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Iwamura M, Nishimori M, Iwasa H, Otani M, Nakaji K, Nitta N, Miyatake K, Yoshimatsu R, Yamanishi T, Matsumoto T, Iguchi M, Okada H, Yamagami T. A case of pulmonary pleomorphic carcinoma associated with cystic airspace. Radiol Case Rep 2023; 18:2692-2696. [PMID: 37273726 PMCID: PMC10238256 DOI: 10.1016/j.radcr.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
Lung cancer associated with a cystic airspace is frequently misdiagnosed or overlooked. Adenocarcinoma, followed by squamous cell carcinoma, is the most typical histologic type of lung cancer connected to a cystic airspace. Here we present the rare case of lung pleomorphic carcinoma associated with a cystic airspace. We encountered a 74-year-old Japanese man diagnosed by computed tomography (CT) as having a nodule outside a cystic airspace in the lung. Several previous CT images showed that the cystic airspace preceded the nodule. Postsurgery, pathology indicated a diagnosis of pleomorphic carcinoma. Since pulmonary pleomorphic carcinomas pursue an aggressive clinical course, their early detection may contribute to an improved prognosis. Our case demonstrated that pleomorphic carcinoma can arise with cystic airspaces. For early diagnosis of those aggressive lung cancers, chest physicians should carefully examine the walls of cystic airspaces on CT.
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Affiliation(s)
- Mamiko Iwamura
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Miki Nishimori
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hitomi Iwasa
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Michimi Otani
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Kosuke Nakaji
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Noriko Nitta
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Kana Miyatake
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Rika Yoshimatsu
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Tomoaki Yamanishi
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Tomohiro Matsumoto
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Mitsuko Iguchi
- Department of Diagnostic Pathology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, Japan
| | - Hironobu Okada
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, Japan
| | - Takuji Yamagami
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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Zhu H, Zhang L, Huang Z, Chen J, Sun L, Chen Y, Huang G, Chen Q, Yu H. Lung adenocarcinoma associated with cystic airspaces: Predictive value of CT features in assessing pathologic invasiveness. Eur J Radiol 2023; 165:110947. [PMID: 37392546 DOI: 10.1016/j.ejrad.2023.110947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/10/2023] [Accepted: 06/21/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVES Lung adenocarcinoma associated with cystic airspaces (LACA) is a unique entity with limited understanding. Our aim was to evaluate the radiological characteristics of LACA and to study which criteria were predictive of invasiveness. METHODS A retrospective monocentric analysis of consecutive patients with pathologically confirmed LACA was performed. The diagnosed adenocarcinomas were classified into preinvasive (atypical adenomatous hyperplasia, adenocarcinoma in situ, or minimally invasive adenocarcinoma) and invasive adenocarcinomas. Eight clinical features and twelve CT features were evaluated. Univariable and multivariable analyses were performed to analyse the correlation between invasiveness, and CT and clinical features. The inter-observer agreement was evaluated using κ statistics and intraclass correlation coefficients. The predictive performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC). RESULTS A total of 252 patients with 265 lesions (128 men and 124 women; mean age, 58.0 ± 11.1 years) were enrolled. Multivariable logistic regression indicated that multiple cystic airspaces (OR, 5.599; 95 % CI, 1.865-16.802), irregular shape of cystic airspace (OR, 3.236; 95 % CI, 1.073-9.761), entire tumour size (OR, 1.281; 95 % CI, 1.075-1.526), and attenuation (OR, 1.007; 95 % CI, 1.005-1.010) were independent risk factors for invasive LACA. The AUC of the logistic regression model was 0.964 (95 % CI, 0.944-0.985). CONCLUSION Multiple cystic airspaces, irregular shape of cystic airspace, entire tumour size, and attenuation were identified as independent risk factors for invasive LACA. The prediction model gives a good predictive performance, providing additional diagnostic information.
