대한흉부영상의학회 Weekly Chest Cases

Case No : 846 Date 2014-01-13

Courtesy of Song Soo Kim / Chungnam National University College of Medicine
Age/Sex 33 / F
Chief ComplaintCough, sputum, fever, and pleuritic chest pain for a week. PHx: Congenital pulmonary airway malformation(Dx in 2008)

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Diagnosis With Brief Discussion

Diagnosis: Lung cancer (adenocarcinoma, mucinous type)
Radiologic Findings: Fig 1. Chest PA shows consolidation with inner air-fluid level in right lower lung field and patchy and nodular consolidation in left mid lung field.
Fig 2-5. CT scans show an consolidation with cavity in RLL and ill defined nodular and patchy consolidation in LUL and RML.
Fig.6-7 After bilobectomy of RML and RLL, CT scans show increased extent of consolidation in LUL and RML.
Brief Review: Mucinous adenocarcinoma
1.Distinguished from nonmucinous adenocarcinomas
- mucinous tumor cell population : tall columnar cells with abundant apical mucin and small basally oriented nuclei
2.Lepidic pattern is common
- most have invasive component
3.When multifocal, often multilobar
-Female(58%), non-smoker(55%)
-CK7 (+) (~88%), CK20 (+) (~54%), TTF-1 (-) (~83%)
-KRAS mutation (~76%), no EGFR mutation (~3%)
4.Limited studies about treatment
: due to new classification system and rare incidence
- according to WHO 2004 classification
: surgery for resectable disease is mainstay treatment of BAC
5. Widely variable CT findings
- consolidation
- air bronchogram
- CT angiogram
- multifocal and sometimes multilobar solid and subsolid (part-solid or nonsolid) nodules or masses
: tend to be centrilobular or bronchocentric
- lower lobe predominance is common
: both the localized and multifocal forms
References: 1.Austin JH et al. Radiologic implications of the 2011 classification of adenocarcinoma of the lung. Radiology. 2013 Jan;266(1):62-71
2.Lee SM et al. A new classification of adenocarcinoma: what the radiologists need to know. Diagn Interv Radiol. 2012 Nov-Dec;18(6):519-26
3. Loachimescu OC et al. From cystic pulmonary airway malformation, to bronchioloalveolar carcinoma and adenocarcinoma of the lung. Eur Respir J 2005;26:1181-7
Keywords: Lung, Malignant tumor,

No. of Applicants : 64

▶ Correct Answer : 16/64, 25.0%

- Niigata City General Hospital , Japan Takao Kiguchi
- Seoul National University Hospital , Korea (South) Sang Min Lee
- National Hospital Organization Okinawa Hospital , Japan Yasuji Oshiro
- kanto Rosai Hp , Japan Takana Yamakawa
- Kyoto University , Japan Akihiko Sakata
- Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
- i.r.c.c.s.istituto scientifico romagnolo per lo studio e cura dei tumori , Italy Alice Rossi
- Asan medical center , Korea (South) Hyun Joo Lee
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- ICD,MCH CALICUT , India rikhy krishnan
- CHU Saint Pierre , Belgium Abd Alla Fares
- Eren T캇p Merkezi Istanbul , Turkey Armagan Sarac
- Research Hospital, The Institute of Medical Science, The University of Tokyo , Japan Toshihiro Furuta
- C.B.H. Dpt of Imaging- "Clinica Mater Dei" BARI , Italy Carlo Florio
- Private sector , Greece Vasilios Tzilas
- Teikyo University Mizonokuchi Hospital , Japan Noriko Kobayashi

▶ Correct Answer as Differential Diagnosis : 16/64, 25.0%

- Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
- University of British Columbia , Canada Amr Ajlan
- UWO , Canada S Lee
- Myongji hospital , Korea (South) Ji Ye Lee
- James Paget Hospital , U.K , United Kingdom nabil mahmood
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- Kizawa Memorial Hospital , Japan Yo Kaneko
- IRSA La Rochelle , France Denis Chabassiere
- CAC Rennes , France nicolas gautier
- Teikyo University Mizonokuchi Hospital , Japan Kaoru Sumida
- IRSA LA ROCHELLE , France, Metropolitan BIGOT
- GHICL , France manuel toledano
- Medicheck health care , Korea (South) Chae Lim

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 846 Date 2014-01-13

Discussion

No. of Applicants : 64