Diagnostic and clinical features of lung cancer associated with cystic airspaces

Small cell lung carcinoma presenting initially with recurrent pneumothoraces: a case report

BACKGROUND

Pneumothorax is a non-physiological collection of air in the pleural space. Pneumothoraces can be broadly divided into Primary, Secondary, and Traumatic. Cancer of the lung is a known cause of secondary pneumothorax in both primary and metastatic lesions, however, pneumothorax as the presentation of lung cancer is exceedingly rare. Non-small cell lung carcinoma (NSCLC) has been reported in the literature to present with a pneumothorax, particularly in adeno/squamous cell carcinomas. It is almost completely unheard of for small cell lung carcinoma (SCLC) to present with a pneumothorax.

CASE PRESENTATION

We present the case of a 62-year-old male patient, presenting twice in two months with spontaneous pneumothorax. The initial management involved admission and chest drain insertion. The patient has a past medical history of COPD and a significant smoking history. On the second admission, he underwent a video-assisted thoracoscopic (VATS) bullectomy and talc pleurodesis. The pathology report of the resected specimen confirmed SCLC with extensive infiltration. No gross evidence of metastatic spread was present on CT. Due to the R1 resection and significant risk of recurrence, the management plan included four cycles of adjuvant chemotherapy with carboplatin and etoposide, and radiotherapy as a consideration upon completion.

CONCLUSIONS

Pneumothorax as the presentation of lung cancer imparts a very poor prognosis, however the reasons for this are largely unknown. Furthermore, the mechanisms underlying spontaneous pneumothorax in lung cancer are also not well understood.

Interpreting Lung Cancer Screening CTs: Practical Approach to Lung Cancer Screening and Application of Lung-RADS

Lung cancer screening via low-dose computed tomography (CT) reduces mortality from lung cancer, and eligibility criteria have recently been expanded to include patients aged 50 to 80 with at least 20 pack-years of smoking history. Lung cancer screening CTs should be interepreted with use of Lung Imaging Reporting and Data System (Lung-RADS), a reporting guideline system that accounts for nodule size, density, and growth. The revised version of Lung-RADS includes several important changes, such as expansion of the definition of juxtapleural nodules, discussion of atypical pulmonary cysts, and stepped management for suspicious nodules. By using Lung-RADS, radiologists and clinicians can adopt a uniform approach to nodules detected during CT lung cancer screening and reduce false positives.

CT-Guided Core-Needle Biopsy of Pulmonary Lesions Associated With Cystic Airspaces: A Case-Control Study

Background: Concern may exist that pulmonary lesions associated with cystic airspaces are at risk of increased biopsy complications or lower biopsy accuracy given challenges in targeting tissue abutting or intermingled with the cystic airspaces. Objective: To evaluate the safety and diagnostic performance of CT-guided core-needle biopsy (CNB) of pulmonary lesions with cystic airspaces. Methods: This retrospective study included 90 patients (median age, 69.5 years; 28 female, 62 male) who underwent CT-guided CNB of pulmonary lesions associated with cystic airspaces (based on review of procedural images) from February 2010 to December 2022 and a matched control group (2:1 ratio) of 180 patients (median age, 68.0 years; 56 female, 124 male) who underwent CNB of noncystic noncavitary lesions during the same period. The groups were compared in terms of complications, nondiagnostic biopsies (i.e., nonspecific benignities, atypical cells, or insufficient specimens), and CNB diagnostic performance for detecting malignancy using as reference the final diagnosis from a joint review of all available records. For lesions associated with cystic airspaces that underwent surgical resection after CNB, histologic slides were re-reviewed to assess cystic airspace etiology. Results: The final diagnosis was malignant in 90% (81/90) of lesions associated with cystic airspaces and 92% (165/180) of noncystic noncavitary lesions. Patients with lesions associated with cystic airspaces and patients with noncystic noncavitary lesions showed no significant difference in frequencies of complication (all: 40% [36/90] vs 38% [68/180], p=.79; major: 4% [4/90] vs 6% [10/180], p=.78; minor: 36% [32/90] vs 32% [58/180], p=.59), frequency of nondiagnostic biopsies (12% [11/90] vs 9% [16/180], p=.40), or diagnostic performance (accuracy: 94.% [85/90] vs 97% [175/180], p=.50; sensitivity: 94% [76/81] vs 97% [160/165], p=.50; specificity: 100% [9/9] vs 100% [15/15]; p>.99), respectively. All false-negative results for malignancy in both groups occurred in patients with nondiagnostic CNB results. Among lesions associated with cystic airspaces that were resected after CNB (all malignant), the cystic airspaces most commonly represented tumor degeneration (22/31, 71%). Conclusion: CT-guided CNB is safe and accurate for assessing pulmonary lesions associated with cystic airspaces. Clinical Impact: CNB may help avoid a missed or delayed cancer diagnosis in pulmonary lesions with cystic airspaces.

