대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Cavitary Bronchioloalveolar Carcinoma (BAC), Mucinous Type

Radiologic Findings

On chest radiograph, a large thin-walled cavitary lesion is seen in the left lung. CT scans shows multiple septa within the cavitary lesion in the superior segment of the left lower lobe. The wall and septa of the cavity are thin, but have irregular thickness.
Left lower lobectomy was performed with mediastinal lymph node dissection. Pathologic examination disclosed a large cystic lesion containing dark brownish mucinous fluid, which is connected with proximal bronchial trees. Periphery of cyst is formed with gray-white mucoid consolidation with multifocal nodular spreading.

Brief Review

Necrotic cavitation is unusual in BAC because the nondestructive growth pattern allows preservation of an adequate blood supply. Weisbrod et al. reported 4 cases of BAC with "pseudocavitation" or cystic change, which were produced by paracicatricial emphysema, fibrosis with honeycombing, and localized bronchiectasis. This appearance may also occur when a BAC develops in the region with any type of preexistent cystic change through a non-destructive growth. The differential diagnosis of thin-walled cystic lesions in the lung includes congenital causes (CCAM, bronchogenic cysts), infections (tuberculosis, fungus, hydatid cysts), other neoplasms (metastasis, lymphoma), autoimmune diseases (Wegener's granulomatosis, rheumatoid nodules), trauma and so on.

References

1. Weisbrod GL, Chamberlain D, Herman SJ. Cystic change (pseudocavitation) associated with bronchioloalveolar carcinoma: a report of four patients. J Thorac Imaging 1995; 10:106-111
2. Weisbrod GL, Towers MJ, Chamberlain DW, et al. Thin-walled cystic lesions in bronchioloalveolar carcinoma. Radiology 1992; 185:401-405
3. Kuhlman JE, Fishman EK, Kuhajda FP, et al. Solitary bronchioloalveolar carcinoma: CT criteria. Radiology 1988; 167:379-382

Keywords

Lung, Malignant tumor, Cavitary Bronchioloalveolar Carcinoma (BAC), Mucinous Type