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Affiliation(s)
- Huiyuan Zhu
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lian Zhang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China; Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China; Department of Radiology, Jiading Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Zike Huang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jing Chen
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linlin Sun
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinan Chen
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gang Huang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China; Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China; Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
| | - Qunhui Chen
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Hong Yu
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Bello AM, Anselmi C, Frau M, Berman KG, Novellas R, Espada Y, Longley MJ, Dhumeaux MP. Pulmonary carcinoma associated with cystic airspaces in two dogs. J Small Anim Pract 2021; 63:486-491. [PMID: 34913482 DOI: 10.1111/jsap.13451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/10/2021] [Accepted: 10/31/2021] [Indexed: 12/17/2022]
Abstract
Malignant pulmonary neoplasia associated with cystic airspaces is a well-recognised disease entity in humans. Two elderly dogs, previously diagnosed with a solitary emphysematous bulla, presented with non-specific clinical signs. At presentation, pulmonary auscultation was unremarkable. In both cases, thoracic CT demonstrated the transformation of the cystic airspace lesions characterised by a progressive increase of the solid component and reduction of the air component. Cytological evaluation and subsequent surgical excision followed by histopathology confirmed pulmonary carcinoma in both cases. These two cases represent the first demonstration of possible malignant transformation of pulmonary cystic airspace in dogs. Veterinarians should consider neoplastic transformation as a differential diagnosis in cases of cystic airspaces, particularly cases with features including thickening or irregularity of the wall, associated soft-tissue nodules or solid and non-solid tissue intermixed within clusters of multiple cystic airspaces. Ongoing monitoring of cystic airspace lesions through diagnostic imaging is recommended.
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Affiliation(s)
- A M Bello
- Pride Veterinary Centre, Derby, DE24 8HX, UK
| | - C Anselmi
- Pride Veterinary Centre, Derby, DE24 8HX, UK
| | - M Frau
- Departament de Medicina i Cirurgia Animals, and Fundació Hospital Clínic Veterinari, Autonomous University of Barcelona, College of Veterinary Medicine, Barcelona, 08193, Spain
| | - K G Berman
- Synlab, VPG Histology, Bristol, BS7 0BJ, UK
| | - R Novellas
- Departament de Medicina i Cirurgia Animals, and Fundació Hospital Clínic Veterinari, Autonomous University of Barcelona, College of Veterinary Medicine, Barcelona, 08193, Spain
| | - Y Espada
- Departament de Medicina i Cirurgia Animals, and Fundació Hospital Clínic Veterinari, Autonomous University of Barcelona, College of Veterinary Medicine, Barcelona, 08193, Spain
| | - M J Longley
- Pride Veterinary Centre, Derby, DE24 8HX, UK
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Munden RF, Black WC, Hartman TE, MacMahon H, Ko JP, Dyer DS, Naidich D, Rossi SE, McAdams HP, Goodman EM, Brown K, Kent M, Carter BW, Chiles C, Leung AN, Boiselle PM, Kazerooni EA, Berland LL, Pandharipande PV. Managing Incidental Findings on Thoracic CT: Lung Findings. A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2021; 18:1267-1279. [PMID: 34246574 DOI: 10.1016/j.jacr.2021.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 12/17/2022]
Abstract
The ACR Incidental Findings Committee presents recommendations for managing incidentally detected lung findings on thoracic CT. The Chest Subcommittee is composed of thoracic radiologists who endorsed and developed the provided guidance. These recommendations represent a combination of current published evidence and expert opinion and were finalized by informal iterative consensus. The recommendations address commonly encountered incidental findings in the lungs and are not intended to be a comprehensive review of all pulmonary incidental findings. The goal is to improve the quality of care by providing guidance on management of incidentally detected thoracic findings.
