대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Adenocarcinoma with acinar and bronchioloalveolar pattern in RUL & Atypical adenomatous hyperplasia in LLL

Radiologic Findings

Chest CT scan shows nodular ground glass opacity with internal solid part in right upper lobe and pure nodular ground-glass opacity in left lower lobe. Right upper lobectomy and wedge resection of left lower lobe were performed. Pathologically, lesion in right upper lobe was adenocarcinoma with acinar and bronchioloalveolar pattern, and lesion in left lower lobe was atypical adenomatous hyperplasia.

Brief Review

With the finer CT collimation made possible by advancements in technology, the relative frequency of detection of the nodular ground-glass opacities will be even higher. The frequency of malignancy in nodular ground-glass opacity was much higher than in solid nodules, in the cases with internal solid part in particular (1). In addition, the distribution by malignancy type was strikingly different in the nodular ground-glass opacities as compared with the solid nodules. The malignancies in nodular ground-glass opacities were typically bronchioloalveolar carcinomas or adenocarcinomas with bronchioloalveolar features, whereas in solid nodules the malignancies were typically other subtypes of adenocarcinoma (1). The solid component in the nodular ground-glass opacities is caused by lack of aeration in the alveoli, perhaps because the alveoli are being compressed or are otherwise being inadequately oxygenated (2-5).

It has been proved that GGO area on HRCT in small adenocarcinoma is well correlated with the pathological BAC area (6). Moreover, the prognostic value of the BAC component of small-sized lung adenocarcinoma of 20 mm or less in diameter was reported. According to the semiquantitative assessment of well differentiated BAC areas of the tumors, the 5-year disease-free survival rate was significantly better in patients with BAC greater than 50% than in those with BAC less than 50% (7). For further research, pooling of data is necessary to adequately determine the natural history of malignancies diagnosed in these nodular ground-glass opacities.



Please also refer to Case 119, Case 132, and Case 310.

References

1. Henschke CI, Yankelevitz DF, Mirtcheva R, McGuinness G, McCauley D, Miettinen OS; ELCAP Group. CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. AJR Am J Roentgenol. 2002;178:1053-1057.
2. Gaeta M, Barone M, Caruso R, Bartiromo G, Pandolfo I. CT-pathologic correlation in nodular bronchioloalveolar carcinoma. J Comput Assist Tomogr. 1994;18:229 ?232.
3. Kushihashi T, Munechika H, Ri K, Kubota H, et al. Bronchioloalveolar adenoma of the lung: CT-pathologic correlation. Radiology. 1994;193:789 ?793.
4. Kobayashi T, Satoh K, Sasaki M, et al. Bronchioloalveolar carcinoma with widespread groundglass shadow on CT in two cases. J Comput Assist Tomogr. 1997;21:133 -135.
5. Koizumi N, Sakai K, Matsuzucki Y, et al. Natural history of cloudy zone of pulmonary adenocarcinoma on HRCT. Nippon Igaku Hoshasen Gakkai Zasshi. 1996;56:715 ?719.
6. Kodama K, Higashiyama M, Yokouchi H, Takami K, Kuriyama K, Mano M, Nakayama T. Prognostic value of ground-glass opacity found in small lung adenocarcinoma on high-resolution CT scanning. Lung Cancer. 2001;33:17-25.
7. Higashiyama M, Kodama K, Yokouchi H, Takami K, Mano M, Kido S, Kuriyama K. Prognostic value of bronchiolo-alveolar carcinoma component of small lung adenocarcinoma. Ann Thorac Surg. 1999;68:2069-2073.

Keywords

Lung, Malignant tumor,