대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 633 Date 2009-12-13

  • Courtesy of Lee Young Kyung / KyungHee University East-West Neo Medical Center
  • Age/Sex 48 / M
  • Chief ComplaintCough for 1 month. Decreased breathing sound in the left lower lung zone.
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Mucinous adenocarcinoma
Radiologic Findings
Posteroanterior radiograph shows a mass-like opacity in left lower lung zone obliterating the ipsilateral hemi-diaphragm without obliteration of left cardiac border, there is no mediastinal shift. Left lateral chest radiograph shows a large opacity in left lower lobe with mild volume decrease. Contrast-enhanced chest CT scans show non-segmental consolidation with low-attenuation (10~20 HU), mild enhancement, mild volume loss in left lower lobe. Gross pathologic photo shows tan white/yellow mass, measuring 10x8.5x6.8cm consisting of tan white solid lesion and multiple yellowish degeneration lesions with mucoid plug. High-power photomicrography clearly shows mucin-producing cancer cells.
Brief Review
Mucinous tumors of bronchial tree and lung are a heterogeneous group of space-occupying lesions characterized by high mucin content. The normal bronchial mucus is 95-98% water and 2-5% solids, and the majority of the solid component is formed by glycoproteins. On CT, concentrated mucus may have attenuation values above 20 HU, and even as high as 130 HU. The low attenuation allows vessels to be seen after administration of intravenous contrast material, so called CT angiogram sign. Mucinous Adenocarcinoma usually appears as multiple low-attenuation consolidations and/or ground-glass opacities on CT scans. Mucinous neoplasm has the tendency to disseminate into the lungs by aerogenous spread. Rapid development of centrilobular ground-glass nodules is the radiologic hallmark of aerogenous neoplastic dissemination.
References
1. Travis WD, Colby TV, Corrin B, Shimosato Y, Brambilla E. Histological classification of lung and pleural tumors. In: Travis WD, ed. WHO International Histological Classification of Tumors: Histological Typing of Lung and Pleural Tumors. 3rd ed. Berlin, Germany: Elsevier Publishing Co; 1999:21-66.
2. Moran C, Hochholzer L, Fishback N, Travis W, Koss M. Mucinous (so-called colloid) carcinoma of the lung. Mod Pathol. 1992;5:634-638.
3. Gaeta M, Vinci S, Minutoli F, Mazziotti S, Ascenti G, Salamone I, Lamberto S, Blandino A. CT and MRI findings of mucin-containing tumors and pseudotumors of the thorax: pictorial review. Eur Radiol. 2002;12:181-189.
Keywords
Lung, Malignant tumor,

No. of Applicants : 78

▶ Correct Answer : 22/78,  28.2%
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Hel-Dieu Montreal , Canada nicolas gautier
  • - Osaka University , Japan Osamu Honda
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - Father Muller Medical College , Mangalore , India nabil mahmood
  • - partner, aditya imaging centre , India vivek patel
  • - hospital Sao Paulo , Brazil israel missrie
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OKUBO
  • - KING KHALID UNIVERSITY HOSPITAL,RIYADH , Saudi Arabia NABIL GHALEB
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - CHRU Lille , France Benjamin Damarey
  • - SMC , Korea (South) Jihoon Cha
  • - CHU Grenoble , France Fabrice Bing
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - KMC,Manipal , India satish maddukuri
  • - Kangnam Sacred Heart Hospital , Korea (South) Jaewon Kim
  • - Hopital du SacrCoeur , Canada Abraham Bohadana
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Bundang CHA hospital , Korea (South) Jung Jin Young
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
  • - Saga University , Japan Ryoko Egashira
▶ Correct Answer as Differential Diagnosis : 22/78,  28.2%
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
  • - CHUV , Switzerland ANNE-SOPHIE KNOEPFLI
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - POPOVO HOSPITAL , Bulgaria VLADISLAV RUSINOV
  • - clinique de rochefort , France viviane pages
  • - McGill University , Canada Ben Smith
  • - CHRU lille , France manuel toledano
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Samsung Medical Center , Korea (South) Sang Yu Nam
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - Louisiana State University - Shreveport , United States Carlos Previgliano
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - All India Institute of medical sciences , India Justin Moses
  • - NASA SCANS , India RAKESH BHATIA
  • - chp st martin , France Mariotte benoit
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
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