대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Lung cancer (adenocarcinoma)

Radiologic Findings

CT scans reveal spiculated nodules in Lt upper lobe, lingular segment and Lt lower lobe, superior segment. Also, there are multiple scattered nodules in both lungs and multiple nodular thickening in Lt. pleura and fissure. The patient was confirmed as adenocarcinoma with acinar pattern by CT-guided biopsy which forms glandular structure with stromal infiltration.

Brief Review

Non-small cell lung cancer is classified into specific subtypes, such as adenocarcinoma or squamous cell carcinoma. Adenocarcinoma represents the most common histologic subtype world-wide, accounting for almost half of all lung cancers. Recently, classification of lung adenocarcinoma was modified to revise for the growing need for universally accepted criteria organizing the widely divergent clinical, radiologic, and pathologic spectrum of adenocarcinoma. The terms Non-small cell lung cancer is classified into specific subtypes, such as adenocarcinoma or squamous cell carcinoma. Adenocarcinoma represents the most common histologic subtype world-wide, accounting for almost half of all lung cancers. Recently, classification of lung adenocarcinoma was modified to revise for the growing need for universally accepted criteria organizing the widely divergent clinical, radiologic, and pathologic spectrum of adenocarcinoma. The terms “bronchioloalveolar carcinoma” (BAC) and “mixed subtype adenocarcinoma” have been suggested for revision. Based on the pathologic features of resection specimens, small solitary adnocarcinomas (less than 3 cm in diameter) are defined as adenocarcinoma in situ (AIS) with pure lepidic growth and minimally invasive adenocarcinoma (MIA) with predominant lepidic growth and less than 5 mm invasion. Invasive adenocarcinomas have been classified as lepidic (formerly nonmucinous BAC pattern with more than 5 mm invasion), acinar, papillary, and solid predominany patterns, and micropapillary predominant pattern was recently added as a new histologicc sub type.Variants of invasive adenocarcinoma (formerly mucinous BAC), colloid, fetal, and enteric adenocarcinoma.
CT features of adenocarcinoma have been described as pure ground glass-attenuated nodules, solid nodules, or part-solid nodules. Atypical adenomatous hyperplasia (AAH) appears as a small (usually less than 5mm) nonsolid nodule, and shows ground-glass attenuation within which the margins of normal structures remain outlined. AAH can be single or multiple. Non-mucinous AIS generally appears as a pure GGN, but may sometimes be observed as a part-solid nodule. Invasive adenocarcinoma is usually a solid nodule or mass with a variable extent of ground-glass attenuation. The ground glass component is correlated with a lepidic pattern and solid component with an invasive pattern. A marginal characteristic of thick spiculation is associated with lymph node metastasis, vascular invasion. Air bronchogram usually suggests a well-differentiated tumor.

References

1. Curado MP EB, Shin HR, et al. Cancer incidence in five continents, Vol. IX. Lyon: IARC Scientific Publications 2007.
2. Travis WD, Brambilia E, Noguchi M, et al. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thoracic Oncol 2011;6:244-285
3. Lee HJ, Lee CH, Jeong YJ, Chung DH, et al. IASLC/ATS/ERS International Multidisciplinary Classification of Lung Adenocarcinoma; Novel Concepts and Radiologic Implications. J Thoracic Imaging 2012;27:340-353.

Keywords

Lung, Malignant tumor,