Pulmonary tuberculoma-induced cyst formation leading to repeated pneumothorax: a case report

Most cases of secondary spontaneous pneumothorax in patients with active pulmonary tuberculosis are caused by rupturing of the visceral pleura caused by Mycobacterium tuberculosis. The check-valve airway mechanism in the lungs is generally involved in the formation of pulmonary cysts, which often cause spontaneous pneumothorax. Herein, we describe a rare case of repeated spontaneous pneumothorax suspected to have been caused by pulmonary cyst formation as a result of a tuberculoma. The patient was a man with a family history of pulmonary tuberculosis. Pulmonary cysts were gradually enlarged on the peripheral side of a lung mass in the upper lobe of the patient's right lung, who experienced two spontaneous pneumothoraxes in the area. Exploratory surgery was performed to diagnose the lung mass and treat the pneumothorax, resulting in a final diagnosis of pulmonary tuberculoma. A check-valve mechanism caused by the pulmonary tuberculoma was suspected based on the patient's clinical course.

[Progress in Diagnosis and Treatment of Lung Cancer Associated with Cystic Airspaces]

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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A case of pulmonary pleomorphic carcinoma associated with cystic airspace

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.

Lung adenocarcinoma associated with cystic airspaces: Predictive value of CT features in assessing pathologic invasiveness

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.

Analysis of the relevance between computed tomography characterization and pathology of pulmonary ground-glass nodules with different pathology types

Background

In this study, we aimed to analyze the relevance between computed tomography characterization and pathology of pulmonary ground-glass nodules with different pathology types.

Methods

Between January 2017 and December 2018, a total of 657 patients (191 males, 466 females; mean age: 60.9±8.1 years; range, 34 to 80 years) with pathologically diagnosed ground-glass nodules were retrospectively analyzed. The clinicopathological characteristics and computed tomography characterizations of patients with ground-glass nodules who received surgical resection were analyzed. The clinical data including age, sex, smoking status and medical history were recorded. Computed tomography characterizations included the location and size of the tumor, the size of the consolidation components, density uniformity, shape, margin, tumor-lung interface, internal signs and surrounding signs.

Results

Based on the computed tomography imaging characteristics, a mean computed tomography value of ≥444.5 HU was more likely to indicate malignant lesions, while ≤444.5 HU indicated benign lesions. A malignant ground-glass nodules" maximum diameter of <6.78 mm, a diameter of the consolidation component of <3.88 mm, and a mean computed tomography value of <-536.5 HU were more likely to indicate atypical adenomatous hyperplasia and adenocarcinoma in situ. A maximum diameter of malignant ground-glass nodules of >11.52 mm, a diameter of the consolidation component of >6.20 mm, and a mean computed tomography value of ≥493.5 HU were more likely to indicate invasive adenocarcinomas. The focus between these parameters indicated minimally invasive adenocarcinomas.

Conclusion

Ill-defined tumor-lung interface, irregular in shape, and smooth nodule margins suggest benign lesions while round or oval, clear tumor-lung interface, spiculation signs, lobulation signs, bubble signs, air bronchograms, pleural indentations, and vessel convergences are helpful in the diagnosis of malignant lesions. A clear tumor-lung interface, the spiculation signs, lobulation signs, and bubble signs indicate the invasion of the lesions.