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Affiliation(s)
- Reginald F Munden
- Professor, Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina; Chair, Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - William C Black
- Professor of Radiology, Emeritus, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Heber MacMahon
- Professor of Radiology, Section of Thoracic Imaging, Department of Radiology, The University of Chicago, Chicago, Illinois
| | - Jane P Ko
- Professor of Radiology, Department of Radiology, NYU Langone Health, New York, New York; Fellowship Director, Cardiothoracic Imaging, Department of Radiology, NYU Langone Health, New York, New York
| | - Debra S Dyer
- Professor, Department of Radiology, National Jewish Health, Denver, Colorado; Chair, Department of Radiology, National Jewish Health, Denver, Colorado
| | - David Naidich
- Professor, Emeritus, NYU-Langone Health, New York, New York; Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | - Santiago E Rossi
- Chairman, Centro Rossi, Buenos Aires, Argentina; Chest Section Head, Hospital Cetrángolo, Buenos Aires, Argentina
| | - H Page McAdams
- Professor of Radiology, Duke University Health System, Durham, North Carolina
| | - Eric M Goodman
- Assistant Professor, Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York; Associate Program Director, Diagnostic Radiology, Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Kathleen Brown
- Professor, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California; Section Chief, Thoracic Imaging, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California; Assistant Dean, Equity and Diversity Inclusion, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Michael Kent
- Associate Professor of Surgery, Harvard Medical School, Boston, Massachusetts; Director, Minimally Invasive Thoracic Surgery, Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Brett W Carter
- Associate Professor, Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas; Director of Clinical Operations, University of Texas MD Anderson Cancer Center, Houston, Texas; Chief Patient Safety and Quality Officer, Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Caroline Chiles
- Professor, Department of Radiology, Wake Forest Baptist Health, Winston Salem, North Carolina
| | - Ann N Leung
- Professor, Clinical Affairs, Stanford University Medical Center, Stanford, California; Associate Chair, Clinical Affairs, Stanford University Medical Center, Stanford, California; Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Phillip M Boiselle
- Professor, Quinnipiac's Frank H. Netter MD School of Medicine, North Haven, Connecticut; Dean, Quinnipiac's Frank H. Netter MD School of Medicine, William and Barbara Weldon Dean's Chair of Medicine, North Haven, Connecticut
| | - Ella A Kazerooni
- Professor of Radiology, Division of Cardiothoracic Radiology and Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Lincoln L Berland
- Professor Emeritus, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pari V Pandharipande
- Director, MGH Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts; Associate Chair, Integrated Imaging & Imaging Sciences, MGH Radiology, Massachusetts General Hospital, Boston, Massachusetts; Executive Director, Clinical Enterprise Integration, Mass General Brigham (MGB) Radiology, Massachusetts General Hospital, Boston, Massachusetts; Associate Professor of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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5
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Aldaghlawi F, Von Holzen U, Li L, Hadid W. A case of squamous cell lung cancer presented as a cystic lesion and recurrent pneumothoraces. Respir Med Case Rep 2021; 33:101382. [PMID: 33796442 PMCID: PMC7995653 DOI: 10.1016/j.rmcr.2021.101382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/16/2021] [Accepted: 03/03/2021] [Indexed: 10/29/2022] Open
Abstract
We report a rare case of a 70-year-old male with recurrent pneumothoraces within one year treated with intermittent insertion of chest tube on each occasion. Diagnostic testing was notable for a cystic lesion in the left lung that was initially interpreted as bulla on chest x-ray and chest computed tomographic scan. Due to thickening and nodularity changes of the thin wall of the cystic lesion, the patient underwent left upper lobectomy. Pathology showed poorly differentiated squamous cell carcinoma of the cystic lesion wall. This case emphasizes the importance of monitoring pulmonary cystic lesions especially in patients with a history of smoking and emphysema.
