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Weekly Chest CasesArchive of Old Cases

Case No : 584 Date 2009-01-05

  • Courtesy of Mi Jin Park, MD, Joo Sung Sun, MD, Kyung Joo Park, MD. / Ajou University Hospital, Korea.
  • Age/Sex 73 / F
  • Chief ComplaintCough and sputum for 2 months
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Initial CXR

Diagnosis With Brief Discussion

Diagnosis
Case of Multifocal BAC
Radiologic Findings
CT scans shows multifocal lobular and geographic ground glass opacity and consolidation in both lungs. Air bronchograms are well visualized within the consolidations.
Some nodules are also depicted.
These finding show no significant interval changes for 2 months.
Brief Review
Bronchioloalveolar carcinoma represents 1.5%-6.5% of all primary pulmonary neoplasm. As with other adenocarcinomas, the prevalence of BAC is relatively high in women (30%-50% of BAC occur in women). Only 255-50% if patients with BAC have a history of heavy smoking. More than half of all patients with BAC are asymptomatic. The most frequent symptoms and signs are cough, sputum, shortness of breath, weight loss, hemoptysis, and fever (1).

According to the classification of the WHO, bronchioloalveolar carcinoma is a subtype of adenocarcinoma. BAC can be defined as a peripheral neoplasm, arising beyond a recognizable
bronchus, with a tendency to spread locally using the lung structure as a stroma (lepidic growth). BAC can be classified into two main types: mucinous (80%) and nonmucinous. Mucinous BAC is more likely to be multicentric and has s worse prognosis than nonmucinous BAC (1).

Bronchioloalveolar carcinoma appears radiographically as a single nodule, segmental or lobar consolidation, or diffuse nodules. At computed tomography (CT), the single nodular form appears
as a peripheral nodule or localized ground-glass attenuation with or without consolidation, frequently associated with bubblelike areas of low attenuation and open bronchus signs. The lobar consolidative form may demonstrate the CT angiogram and open bronchus signs. The diffuse nodular form appears as multiple nodules or areas of ground-glass attenuation or consolidation (1).

The radiological feature that distinguishes BAC from other cell types is the demonstration of multifocal and lobar pneumonic opacities. The consolidative form of BAC accounts for approximately 30% of all BAC and corresponds to a mucinous histological subtype. Non-resolving central or peripheral consolidation, especially with associated nodules, raises the possibility of BAC. The stretching, attenuation, sweeping and widening of branching air-filled bronchi within an area of consolidation on CT favor the diagnosis of BAC (2).
References
1. Lee KS, Kim Y, Han J, et al. Brochioloalveolar carcinoma: clinical, histopathologic, and radiologic findings. Radiographics 1997;17:1345-1357
2. D Patsios, H C Roberts, N S Paul, et al. Pictorial review of the many faces of brochioloalveolar cell carcinoma. BJR 2007;80:1015-1023
Keywords
Lung, Malignant tumor, BAC

No. of Applicants : 104

▶ Correct Answer : 13/104,  12.5%
  • - Saga University , Japan Ryoko Egashira
  • - CH Sud Rnion , Reunion jean-babtiste Noel
  • - PingTung Christian Hospital,Taiwan,R.O.C , Taiwan Jun Jun Yeh
  • - Ruby Hall Clinic , India john joseph
  • - Das Allgemeine Krankenhaus , Germany Davis Chiramel
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - KMC,Manipal , India satish maddukuri
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - chest hospital , Egypt assaad assaad
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - ASL BOLOGNA - MAGGIORE HOSPITAL- ITALY , Italy MARCELLINO BURZI
  • - Clinique Beaulieu, Gene , Switzerland gilles GENIN
▶ Correct Answer as Differential Diagnosis : 24/104,  23.1%
  • - Samsung Medical Center , Korea (South) Dae Kun Oh
  • - Samsung Medical Center , Korea (South) Eun Kim
  • - McGill University Health Centre , Canada Amr Ajlan
  • - Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
  • - Changhua Christian Hospital , Taiwan Chia-Fu Tsai
  • - National Taiwan University Hospital, YL branch , Taiwan Chin-Chung Shu
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - kims,narkatpally , India k bhaskar
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - BOLLINENI HOSPITAL NELLORE , India jignesh dubal
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
  • - Seoul National University Hospital , Korea (South) Kwang Nam Jin
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - NOUR EL-ISLAM RADIOLOGY CENTER , Egypt Elsayed Mousa
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - IRSA , France jean BIGOT
  • - All India Institute of Medical Sciences , India Ashish Gupta
▶ Semi-Correct Answer : 54/104,  51.9%
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
  • - Father Muller Medical College , Mangalore , India nabil mahmood
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - Osaka University , Japan Osamu Honda
  • - seoul national university hospital , Korea (South) Ijin Joo
  • - KONARK DIAGNOSTIC CENTRE , India AHAMAD MUKARRAB
  • - Yashoda Super Speciality hospital , India Ramesh Pandey
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - second hospital xian jiaotong university , China li ming
  • - wonju christial hospital , Korea (South) Daekeon Lim
  • - Changi General Hospital , Singapore Angeline Poh
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - Lilavati Hospital & Research Centre , India Mahavir Swami
  • - Stroger hospital , United States ky yoo
  • - john h stroger hsp , United States dheeraj reddy gopireddy
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - nirman hitech diagnostic centre , India minal seth
  • - POPOVO HOSPITAL , Bulgaria VLADISLAV RUSINOV
  • - MD PG Resident, PIMS,LONI, MAHARASHTRA, INDIA , India Sushant Bhadane
  • - bhrc delhi , India monika aggarwal
  • - Goodmorning hosipital , Korea (South) Kwang Keun Lee
  • - Daegu Fatima Hospital , Korea (South) Tae-Hun Kim
  • - Mackay Memorial Hospital , Taiwan Shen-Yeh Shen
  • - yashodha hospital , India pravin mahadevappa
  • - Trakya Univercity School of Medicine, , Turkey Belma Kmazaslan
  • - Hanmaeum Hospital , Korea (South) Kwon Hyoung Kim
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Kasturba Medical College Manipal , India Paresh Desai
  • - EKH-Berlin , Germany Michael Weber
  • - Retd. Prof Thoracic Surgery B.J.MEDIDCAL COLLEGE Punr India , India Bankim Amin
  • - Ruby Hall Clinic , India Aniruddha Joshi
  • - McGill University Health Center , Canada Alexandre Semionov
  • - UZ GASTHUISBERG , Belgium Johan COOLEN
  • - Yonsei University college of medicine Severance Hospital , Korea (South) Hua Sun Kim
  • - xi , China qiu zhang
  • - Annecy hospital , France, Metropolitan Antoine MARIE
  • - Trakya Univercity School of Medicine , Turkey Armagan Sarac
  • - batra hospital new delhi , India shiva rastogi
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - chp st martin , France Mariotte benoit
  • - E-DA Hospital / I-Shou University , Taiwan Yu-Feng Wei
  • - MIR , United States Clint Jokerst
  • - Government Medical college, Kozhikkode , India jineesh thottath
  • - Cheongshim international medical center , Korea (South) Hae Jum Yang
  • - Taichung Veterans General Hospital, Radiology department , Taiwan SI-WA CHAN
  • - ULTRA CARE , India Debabrata Das
  • - CHU Grenoble , France Fabrice Bing
  • - KASTURBA MEDICAL COLLEGE , India NAVEEN KULKARNI
  • - govt royapettah hospital , India gopinathan kathirvelu
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Soonchunhyang University Cheonan Hospital , Korea (South) Park Sang Hyun
  • - al watany hosp , Syria mohamad jader
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