Case Report: Misdiagnosis of Lung Carcinoma in Patients with Shrunken Lung Cyst After High Altitude Travel

Background

Lung cancer associated with cystic airspace is a rare disease, and the imaging understanding of lung cancer with cystic cavity is still unclear. Little is known in the literature on whether cystic lung cancer is caused by emphysema or ruptured bullae.

Case Reports

We report the case of a 50-year-old female patient after finishing a business trip in November 2021, when another chest CT demonstrated an unexpected reduction in the cyst, with a solid mural nodule on the posterior wall. The airspace of the cyst is only about 13 mm × 12 mm × 6 mm in size. The size of the mural nodule in the posterior wall is about 10 mm × 6 mm × 5 mm. The patient felt anxious due to suspicion of lung cancer. 2.5 months after the last chest CT, she accepted minimally invasive thoracoscopic surgery on the posterior basal segment of the left lower lobe. The postoperative pathology showed benign lesions.

Conclusion

For radiologists, it is important to recognize the process from lung cysts or bullae to LC-CAS, especially the morphological changes of the cyst airspace and the cyst wall, in order to identify the malignant features of lung cysts in time.

A diagnostic dilemma of a pulmonary nodule of a patient who suffered advanced ovarian cancer: A case report and a hypothesis

INTRODUCTION

This report presents a case of lung cancer which can be easily misdiagnosed as distant metastasis. Along with a literature review on the morphological, pathological and prognostic characteristics of lung cancer associated with cystic airspaces (LCCA), it would help to improve our understanding of the dynamic evolution of LCCA, to avoid its delayed diagnosis and treatment. We also propose here a hypothesis on the etiology of LCCA.

CASE PRESENTATION

A patient with advanced ovarian cancer who presented with elevated serum CA125 at time of admission and had undergone TAHBSO at first, and second operation of sigmoid colon resection was performed due to her locoregional recurrence of ovarian cancer. After her second operation, patient showed further increment of serum CA125 and CECT scan indicated an airspace-related pulmonary nodule in the right middle lobe of her lungs. It was suspected that distant metastases of ovarian cancer had reoccurred postoperatively.

CLINICAL DISCUSSION

After comparing the characteristic of metastatic ovarian cancer with LCCA, we diagnosed the pulmonary nodule as primary lung cancer. Surgery eventually confirmed the pulmonary nodule as second primary lung cancer associated with cystic airspaces.

CONCLUSION

The rare occurrence of LCCA should merit special attention from clinicians and radiologists so as to avoid missed or delayed diagnosis. We propose here a hypothesis that LCCA is related to spreading of tumour cells during surgical procedures in lung cancer surgery. Should our hypothesis be substantiated in further studies, this would affect the operation procedures for surgeons in the future.

Pulmonary carcinoma associated with cystic airspaces in two dogs

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.

Solitary multicystic lesion lung cancer: two case reports and review of the literature

Background

Lung cancer associated with cystic airspaces, especially solitary multicystic lesion lung cancer, is a rare disease (a rare imaging performance of non-small cell lung cancer). It is difficult to diagnose owing to the lack of a clear definition; therefore, diagnosis of these neoplastic lesions remains challenging.

Case presentation

We outlined two cases of elderly Chinese men who were admitted to the hospital with a solitary multicystic lesion of the lung and subsequent surgical resection, confirming a diagnosis of adenocarcinoma.

Conclusions

For solitary pulmonary cystic airspaces (especially solitary multicystic lung lesions), it is important to properly recognise their imaging features. Due to the possibility of malignancies, timely surgery is an effective treatment strategy for early diagnosis.

Cystic Primary Lung Cancer: Evolution of Computed Tomography Imaging Morphology Over Time

PURPOSE

Primary lung cancers associated with cystic airspaces are increasingly being recognized; however, there is a paucity of data on their natural history. We aimed to evaluate the prevalence, pathologic, and imaging characteristics of cystic lung cancer in a regional thoracic surgery center with a focus on the evolution of computed tomography morphology over time.

