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Lee J, Park E. Overdiagnosing giant bullous emphysema as metastatic adenocarcinoma: a case report. J Cardiothorac Surg 2024; 19:564. [PMID: 39354557 PMCID: PMC11443899 DOI: 10.1186/s13019-024-03112-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 09/15/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Giant bullous emphysema is characterized by large bullae occupying at least one-third of the hemithorax and leading to compression of the surrounding lung parenchyma. Overdiagnosis can occur because of the atypical appearance of hyperplastic type II pneumocytes, which may be mistaken for malignant cells. CASE PRESENTATION A 48-year-old male with a history of smoking and occupational exposure presented with dyspnea and drowsiness. Initial chest X-ray revealed a tension pneumothorax, and subsequent chest CT revealed extensive bullous emphysema and lung cancer in the right middle lobe (RML). Pathologic examination initially indicated resected bullae to metastatic adenocarcinoma, but upon review, it was determined that the reactive alveolar cells were misdiagnosed as malignant. CONCLUSIONS This case emphasizes the need for thorough histopathological assessment and prudent interpretation of atypical cellular morphology.
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Affiliation(s)
- Jiyun Lee
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Eunsu Park
- Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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YANG J, CHEN Y, LEI Y, HUANG Y. [Progress in Diagnosis and Treatment of Lung Cancer Associated with Cystic Airspaces]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2023; 26:774-781. [PMID: 37989340 PMCID: PMC10663780 DOI: 10.3779/j.issn.1009-3419.2023.101.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Indexed: 11/23/2023]
Abstract
Lung cancer associated with cystic airspaces (LCCA) is a type of lung cancer characterized by the presence of cystic cavities in or around the tumor on imaging. Due to its high potential for misdiagnosis or underdiagnosis, the prognosis of LCCA patients is poor, necessitating further large-scale clinical studies to elucidate its characteristics. Currently, four imaging classification systems exist, and there has been a progressive increase in attention towards LCCA, particularly with regard to the study of its imaging features. The results indicate a correlation between the pathological features and imaging findings of LCCA; however, research on driver gene mutations and molecular subtyping associated with lung cancer remains insufficient. Due to the challenges associated with early diagnosis and the poorer prognosis compared to general types of lung cancer, this paper comprehensively reviews the research progress on LCCA, including its definition, etiology, pathogenesis, imaging features, histological and pathological features, treatment, and prognosis, aiming to serve as a valuable resource for clinical decision-making.
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Detterbeck FC, Kumbasar U, Li AX, Rubinowitz AN, Traube L, Gosangi B, Udelsman BV, Bade BC, Ely S, Barreto G, Tanoue LT, Marom EM, Rivera MP. Lung cancer with air lucency: a systematic review and clinical management guide. J Thorac Dis 2023; 15:731-746. [PMID: 36910113 PMCID: PMC9992605 DOI: 10.21037/jtd-22-1199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/06/2023] [Indexed: 02/25/2023]
Abstract
Background Lung cancers with air lucency are poorly understood, often recognized only after substantial progression. Methods From a systematic review (PubMed and EMBASE, 2000-2022, terms related to cystic, cavitary, bulla, pseudocavitary, bubble-like, date 10-30-2022) 49 studies were selected using broad inclusion criteria (case series of ≥10 cases up to trials and reviews). There was no source of funding. Primary evidence relevant to clinical management issues was assembled. Because data was available only from heterogeneous retrospective case series, meta-analysis and formal risk-of-bias assessment was omitted. A framework was developed to guide clinical management based on the available data. Results Demographic, smoking and histologic differences suggest that cystic, cavitary and bullous lung cancers with air lucency may be distinct entities; insufficient data leaves it unclear whether this also applies to pseudocavitary (solid) or bubble-like (ground glass) cancers. Annual observation of irregular thin-walled cysts is warranted; a surgical diagnosis (and resection) is justified once a solid component appears because subsequent progression is often rapid with markedly worse outcomes. Bubble-like ground glass lesions should be managed similarly. Cavitary lesions must be distinguished from infection or vasculitis, but generally require needle or surgical biopsy. Pseudocavitary lesions are less well studied; positron emission tomography may be useful in this setting to differentiate scar from malignancy. Further research is needed because these conclusions are based on interpretation of retrospective case series. Conclusions The aggregate of available evidence suggests a framework for management of suspected lung cancers with air lucency. Greater awareness, earlier detection, and aggressive management once a solid component appears are needed. This review and framework should facilitate further research; questions include whether the suggested entities and proposed management are borne out and should involve clearly defined terms and outcomes related to progression and treatment. In summary, a conceptual understanding is emerging from interpretation of available data about a previously poorly understood topic; this should improve patient outcomes.