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Affiliation(s)
- Fadi Aldaghlawi
- Department of Medicine, Indiana University School of Medicine-South Bend, South Bend, IN, USA
| | - Urs Von Holzen
- Department of Surgical Oncology, Indiana University School of Medicine-South Bend, USA
- Goshen Center for Cancer Care, Goshen, IN, USA
| | - Liang Li
- Department of Pathology, Goshen Health Hospital, Goshen, IN, USA
| | - Walid Hadid
- Department of Medicine, Indiana University School of Medicine-South Bend, South Bend, IN, USA
- Goshen Center for Cancer Care, Goshen, IN, USA
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6
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Penha D, Pinto E, Taborda-Barata L, Irion K, Marchiori E. Lung cancer associated with cystic airspaces: a new radiological presentation of lung cancer. J Bras Pneumol 2020; 46:e20200156. [PMID: 32965296 PMCID: PMC7567613 DOI: 10.36416/1806-3756/e20200156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Diana Penha
- . Universidade da Beira Interior, Covilhã, Portugal
| | - Erique Pinto
- . Universidade da Beira Interior, Covilhã, Portugal
| | | | - Klaus Irion
- . Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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7
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Shen Y, Xu X, Zhang Y, Li W, Dai J, Jiang S, Wu T, Cai H, Sihoe A, Shi J, Jiang G. Lung cancers associated with cystic airspaces: CT features and pathologic correlation. Lung Cancer 2019; 135:110-115. [PMID: 31446982 DOI: 10.1016/j.lungcan.2019.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/23/2019] [Accepted: 05/06/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Lung cancer associated with cystic airspaces (LCCA) is a rare entity. The diagnosis and treatment is often delayed due to lack of comprehension of this disease. We aimed to elucidate LCCA's clinicopathological characteristics and investigate imaging features correlated with pathological invasiveness. METHOD The preoperative computed tomographic (CT) scans of 10,835 patients diagnosed with NSCLC between January 2015 and December 2016 were reviewed by two thoracic radiologists for association with a cystic airspace. A clinicopathological and radiological feature analysis was done. RESULT A total number of 123 LCCA patients were identified and four morphologic patterns were recognized: I, thin-walled type (n = 23, 18.7%); II, thick-walled type (n = 34, 27.6%); III, a cystic airspace with a mural nodule (CWN) type (n = 43, 35.0%); and IV, mixed type (n = 23, 18.7%). A solid component in the cyst wall predicted histological invasiveness in all four types of LCCA. The proportion of moderately/poorly (M/P)-differentiated subtype in type III (85.0%) was higher than in other three patterns (which were 50.0%, 50.0%, and 69.6%, respectively). Multivariate analysis revealed that type III pattern (odds ratio [OR], 6.5; 95% confidence interval [CI], 1.1-36.4; P = 0.035), part-solid/solid component in wall (part-solid: OR, 27.2; 95% CI, 5.6-3131.6; P < 0.001; solid: OR 614.6; 95% CI, 36.4-10,368.6; P < 0.001), and irregular inner surface of cyst (OR 7.0; 95% CI 1.9-26.2; P = 0.004) were independent risk factors for the M/P-differentiated subtype. EGFR mutations were the predominant genetic alterations in each type of LCCAs, but no significant difference was found among them. CONCLUSIONS In LCCA, morphological patterns and wall components were two important predictors for determining pathological invasiveness.
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Affiliation(s)
- Yingran Shen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Xinnan Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Yunfei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Weitong Li
- Department of Medical Imaging, Shishi Hospital, Fujian, 362700, China
| | - Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Siming Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Tong Wu
- Department of Medical Imaging, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Haomin Cai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Alan Sihoe
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Jingyun Shi
- Department of Medical Imaging, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China.
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China.
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Tan Y, Gao J, Wu C, Zhao S, Yu J, Zhu R, Zhang Q, Wu G, Xue X, Wu J. CT Characteristics and Pathologic Basis of Solitary Cystic Lung Cancer. Radiology 2019; 291:495-501. [PMID: 30860446 DOI: 10.1148/radiol.2019181598] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There are increasing reports of a type of lung cancer that manifests as solitary cystic airspaces. The purpose of this case series was to
identify the CT features and possible mechanisms of solitary cystic lung cancer, on the basis of CT observations and pathologic characteristics.
