). These two subtypes have different clinical-pathological features and mutation changes. L-FLAC, ie, low-grade fatal adenocarcinoma, is pathologically characterized by immature epithelium morphologically similar to 10-15 weeks of fetal lung. L-FLAC was first reported by Kradin et al in 1982 as a pulmonary blastoma subtype. Now, in general, L-FLAC is considered to be composed of pure epithelium without other components, whereas pulmonary blastoma is performed in a two-phase view of both carcinoma and sarcoma components. High-grade fetal adenocarcinoma consists of low-grade fetal adenocarcinoma (at least 50%) and conventional adenocarcinoma (such as acne type, papillary type, micropapillary type, lepidic type and solid type), even high-grade neuroendocrine carcinoma with necrosis and pathological mitoses.

However, it is still controversial whether highgrade fetal adenocarcinoma is a prominent variant of lung cancer or simply a morphological model of traditional adenocarcinoma. Most of the previously reported L-FLAC cases are asymptomatic and usually present in the third or fourth year of life with mild female predisposition. Whether smoking history is important in L-FLAC is controversial. The youngest patient was a 6-year-old child. These two cases of L-FLAC were a 31-year-old male with a smoking history and a 21-year-old non-smoker male. Besides young age and gender, they do not show the effect of smoke. Histologically, L-FLAC is a completely epithelial malignancy and consists of well-differentiated glands sorted by fake columnar cells with single or clear cytoplasm.

GSOA cordially invites you to submit your research work on this topic. We accept Research/ Review/ Case reports/ Short communication/ Commentary articles. Submissions can be made online through Editorial tracking system present in our journal homepage or through email as an attachment to mailto:surgeryopenres@medicalsci.org

Regards
ALEX JOHN
Managing Editor
General Surgery: Open Access