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Affiliation(s)
| | - Ulas Kumbasar
- Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Andrew X. Li
- General Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Ami N. Rubinowitz
- Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Leah Traube
- Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Babina Gosangi
- Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | | | - Brett C. Bade
- Pulmonary Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sora Ely
- Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Gaspar Barreto
- General Surgery, Quinnipiac University School of Medicine, Waterbury Hospital, Waterbury, CT, USA
| | - Lynn T. Tanoue
- Pulmonary Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Edith M. Marom
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-Aviv University, Ramat Gan, Israel
| | - M. Patricia Rivera
- Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, NY, USA
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Jung W, Cho S, Yum S, Chung JH, Lee KW, Kim K, Lee CT, Jheon S. Stepwise Disease Progression Model of Subsolid Lung Adenocarcinoma with Cystic Airspaces. Ann Surg Oncol 2020; 27:4394-4403. [PMID: 32363512 DOI: 10.1245/s10434-020-08508-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Subsolid lung adenocarcinoma with cystic airspaces (LACA) is a unique manifestation of lung cancer. This study was conducted to establish a radiologic disease progression model of LACA and to explore its association with the clinical course and clinicopathologic features of LACA. MATERIALS AND METHODS Sixty patients with LACA who underwent surgery at our center between 2004 and 2017 were retrospectively reviewed. The morphological changes of LACA over time on 98 serial computed tomography scans from 27 of 60 patients were tracked to establish a radiologic disease progression model. Associations between this model and the clinicopathologic characteristics of LACA were investigated. RESULTS The following stepwise progression model of LACA was developed: in phase I, cystic airspaces (CAs) appear in the middle of non-solid nodules; in phase II, the CAs grow; in phase III, a solid component appears on the border of the CAs; and in phase IV, the solid component gradually surrounds the CAs and becomes thicker, and the CAs shrink. In total, 10 (17%), 33 (55%), and 17 (28%) LACA patients were classified as belonging to phases II, III, and IV at the time of surgery, respectively. More advanced phases were associated with higher pathologic T and N staging, lymphovascular invasion, visceral pleural invasion, spread through air spaces, and solid/micropapillary subtype. In the multivariate analysis, our model demonstrated a good discrimination capability for cancer recurrence risk. CONCLUSIONS The stepwise disease progression model of LACA based on radiologic findings developed in this study represented its natural clinical course and clinicopathologic features well.
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Affiliation(s)
- Woohyun Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. .,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Sungwon Yum
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jin-Haeng Chung
- Department of Pathology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Choon Taek Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Jung W, Cho S. ASO Author Reflections: Understanding Subsolid Lung Adenocarcinoma with Cystic Airspaces (LACA). Ann Surg Oncol 2020; 27:4404. [PMID: 32356268 DOI: 10.1245/s10434-020-08528-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Woohyun Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. .,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Pérez-Accino J, Liuti T, Pecceu E, Cazzini P. Endogenous lipoid pneumonia associated with pulmonary neoplasia in three dogs. J Small Anim Pract 2020; 62:223-228. [PMID: 31943233 DOI: 10.1111/jsap.13101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 10/26/2018] [Accepted: 01/02/2019] [Indexed: 12/17/2022]
Abstract
Endogenous lipoid pneumonia is a poorly characterised condition in veterinary medicine, particularly in dogs, but it is well recognised in association with lung neoplasia in humans. This case series describes three unique cases of endogenous lipoid pneumonia associated with lung neoplasia, including clinical, imaging, cytological findings and outcome. Clinical presentation and imaging lesions can appear non-specific and may be obscured by neoplastic infiltrate and so diagnosis requires cytology or histopathology. Awareness of endogenous lipoid pneumonia in dogs with pulmonary neoplasia has an impact on staging and monitoring, treatment of clinical signs and quality of life and also aids appropriate use of antimicrobials.
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Affiliation(s)
- J Pérez-Accino
- Hospital for Small animals, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Roslin, EH25 9RG, UK
| | - T Liuti
- Hospital for Small animals, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Roslin, EH25 9RG, UK
| | - E Pecceu
- Hospital for Small animals, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Roslin, EH25 9RG, UK
| | - P Cazzini
- Easter Bush Pathology, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Roslin, EH25 9RG, UK
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Shinohara S, Sugaya M, Onitsuka T, Machida K, Matsuo M, Kato K, Tanaka F. Impact of the favorable prognosis of patients with lung cancer adjoining bullae. J Thorac Dis 2018; 10:3289-3297. [PMID: 30069325 DOI: 10.21037/jtd.2018.05.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Lung cancer adjoining bullae (LC-AB) is an uncommon manifestation. The clinical characteristics and prognosis of LC-AB remain unclear. The aim of this study is to investigate the clinical features and overall survival (OS) of patients with LC-AB following lung resection compared to non-LC-AB group. Methods We retrospectively investigated 291 consecutive patients with lung cancer who underwent curative resection in a single institution between April 2007 and March 2015. A total of LC-AB was 52 patients. LC-AB was determined using thin slice computed tomography (CT) imaging and pathological findings. Survival analysis was calculated using the Kaplan-Meier method. We used a Cox proportional hazards model for the univariate and multivariate analysis to identify prognostic factors. Results The LC-AB group showed a higher frequency of younger patients (P=0.017), former or current smokers (P=0.011), men (P=0.021), tumor location in the upper lobe (P=0.031), moderately or poorly differentiated tumor histology (P<0.001), pleural indentation (P=0.007), and non-adenocarcinoma histology (P=0.016) than the non-LC-AB group. The 5-year survival and recurrence-free survival (RFS) rates were significantly higher in the LC-AB group than the non-LC-AB group (88.5% vs. 74.9%, P=0.010, 75.4% vs. 61.3%, P=0.030, respectively). Multivariate analysis using a Cox proportional hazard model of OS showed that LC-AB was an independent prognostic factor [hazard ratio (HR): 0.30, 95% confidence interval (CI): 0.12-0.77, P=0.012]. Conclusions Patients with LC-AB had better OS than those with non-LC-AB. Thus, LC-AB may be an independent favorable prognostic factor following curative resection.
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Affiliation(s)
- Shuichi Shinohara
- Department of Thoracic Surgery, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Masakazu Sugaya
- Department of Thoracic Surgery, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Takamitsu Onitsuka
- Department of Thoracic Surgery, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Kazuhiko Machida
- Department of Pulmonary and Respiratory Medicine, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Masaki Matsuo
- Department of Pulmonary and Respiratory Medicine, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Kazuo Kato
- Department of Pathology, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Fumihiro Tanaka
- Second Department of Surgery, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
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