MATERIALS AND METHODS

Consecutive patients referred for potential surgical management of primary lung cancer between January 2016 and December 2018 were included. Clinical, imaging, and pathologic data were collected at the time of diagnosis and at the time of the oldest computed tomography showing the target lesion. Descriptive analysis was carried out.

RESULTS

A total of 441 cancers in 431 patients (185 males, 246 females), median age 69.6 years (interquartile range: 62.6 to 75.3 y), were assessed. Overall, 41/441 (9.3%) primary lung cancers were cystic at the time of diagnosis. The remaining showed solid (67%), part-solid (22%), and ground-glass (2%) morphologies. Histopathology of the cystic lung cancers at diagnosis included 31/41 (76%) adenocarcinomas, 8/41 (20%) squamous cell carcinomas, 1/41 (2%) adenosquamous carcinoma, and 1/41 (2%) unspecified non-small cell lung carcinoma. Overall, 8/34 (24%) cystic cancers at the time of diagnosis developed from different morphologic subtype precursor lesions, while 8/34 (24%) cystic precursor lesions also transitioned into part-solid or solid cancers at the time of diagnosis.

CONCLUSIONS

This study demonstrates that cystic airspaces within lung cancers are not uncommon, and may be seen transiently as cancers evolve. Increased awareness of the spectrum of cystic lung cancer morphology is important to improve diagnostic accuracy and lung cancer management.

Prognosis of lung cancer associated with cystic airspaces: A propensity score matching analysis

OBJECTIVE

The association between the morphological characteristics and survival outcome of lung cancer associated with cystic airspaces (LCCAs) is unclear due to rarity of this disease. The current study attempted to compare the survival outcome between LCCAs and non-LCCAs and investigate the correlation between imaging features and prognosis of LCCA.

METHOD

Of 10,835 patients diagnosed with non-small cell lung carcinoma (NSCLC) between January 2015 and December 2016, 123 patients with LCCA were included. The non-LCCA group comprised 3136 patients with primary solitary adenocarcinoma or squamous cell lung cancer. Propensity score matching (PSM) was performed for age, sex, tumor size, tumor stage, and lymph node involvement in a 1:1 ratio between the LCCAs and non-LCCAs, and the correlation between radiological features and recurrence-free survival (RFS) was analyzed.

RESULT

The computed tomography (CT) lesion size was found to be higher in all LCCA subtypes, particularly in Type III (a cystic airspace with a mural nodule) and Type IV (mixed) LCCAs (3.09 and 3.65 cm, respectively), than in non-LCCAs (2 cm) after PSM. Three-year RFS in the LCCA group was higher than in the non-LCCA group (Type I- IV LCCAs: 100%, 84%, 77% and 83%, respectively vs. non-LCCAs: 77%). However, statistically significant difference was only found in comparison between LCCA Type I (thin-walled) and non-LCCA groups (P = 0.026). Type III lung cancer exhibited the worst survival among all four LCCA subtypes.

CONCLUSIONS

The CT lesion size and pathologic tumor size varied significantly across LCCAs. Type I LCCAs exhibited better survival than non-LCCAs, whereas Type III LCCAs exhibited the worst survival rate among the four LCCA subtypes.

Clinical Value and Pathologic Basis of Cystic Airspace Within Subsolid Nodules Confirmed as Lung Adenocarcinomas by Surgery

PURPOSE

To investigate the clinical value and pathologic basis of cystic airspace within lung adenocarcinomas manifesting as subsolid nodules.

PATIENTS AND METHODS

A retrospective study was conducted on a total of 541 surgically confirmed lung adenocarcinomas manifesting as subsolid nodules in computed tomography images, including 87 cases with cystic airspace and 454 cases without cystic airspace. The pathologic characteristics of the cases with and without cystic airspace were compared. The investigation of the pathologic structure of cystic airspace was attempted on the postoperative paraffin sections.