The clinical, imaging, and pathologic data of 106 patients with solitary cystic lung cancer were collected and analyzed between
January 2011 and December 2017. CT images were reviewed independently by three radiologists who were blinded to pathologic findings.
Demographic data and clinical and smoking status were extracted from the medical records. The mean age was 58.8 years 6 10.6
(standard deviation) (range, 30–82 years). CT features in the 106 patients included nonuniform cystic walls in 96 (90.6%) patients, cyst
septations in 62 (58.5%) patients, nodular walls in 58 (54.7%) patients, ground-glass opacity around the cyst in 53 patients (50.0%), and
irregular margins in 42 (39.6%) patients. At histologic examination, the majority of cases (81 [87.1%] of 93) were adenocarcinoma.
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Affiliation(s)
- Yang Tan
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
| | - Jie Gao
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
| | - Chongchong Wu
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
| | - Shaohong Zhao
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
| | - Jing Yu
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
| | - Ruiping Zhu
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
| | - Qing Zhang
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
| | - Guangyao Wu
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
| | - Xinying Xue
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
| | - Jianlin Wu
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
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Snoeckx A, Reyntiens P, Carp L, Spinhoven MJ, El Addouli H, Van Hoyweghen A, Nicolay S, Van Schil PE, Pauwels P, van Meerbeeck JP, Parizel PM. Diagnostic and clinical features of lung cancer associated with cystic airspaces. J Thorac Dis 2019; 11:987-1004. [PMID: 31019789 DOI: 10.21037/jtd.2019.02.91] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
"Lung cancer associated with cystic airspaces" is an uncommon manifestation, in which lung cancer presents on imaging studies with a cystic area with associated consolidation and/or ground glass. With the widespread use of computed tomography (CT), both in clinical practice and for lung cancer screening, these tumors are being more frequently recognized. An association of this entity with smoking has been established with the majority of cases reported being in former and current smokers. The true pathogenesis of the cystic airspace is not yet fully understood. Different causes of this cystic airspace have been described, including a check-valve mechanism obstructing the small airways, lepidic growth of adenocarcinoma on emphysematous lung parenchyma, cyst formation of tumor and tumor growth along the wall of a pre-existing bulla. Adenocarcinoma is the commonest histological type, followed by squamous cell carcinoma. Two classification systems have been described, based on morphological features of the lesion, taking into account both the cystic airspace as well as the morphology of the surrounding consolidation or ground glass. The cystic component may mislead radiologists to a benign etiology and the many different faces on imaging can make early diagnosis challenging. Special attention should be made to focal or diffuse wall thickening and consolidation or ground glass abutting or interspersed with cystic airspaces. Despite their atypical morphology, staging and management currently are still similar to that of other lung cancer types. Although the rarity of this entity will hamper larger studies, numerous aspects regarding this particular lung cancer type still need to be unraveled. This manuscript reviews the CT-imaging findings and gives an overview of available data in the English literature on pathogenesis, histopathology and clinical findings. Differential diagnosis and pitfalls are discussed as well as future directions regarding staging and management.
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Affiliation(s)
- Annemie Snoeckx
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Pieter Reyntiens
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Maarten J Spinhoven
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Haroun El Addouli
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Astrid Van Hoyweghen
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Simon Nicolay
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Patrick Pauwels
- Department of Pathology Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Jan P van Meerbeeck
- Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Paul M Parizel
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
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Mets OM, Schaefer-Prokop CM, de Jong PA. Cyst-related primary lung malignancies: an important and relatively unknown imaging appearance of (early) lung cancer. Eur Respir Rev 2018; 27:27/150/180079. [PMID: 30567934 DOI: 10.1183/16000617.0079-2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/11/2018] [Indexed: 12/18/2022] Open
Abstract
It is well known that lung cancer can manifest itself in imaging as solid and subsolid nodules or masses. However, in this era of increased computed tomography use another morphological computed tomography appearance of lung cancer is increasingly being recognised, presenting as a malignancy in relation to cystic airspaces. Despite the fact that it seems to be a relatively common finding in daily practice, literature on this entity is scarce and presumably the overall awareness is limited. This can lead to misinterpretation and delay in diagnosis and, therefore, increased awareness is urgently needed. This review aims to illustrate the imaging appearances of cyst-related primary lung malignancies, demonstrate its mimickers and potential pitfalls, and discuss the clinical implications based on the available literature and our own experience in four different hospitals.
