대한흉부영상의학회 Weekly Chest Cases

Case No : 731 Date 2011-11-01

Courtesy of Hwan-Seok Yong, Eun-Young Kang. / Korea University Guro Hospital
Age/Sex 67 / F
Chief Complaintchronic cough and sputum (2 months)

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Figure 1. 2 months ago.

Diagnosis With Brief Discussion

Diagnosis: Invasive Mucinous Adenocarcinoma
Radiologic Findings: On chest CT, patchy GGOs are diffusely distributed in bilateral lungs, mainly involving subpleural and peribronchovascular areas. In addition, consolidations and numerous centrilobular nodules are also noted in both lung fields. Enlarged lymph nodes are seen in bilateral hilar and subcarinal areas.
Brief Review: Adenocarcinoma is the most common histologic type of lung cancer. Recent new adenocarcinoma classification provides uniform terminology and diagnostic criteria, especially for bronchioloalveolar carcinoma (BAC). The terms BAC and mixed subtype adenocarcinoma are no longer used. For resection specimens, new concepts are introduced such as adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) for small solitary adenocarcinomas with either pure lepidic growth (AIS) or predominant lepidic growth with less than 5 mm invasion (MIA). AIS and MIA are usually nonmucinous but rarely may be mucinous. Invasive adenocarcinomas are classified by predominant pattern after using comprehensive histologic subtyping with lepidic (formerly most mixed subtype tumors with nonmucinous BAC), acinar, papillary, and solid patterns; micropapillary is added as a new histologic subtype. Variants include invasive mucinous adenocarcinoma (formerly mucinous BAC), colloid, fetal, and enteric adenocarcinoma.

Invasive mucinous adenocarcinoma, formerly called mucinous BAC, characteristically presents in imaging studies as a range of nodules to lobar replacement by a spectrum of patterns including GGO, mixed GGO/solid foci, or consolidation, but intraalveolar mucus may make the CT appearance solid or nearly solid. The mucoid component may appear as homogeneous consolidation with soft-tissue attenuation that is lower than that of muscle. After administration of an intravenous iodinated contrast agent, vessels are well shown traversing these regions (CT angiogram sign). Overlap does occur between imaging features of mucinous and nonmucinous
invasive adenocarcinomas. SUV for adenocarcinoma of the lung tends to be lower than for other histologic types of lung cancer. For mucinous versus nonmucinous adenocarcinoma, after adjusting for size of the lesion, no significant difference in SUV has been found.
References: 1. Travis WD, Brambilla 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 Thorac Oncol 2011; 6:244-285.
2. Goo JM, Park CM, Lee HJ. Ground-glass nodules on chest CT as imaging biomarkers in the management of lung adenocarcinoma. AJR Am J Roentgenol 2011; 196:533-543.
3. Gaeta M, Vinci S, Minutoli F, et al. 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 : 91

▶ Correct Answer : 7/91, 7.7%

- Korea university , Korea (South) SUMIN HA
- IRCCS S.Luca Hosp. , Italy filippo casolo
- Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
- Emory University Department of Radiology , United States Travis Henry
- China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani

▶ Correct Answer as Differential Diagnosis : 21/91, 23.1%

- Onomichi municipal hospital , Japan Hirofumi Mifune
- Fukuyama daiichi Hospital , Japan Mototsugu Saeki
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- CHU NANCY , France, Metropolitan LEGOU Francois
- Montreal , Canada D J
- Youngdong Hospital , Korea (South) Sang Min Lee
- McGill University Health Center , Canada Alexandre Semionov
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- IRSA La Rochelle France , France Denis Chabassiere
- Homs National Hospital , Syria Rami Abou Zalaf
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- Mallinckrodt Institute of Radiology , United States Joseph Azok
- Radnet Teleradiology , Turkey Murat Ulusoy
- McGill , Canada ilan azuelos
- National Jewish Health , United States Jonathan Chung
- Virgin Mary Hospital Burgas , Bulgaria VLADISLAV RUSINOV
- Hotel-Dieu Montreal , Canada nicolas gautier
- Onomichi municipal hospital , Japan Ryotaro Kishi
- Kizawa Memorial Hospital , Japan Yo Kaneko
- Gwangju 21st century hospital , Korea (South) Hyungwoo Oh
- Private sector , Greece Vasilios Tzilas

▶ Semi-Correct Answer : 9/91, 9.9%

- Inha University Hospital , Korea (South) Ju Won Lee
- radiologist, aditya imaging centre , India vivek patel
- Kyungpook National University Medical Center , Korea (South) Sunkyung Lim
- Kobe City Medical Center General Hospital , Japan Junko Ochi
- Radnet Teleradiology Istanbul , Turkey Armagan Sarac
- Ondokuz Mayis University , Turkey Cetin Celenk
- Seoul St Mary Hospital , Korea (South) Chaehun Lim
- IRSA , France jean-luc BIGOT
- Beaulieu clinic Geneva , Switzerland gilles GENIN

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 731 Date 2011-11-01

Discussion

No. of Applicants : 91