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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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Spontaneous pneumothorax associated with cavitating pulmonary metastasis from breast cancer: a case report and literature review. Gen Thorac Cardiovasc Surg 2020; 69:137-141. [PMID: 32617838 DOI: 10.1007/s11748-020-01423-1] [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: 05/19/2020] [Accepted: 06/24/2020] [Indexed: 10/23/2022]
Abstract
We report a 69-year-old woman with spontaneous pneumothorax associated with cavitating pulmonary metastasis from breast cancer. She was treated for right breast cancer (invasive ductal carcinoma, ypT4bN1M0, stage IIIB) 2 years earlier, and was admitted for right pneumothorax and chest computed tomography, which showed multiple small cavitating lesions in bilateral lungs. The pneumothorax was treated conservatively with chest drainage, but subsequently recurred ipsilaterally. During video-assisted thoracic surgery, we detected small white nodules with visceral pleural rupture; therefore, we performed partial lung resection. The pathological findings revealed metastatic breast cancer with pleural invasion. Forty days later, ipsilateral pneumothorax recurred, and chemical pleurodesis was performed, which resolved the pneumothorax and prevented subsequent recurrence. Early diagnosis and definitive treatment, including pleurodesis, should be considered to prevent recurrence of spontaneous pneumothorax and improve patients' quality of life, even in patients with advanced malignancy.
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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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Haro A, Wakasu S, Takada K, Osoegawa A, Kamitani T, Tagawa T, Mori M. Pulmonary metastasis presenting as a ground glass opacity-like lesion with a thin-walled cavity: A case report. Int J Surg Case Rep 2019; 60:287-290. [PMID: 31265989 PMCID: PMC6609783 DOI: 10.1016/j.ijscr.2019.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 01/18/2023] Open
Abstract
Most of pulmonary metastasis present as a well-defined solid and round nodule. This is the rare case of a pulmonary metastasis presenting as a ground glass opacity-like lesion with a thin-walled cavity of tongue cancer. The positron emission tomography/computed tomography examination was useful to show hilar lymph node metastasis.
Introduction Most of pulmonary metastases present as well-defined solid and round nodules. Here we report a case of a pulmonary metastasis presenting as a ground glass opacity (GGO)-like lesion with a thin-walled cavity and lymph node metastasis of tongue cancer. Case presentaion A 22-year-old man was referred to our department for surgical diagnosis and treatment for a GGO-like pulmonary nodule with a thin-walled cavity in the right lower lobe. He had a history of surgical resection for tongue cancer. The size of the GGO-like lesion with a thin-walled cavity in the center gradually increased. A right lower lobectomy and hilar lymphadenectomy were performed. Postoperative pathology revealed the lesion as pulmonary metastasis and hilar lymph node metastasis of tongue cancer. Discussion Our case report of pulmonary metastasis of tongue cancer is rare from the viewpoint of pulmonary GGO-like lesions with a following thin-walled cavity and hilar lymph node metastasis. The positron emission tomography/computed tomography (PET/CT) examination was useful to show right hilar lymph node metastasis. Conclusion It is important to make a differential diagnosis of from the pulmonary nodule in case of a GGO-like lesion with a thin-walled cavity.
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Affiliation(s)
- Akira Haro
- Deparment of Surgery and Science, Kyushu University Hospital, Fukuoka, Japan.
| | - Sho Wakasu
- Deparment of Surgery and Science, Kyushu University Hospital, Fukuoka, Japan; Department of Anatomic Pathology, Pathological Science, Kyushu University Hospital, Fukuoka, Japan
| | - Kazuki Takada
- Deparment of Surgery and Science, Kyushu University Hospital, Fukuoka, Japan
| | - Atsushi Osoegawa
- Deparment of Surgery and Science, Kyushu University Hospital, Fukuoka, Japan
| | - Takeshi Kamitani
- Department of Clinical Radiology, Kyushu University Hospital, Fukuoka, Japan
| | - Tetsuzo Tagawa
- Deparment of Surgery and Science, Kyushu University Hospital, Fukuoka, Japan
| | - Masaki Mori
- Deparment of Surgery and Science, Kyushu University Hospital, Fukuoka, Japan
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