대한흉부영상의학회 Weekly Chest Cases

Case No : 1145 Date 2019-10-07

Courtesy of ChoHee Kim, Ho Yun Lee / Samsung Medical Center
Age/Sex 61 / M
Chief ComplaintAbnormality in health screening

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Diagnosis With Brief Discussion

Diagnosis: Adenocarcinoma associated with cystic airspace
Radiologic Findings: Fig 1. Chest PA shows mass like opacity in left mid lung zone.
Fig 2-3. CT scans reveals about 22.5 mm-sized air-filled cystic and solid component nodule in the lingular division of the left upper lobe.
Fig 4. The previous CT, scanned in 10 years ago, shows smaller air-filled cystic and solid component nodule at the same location in the lingular division of the left upper lobe.
Brief Review: The incidence of solitary cystic lung cancer is approximately 3.7% according to the International Early Lung and Cardiac Action Program. Early carcinoma occurring in association with small cystic airspaces in the lung parenchyma is often initially misinterpreted as inflammatory changes or infection, often leading to a delayed diagnosis. In practice, suspicion for cancer in the morphologic change of a cyst or pericystic nodule can help to make an early diagnosis of this disease. There are many theories about the formation mechanisms of solitary cystic lung cancer, such as the “check valve” effect, alveolar cavity fusion caused by alveolar wall destruction, and expectoration of necrotic tumor tissue.

A cyst is distinguished from a cavity based on a wall thickness of less than 4 mm. On CT images, four morphologic types of pericystic cancers were described by Mascalchi et al and Maki et al. Type I is that of a nodule abutting the external aspect of a lung cyst, whereas Type II is that of a nodule arising from the cyst wall and projecting into the cystic space, Type III is that of cyst wall thickening, and Type IV is that of a multicystic lesion that contains areas of soft tissue attenuation. CT features including GGO around the cyst, irregular margins, and gradual expansion of the cystic airspaces are also seen in the evolution of solitary cystic lung cancer.

The most common pathologic type of solitary cystic lung cancer is adenocarcinoma. Less common pathologic subtypes are squamous carcinoma, adenosquamous cell carcinoma, and pulmonary lymphoma.
Please refer to: KSTR Imaging Conference 2004 Summer Case 4,
References: 1. Tan Y et al. CT Characteristics and Pathologic Basis of Solitary Cystic Lung Cancer. Radiology. 2019 May;291(2):495-501.
2. Sheard S et al. Lung Cancers Associated with Cystic Airspaces: Underrecognized Features of Early Disease. Radiographics. 2018 May-Jun;38(3):704-717.
Keywords

No. of Applicants : 65

▶ Correct Answer : 8/65, 12.3%

- ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
- Qatif Central Hospital , Saudi Arabia HANI MAKKY ALSALAM
- Gifu University Hospital , Japan Yo Kaneko
- Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- , Korea (South) JANG SEONG WON
- Chonbuk National University Hospital , Korea (South) SOL KI KIM
- Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
- Chonnam National University Hwasun Hospital , Korea (South) WONGI JEONG

▶ Correct Answer as Differential Diagnosis : 11/65, 16.9%

- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- McGill University Health Center , Canada Alexandre Semionov
- Other , Korea (South) SEONGSU KANG
- National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
- Other , Korea (South) JUWON KIM
- The University of Tokyo Hospital , Japan RYO KUROKAWA
- Ajou University Hospital , Korea (South) HYERIN KIM
- Chonnam National University Hospital , Korea (South) PARK SEUNG GWI
- University of Tsukuba Hospital , Japan SODAI HOSHIAI
- , Japan YUMI MAEHARA
- the first affiliatited hospital of nanjing medical univercity , China HAI XU

▶ Semi-Correct Answer : 5/65, 7.7%

- Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- , Taiwan NING CHIEN
- Chonbuk National University Hospital , Korea (South) MINJEE KIM

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1145 Date 2019-10-07

Discussion

No. of Applicants : 65