대한흉부영상의학회 Weekly Chest Cases

Case No : 548 Date 2008-04-28

Courtesy of Bo-Ram Park, MD., Dong-Wook Sung, MD. / Department of Diagnostic Radiology, Kyung Hee University Hospital, Korea
Age/Sex 60 / M
Chief ComplaintLeft axillary area chest pain, 1yr ago

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Diagnosis With Brief Discussion

Diagnosis: Peripheral type lung cancer (adenocarcinoma)
Radiologic Findings: Chest PA (Fig. 1) shows peripheral consolidation or pleural thickening on left upper lateral hemithorax. CT (Fig. 2) shows elongated mass like soft tissue lesion with irregular margin on LUL peripheral portion. Focal air shadow within the mass like consolidation is seen, which is due to underlying bullous emphysema. And adjacent rib is destructed.

After 3months, CT (Fig. 3) shows that the lesion is increased and more aggravated bony destruction.
Brief Review: Forty percents of lung cancers are adenocarcinomas and it recurred more common in women and most frequent type seen in non-smokers.

Adenocarcinoma is widely accepted to occur as a solitary, peripheral, subpleural, pulmonary mass with infrequent hilar and rare mediastinal involvement (1). The peripheral masses were subpleural in location in about 49% (1).

Adenocarcinoma (including bronchioloalveolar carcinoma) may be seen as a subpleural mass that invades the overlying pleura (2), and often associated with scarring of the lungs (3).
References: 1. JH Woodring, CB Stelling. Adenocarcinoma of the lung: a tumor with a changing pleomorphic character. AJR 1983;140:657-664
2. CS White, BM Romney, AC Mason, JH Austin, BH Miller, and Z Protopapas. Primary carcinoma of the lung overlooked at CT: analysis of findings in 14 patients. Radiology 1996;199:109-115
3. KS Lee, Y Kim, J Han, EJ Ko, CK Park, and SL Primack. Bronchioloalveolar carcinoma: clinical, histopathologic, and radiologic findings. Radiographics 1997;17:1345-1357
Keywords: Lung, Chest wall, Malignant tumor,

No. of Applicants : 70

▶ Correct Answer : 7/70, 10.0%

- Shiga University of Medical Science , Japan Norihisa Nitta
- Gimpo Woori Hospital , Korea (South) Son Youl Lee
- Osaka University , Japan Osamu Honda
- Dana Farber cancer Institute , United States jyothi jagannathan
- Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
- Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
- Asan medical center , Korea (South) Dae Yoon Kim

▶ Correct Answer as Differential Diagnosis : 8/70, 11.4%

- Asan Medical Center , Korea (South) Eun Jin Chae
- Saga University, Japan , Japan Ryoko Egashira
- Seoul National University Hospital , Korea (South) Sang Min Lee
- Yonsei University college of medicine Severance hospital, Seoul, Korea , Korea (South) Hua Sun Kim
- IRSA La Rochelle France , France Denis Chabassie
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Jackson Memorial Hospital , United States Naganathan Mani
- All India Institute of Medical Sciences , India Ashish Gupta

▶ Semi-Correct Answer : 7/70, 10.0%

- NBE , India vishal garg
- hospital Sao Paulo , Brazil israel missrie
- Marien Hospital, Hamm , Germany Davis Chiramel
- SNUH , Korea (South) Mi-Jin Kang
- Ondokuz Mayis University , Turkey Cetin Celenk
- CH de la Ce Basque , France Paul ARDILOUZE
- OSWAL CANCER HOSPITAL , India LOVKESH MITTAL

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 548 Date 2008-04-28

Discussion

No. of Applicants : 70