RESULTS

There was a significant difference in the containing of cystic airspace between preinvasive and invasive adenocarcinomas (10.5 vs 26.6%; P < .001). Multivariate analysis indicated that cystic airspace is an independent predictor of invasive adenocarcinomas (odds ratio, 3.220; 95% confidence interval, 1.822-5.687). Nodules containing multiple cystic airspaces are more likely to be invasive adenocarcinomas than nodules with a single cystic airspace (47.1 vs 72.2%; P < .05). On paraffin sections, the walls of the cystic airspace seemed to be mainly composed of atypical hyperplasia and/or tumor cells on the surface and the remaining smooth muscle cells and stroma below, which is similar to the structure of bronchi.

CONCLUSIONS

Cystic airspace may be a reliable predictor of invasive adenocarcinomas, the classification method based on the number of cystic airspaces might be suitable for the computed tomography-based typing of cystic airspace within subsolid nodules. Cystic airspace may derive from the destroyed and enlarged bronchi owing to the growth or infiltration of atypical hyperplasia and/or tumor cells.

The radiologist's role in lung cancer screening

Lung cancer is still the deadliest cancer in men and women worldwide. This high mortality is related to diagnosis in advanced stages, when curative treatment is no longer an option. Large randomized controlled trials have shown that lung cancer screening (LCS) with low-dose computed tomography (CT) can detect lung cancers at earlier stages and reduce lung cancer-specific mortality. The recent publication of the significant reduction of cancer-related mortality by 26% in the Dutch-Belgian NELSON LCS trial has increased the likelihood that implementation of LCS in Europe will move forward. Radiologists are important stakeholders in numerous aspects of the LCS pathway. Their role goes beyond nodule detection and nodule management. Being part of a multidisciplinary team, radiologists are key players in numerous aspects of implementation of a high quality LCS program. In this non-systematic review we discuss the multifaceted role of radiologists in LCS.

Screen-detected solid nodules: from detection of nodule to structured reporting

Lung cancer screening (LCS) is gaining some interest worldwide after positive results from International trials. Unlike other screening practices, LCS is performed by an extremely sensitive test, namely low-dose computed tomography (LDCT) that can detect the smallest nodules in lung parenchyma. Up-to-date detection approaches, such as computer aided detection systems, have been increasingly employed for lung nodule automatic identification and are largely used in most LCS programs as a complementary tool to visual reading. Solid nodules of any size are represented in the vast majority of subjects undergoing LDCT. However, less than 1% of solid nodules will be diagnosed lung cancer. This fact calls for specific characterization of nodules to avoid false positives, overinvestigation, and reduce the risks associated with nodule work up. Recent research has been exploring the potential of artificial intelligence, including deep learning techniques, to enhance the accuracy of both detection and characterisation of lung nodule. Computer aided detection and diagnosis algorithms based on artificial intelligence approaches have demonstrated the ability to accurately detect and characterize parenchymal nodules, reducing the number of false positives, and to outperform some of the currently used risk models for prediction of lung cancer risk, potentially reducing the proportion of surveillance CT scans. These forthcoming approaches will eventually integrate a new reasoning for development of future guidelines, which are expected to evolve into precision and personalized stratification of lung cancer risk stratification by continuous fashion, as opposed to the current format with a limited number of risk classes within fixed thresholds of nodule size. This review aims to detail the standard of reference for optimal management of solid nodules by low-dose computed and its projection into the fine selection of candidates for work up.

Molecular profiling in lung cancer associated with cystic airspaces

'Lung cancer associated with cystic airspaces' is a rare radiological entity that is more frequently encountered on imaging studies and is gaining more attention since the widespread use of CT for lung cancer screening. Numerous aspects of this entity remain unraveled, including molecular profiling. The goal of this observational retrospective single-center case series is to investigate the molecular profile of lung cancers presenting with this specific morphology in a Caucasian population. Between January 2014 and May 2017, 13 patients were presented at the Multidisciplinary Thoracic Oncology Tumor Board with imaging findings consistent with 'lung cancer associated with cystic airspaces'. Electronic medical files were reviewed for patient characteristics, stage, histopathological findings and - in particular - molecular profiling. Histopathological diagnosis showed adenocarcinoma in 11 patients in our series. Mutational analysis in 10 showed different molecular alterations: an EGFR exon 18 mutation, ROS1 rearrangement and BRAF mutation in one patient each. Two patients showed KRAS mutations. With 5 out of 10 patients with an adenocarcinoma presenting with cystic airspace morphology showing a molecular alteration, this may indicate that in this subgroup, molecular profiling is mandatory, regardless of smoking history.