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Affiliation(s)
- Onno M Mets
- Dept of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelia M Schaefer-Prokop
- Diagnostic Imaging Analysis Groups, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Dept of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Pim A de Jong
- Dept of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Sheard S, Moser J, Sayer C, Stefanidis K, Devaraj A, Vlahos I. Lung Cancers Associated with Cystic Airspaces: Underrecognized Features of Early Disease. Radiographics 2018; 38:704-717. [DOI: 10.1148/rg.2018170099] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Sarah Sheard
- From the Department of Radiology, St George’s Hospitals NHS Trust, Blackshaw Rd, London SW17 0QT, England (S.S., J.M., K.S., I.V.); Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, England (C.S.); and Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England (A.D.)
| | - Joanna Moser
- From the Department of Radiology, St George’s Hospitals NHS Trust, Blackshaw Rd, London SW17 0QT, England (S.S., J.M., K.S., I.V.); Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, England (C.S.); and Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England (A.D.)
| | - Charlie Sayer
- From the Department of Radiology, St George’s Hospitals NHS Trust, Blackshaw Rd, London SW17 0QT, England (S.S., J.M., K.S., I.V.); Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, England (C.S.); and Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England (A.D.)
| | - Konstantinos Stefanidis
- From the Department of Radiology, St George’s Hospitals NHS Trust, Blackshaw Rd, London SW17 0QT, England (S.S., J.M., K.S., I.V.); Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, England (C.S.); and Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England (A.D.)
| | - Anand Devaraj
- From the Department of Radiology, St George’s Hospitals NHS Trust, Blackshaw Rd, London SW17 0QT, England (S.S., J.M., K.S., I.V.); Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, England (C.S.); and Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England (A.D.)
| | - Ioannis Vlahos
- From the Department of Radiology, St George’s Hospitals NHS Trust, Blackshaw Rd, London SW17 0QT, England (S.S., J.M., K.S., I.V.); Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, England (C.S.); and Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England (A.D.)
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Snoeckx A, Dendooven A, Carp L, Desbuquoit D, Spinhoven MJ, Lauwers P, Van Schil PE, van Meerbeeck JP, Parizel PM. Wolf in Sheep’s Clothing: Primary Lung Cancer Mimicking Benign Entities. Lung Cancer 2017; 112:109-117. [DOI: 10.1016/j.lungcan.2017.07.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 07/24/2017] [Accepted: 07/31/2017] [Indexed: 12/12/2022]
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Roemers R, Patberg K, van de Wauwer C, Nguyen T, Shahin G. Robot-assisted thoracoscopic lobectomy as treatment of a giant bulla. J Cardiothorac Surg 2017; 12:31. [PMID: 28521787 PMCID: PMC5437605 DOI: 10.1186/s13019-017-0595-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A bulla is a marked enlarged space within the parenchyma of the lung. Bullae may cause dyspnea by compressing healthy lung parenchyma and can cause a pneumothorax. Also, bullae are associated with malignancy, therefore surgical bullectomy is indicated on preventive basis. This case is unique and therefore valuable because of the remarkable presentation, innovative treatment and the spectacular improvement of lung function and socio-economic performance of the patient. CASE PRESENTATION In this case report we describe the presentation, minimally invasive surgical treatment by means of a robot-assisted lobectomy and postoperative outcome of a young patient with a giant congenital bulla of the left upper lobe. CONCLUSIONS In this case robot-assisted lobectomy has shown spectacular improvement of lung function and fast-track recovery with beneficial socio-economic performance in a young patient with a giant congenital bulla.