Pulmonary high-grade fetal adenocarcinoma associated with cystic airspace: A case report

Lung cancers associated with cystic airspaces have a life‐threatening risk of a missed or delayed diagnosis. Here, we report a case of pulmonary high‐grade fetal adenocarcinoma, a rare lung carcinoma associated with cystic airspaces, as confirmed by computed tomography (CT) scan. A 73‐year‐old asymptomatic male with a 52‐pack a year smoking habit was referred to our hospital. Lung CT showed a thin‐walled cystic space with exophytic and endophytic solid nodules along the cyst wall. After surgery, histological analysis of a resected lung specimen revealed a pure high‐grade fetal adenocarcinoma probably associated with emphysematous bullae in pulmonary emphysema, suggesting smoking contributed to this pure form, as well as the emphysema. In conclusion, when treating elderly men with a smoking history, physicians need to carefully examine the walls of cystic airspaces on CT for fetal adenocarcinoma.

Key points

Significant findings of the study•

Pulmonary high‐grade fetal adenocarcinoma may be associated with emphysematous bullae manifesting as cystic air spaces as shown by computed tomography.

What this study adds•

When scanning by computed tomography, physicians should carefully examine the pulmonary cystic airspace walls in elderly men with a smoking history.

The first case of micropapillary adenocarcinoma associated with cystic airspace in a non-smoking man

Lung cancers associated with cystic airspaces are attracting increasing attention because of delayed diagnosis. The cancers that usually occur in smokers comprise lepidic, papillary, and/or acinar adenocarcinoma, but a micropapillary type has not been described to date. Pulmonary micropapillary adenocarcinoma was added to the 2015 World Health Organization (WHO) classification system as a new subtype with a notably poor prognosis. We describe the first micropapillary adenocarcinoma of the lung associated with cystic airspaces in a 79-year-old non-smoking man.

Enhancing the cytotoxic efficacy of combined effect of doxorubicin and Cyclosporin encapsulated photoluminescent graphene dotted mesoporous nanoparticles against lung cancer cell-specific drug targeting for the nursing care of cancer patients

In recent years, biological nanomedicine-based biomaterials have an extreme attention for biomedical uses, herein we examined a novel kind advance of photoluminescent Graphene quandum dots encapsulated mesoporous nanoparticles (GND@MSNs) encapsulated by well-known anticancer drugs Doxorubicin (DOX) and Cyclosporin (CsA) for lung carcinoma. Electron microscopic technique exhibit the nanostructure and spherical morphology of GND@MSNs+DOX+CsA with mean size ≈110 nm. Moreover, Dynamic Light Scattering (DLS) exposed that blended GND@MSNs+DOX+CsA nanoparticles were highly stable with extremely negatively charged nanoparticles. Raman investigation was done on the all naturally dynamic nanoparticles containing shed graphene to survey the blend condition of the graphene inside the silica mesoporous nanoparticles. GND@MSNs+DOX+CsA provided an outstanding anti-cancer efficiency against the lung cancer cell lines (i.e., A549 and HEL-299). MTT assay monitored that GND@MSNs, GND@MSNs+DOX and GND@MSNs+DOX+CsA have a robust toxicity behaviour on the A549 and HEL-299 model lung cancer cell lines. Additionally, investigation of the cell death was found on AO-EB, Hoechst 33452 staining and flowcytometry techniques. Furthermore, the DNA damage were confirmed by cell cycle arrest and comet assay. Hence, we suggesting that these GND@MSNs+DOX+CsA could be applied as auspicious drug vesicles for novel lung cancer therapeutic potential and new openings to solve the complexity of lung cancer in the care of cancer patients.