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Affiliation(s)
- Rosa Roemers
- Department of Cardio-thoracic Surgery, Universitair Medisch Centrum Groningen (UMCG), Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Kornelis Patberg
- Department of Pulmonology, Isala Clinics Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Caroline van de Wauwer
- Department of Cardio-thoracic Surgery, Universitair Medisch Centrum Groningen (UMCG), Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Tam Nguyen
- Department of Pulmonology, Isala Clinics Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Ghada Shahin
- Department of Cardio-thoracic Surgery, Isala Clinics Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
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Bronte G, Rolfo C. Semi-automated volumetric analysis in the NELSON trial for lung cancer screening: is there room for diagnostic experience yet? J Thorac Dis 2016; 8:E1490-E1492. [PMID: 28066640 DOI: 10.21037/jtd.2016.11.36] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Giuseppe Bronte
- Phase I Early Clinical Trials Unit, Oncology Department, Antwerp University Hospital & Center for Oncological Research (CORE), Antwerp University, Antwerp, Belgium
| | - Christian Rolfo
- Phase I Early Clinical Trials Unit, Oncology Department, Antwerp University Hospital & Center for Oncological Research (CORE), Antwerp University, Antwerp, Belgium
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Rampinelli C, Calloni SF, Minotti M, Bellomi M. Spectrum of early lung cancer presentation in low-dose screening CT: a pictorial review. Insights Imaging 2016; 7:449-59. [PMID: 27188380 PMCID: PMC4877352 DOI: 10.1007/s13244-016-0487-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/20/2016] [Accepted: 03/18/2016] [Indexed: 12/14/2022] Open
Abstract
The typical presentation of early stage lung cancers on low-dose CT screening are non-calcified pulmonary nodules. However, there is a wide spectrum of unusual focal abnormalities that can be early presentations of lung cancer. These abnormalities include, for example, cancers associated with 'cystic airspaces' or scar-like cancers. The detection of lung cancer with low-dose CT can be affected by the absence of intravenous contrast medium. As a consequence, endobronchial and central lesions can be difficult to recognize, raising the potential for missed cancers. Focal lesions arising within pre-existing lung disease, such as lung fibrosis or apical scars, can also be early lung cancer manifestations and deserve particular consideration as recognition of these lesions may be hindered by the underlying disease. Furthermore, the unpredictable growth rate of lung cancer, which ranges from indolent to aggressive cancers, necessitates attention to the wide spectrum of progression in lung cancer appearance on serial low-dose CT scans. In this pictorial review we discuss the spectrum of early lung cancer presentation in low-dose CT screening, highlighting typical as well as unusual radiological features and the varied growth rates of early lung cancer. Teaching Points • There is a wide spectrum of early presentations of lung cancer on LDCT. • Low radiation dose and the absence of contrast medium injection can affect lung cancer detection. • Lung cancer growth shows various behaviours, ranging from indolent to aggressive cancers. • Familiarity with LDCT technique can improve CT screening effectiveness and avoid missed diagnosis.
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Affiliation(s)
- Cristiano Rampinelli
- Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Via Ripamonti, 435, 20141, Milan, Italy.
| | | | - Marta Minotti
- School of Medicine, University of Milan, Milan, Italy
| | - Massimo Bellomi
- Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Via Ripamonti, 435, 20141, Milan, Italy
- School of Medicine, University of Milan, Milan, Italy
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Abstract
OBJECTIVE This study aimed to define computed tomographic morphologic features of lung cancer associated with cystic airspaces, their modifications in serial computed tomographic scans, and 18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography uptake. METHODS Computed tomographic scans and 18F-FDG positron emission tomography in 24 patients with lung cancer (17 adenocarcinomas, 7 squamous cell carcinomas, 12 stage I and 12 stage II to IV) associated with cystic airspaces were reviewed. RESULTS Mean diameter of airspace was initially 17.6 mm (range, 5-30 mm), and 4 morphologic patterns were recognized: solid nodule protruding externally (type I, n = 5) or internally (type II, n = 4) from the cyst wall; circumferential thickening of the cyst wall (type III, n = 8); and tissue intermixed within clusters of cysts (type IV, n = 7). With tumor growth, airspace size decreased in 9, increased in 6, and was unchanged in 9 cases. Five cases evolved from type III to type I, and 5 lesions became completely solid. 18F-fluoro-2-deoxy-D-glucose uptake was initially absent to mild in 7 and moderate to marked in 14 lesions. CONCLUSIONS Progressive wall thickening or appearance/increase of a nodule inside or outside a cystic airspace should raise suspicion of lung cancer irrespective of FDG uptake.
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Abstract
OBJECTIVE The objectives of this study were to determine the frequency of lung cancers associated with a discrete cystic airspace and to characterize the morphologic and pathologic features of the cancer and the cystic airspace. MATERIALS AND METHODS We reviewed all diagnosed cases of lung cancer resulting from baseline screening (n=595) and annual screening (n=111) in the International Early Lung Cancer Action Program to identify those abutting or in the wall of a cystic airspace. We also reviewed the pathologic specimens. RESULTS A total of 26 lung cancers were identified abutting or in the wall of a cystic airspace. Of these, 13 were identified at baseline (13/595, 2%) and 13 at annual screening (13/111, 12%), which was significant (p<0.0001). The median circumferential portion of wall involved was less for the annual cancers than for the baseline ones, but this difference did not reach significance (90° vs 240°, p=0.07). The diagnosis was adenocarcinoma in all but three cases. Histologic analysis showed that the cystic space was a bulla, a fibrous walled cyst without a defined lining, or a pleural bleb and that in all but one case, the tumor was eccentric relative to the airspace and the wall of the airspace was unevenly thickened. CONCLUSION At annual repeat CT screening, the finding of an isolated cystic airspace with increased wall thickness should raise the suspicion of lung cancer.
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Furukawa M, Oto T, Yamane M, Toyooka S, Kiura K, Miyoshi S. Spontaneous regression of primary lung cancer arising from an emphysematous bulla. Ann Thorac Cardiovasc Surg 2011; 17:577-9. [PMID: 21881362 DOI: 10.5761/atcs.cr.10.01638] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bullous emphysema is an important risk factor for lung cancer. Here, we report the case of a 56-year-old man who underwent surgical treatment for primary lung cancer arising from the wall of a bulla. Chest computed tomography (CT) had revealed a nodule arising from the bulla wall. This nodule showed positive uptake of (18)fluorodeoxyglucose (FDG) during positron emission tomography (PET)-CT. However, repeat CT performed after 2 months showed a spontaneous decrease in the tumor size. Exploratory resection revealed non-small cell lung cancer, which was confirmed by the findings of intraoperative frozen-section analysis; therefore, right upper lobectomy and mediastinal lymph node dissection were performed. The postoperative, pathological diagnosis was squamous cell carcinoma arising from the wall of a bulla. From this case, we infer that lung cancer arising from the wall of a bulla may spontaneously regress, and FDG/PET is a useful tool to diagnose lung tumor in patients with pulmonary bullous disease.
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Affiliation(s)
- Masashi Furukawa
- Department of Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama, Japan
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Yoshikawa T, Misao T, Aoe M. Primary lung cancer arising from the wall of a giant bulla in which positron emission tomography was useful for preoperative diagnosis. Gen Thorac Cardiovasc Surg 2011; 59:137-40. [DOI: 10.1007/s11748-010-0618-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 03/16/2010] [Indexed: 10/18/2022]
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