Bronchioloalveolar Carcinoma With Fluctuating Extent of Consolidation on Chest Radiography

Sadohara, Junko; Fujimoto, Kiminori; Tazaki, Hiroshi; Nonoshita, Masaaki; Hayabuchi, Naofumi

doi:10.1097/00005382-200401000-00014

Cited by 8 publications

(8 citation statements)

References 13 publications

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“…This fluctuation in size and attenuation of the opacities has been described in BAC. When serial scans show such a pattern, this should arouse suspicion of BAC [9,10]. Development of cavitation with time, as seen in our patient, has also been described in BAC presenting as a consolidation [9].…”

Section: Discussionsupporting

confidence: 77%

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Bronchioloalveolar Cell Carcinoma Presenting as a “Non-Resolving Consolidation” for Two Years

Mir

Sareen

Kulshreshtha

et al. 2015

Advances in Respiratory Medicine

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Bronchioloalveolar carcinoma (BAC), a rare form of lung malignancy, is usually seen in non-smokers and women. Three distinct histological forms have been identified viz, mucinous, non-mucinous and mixed or indeterminate. The mucinous variety of BAC may present as a consolidation which is very difficult to differentiate from an infective pneumonia. We present a case of a middle aged female who was evaluated for a "non-resolving consolidation" for a period of two years. She had undergone an inconclusive bronchoscopy and had received several courses of antibiotics including anti-tuberculous therapy without relief. The size of the lesion had remained largely unchanged during this period and there was no significant clinical deterioration in the patient. Transbronchial biopsy done on presentation revealed BAC of the mucinous variety. BAC presenting as a large consolidation without significant change for a period of two years has rarely been documented in the literature. StreszczenieRak oskrzelikowo-pęcherzykowy, rzadka postać nowotworu występuje częściej u osób niepalących i u kobiet. Wyróżnia się trzy postacie histopatologiczne: śluzową, nieśluzową oraz mieszaną lub nieokreśloną. Odmiana śluzowa może przebiegać pod postacią nacieku trudnego do zróżnicowania z zapaleniem płuc. Przedstawiamy przypadek raka oskrzelikowo-pęcherzykowego u kobiety diagnozowanej przez 2 lata z powodu nieustępującego nacieku. Początkowo wykonano u pacjentki badanie bronchofiberoskopowe, które nie wyjaśniło przyczyny. Była kilkakrotnie nieskutecznie leczona antybiotykami oraz odbyła leczenie przeciwgruźlicze, które również nie przyniosło poprawy. Rozmiar nacieku nie ulegał zasadniczym zmianom w ciągu całego okresu obserwacji a stan pacjentki nie ulegał pogorszeniu. Przezoskrzelowa biopsja płuca wykonana przy przyjęciu wykazała odmianę śluzową raka oskrzelikowo-pęcherzykowego. Opisano dotychczas zaledwie pojedyncze przypadki raka oskrzelikowo-pęcherzykowego przebiegającego w postaci nieustępujących w tak długim okresie rozległych nacieków w płucach.Słowa kluczowe: rak oskrzelikowo-pęcherzykowy, rak płuca, postać śluzowa, nieustępujący naciek Pneumonol Alergol Pol 2015; 83: 208-211

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Section: Discussionsupporting

confidence: 77%

“…Occasionally, the consolidation in BAC may remain unchanged for months [9]. Fluctuant extent of consolidation too has been documented [10].…”

Section: Introductionmentioning

confidence: 99%

Bronchioloalveolar Cell Carcinoma Presenting as a “Non-Resolving Consolidation” for Two Years

Mir

Sareen

Kulshreshtha

et al. 2015

Advances in Respiratory Medicine

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“…There has been one case report which has described the same phenomenon, although the authors used the term "fluctuating extent" instead of SRA. 4 However, to the best of our knowledge, our study is the first to systematically investigate this phenomenon in IMAs. By correlating the CT images with histopathological analysis of pneumonic-type IMAs in the SRA group, we can substantiate this hypotheses.…”

Section: Discussionmentioning

confidence: 91%

Invasive mucinous adenocarcinoma of the lung: Serial CT findings, clinical features, and treatment and survival outcomes

et al. 2020

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Background: Invasive mucinous adenocarcinoma (IMA) of the lung is a rare and distinct subtype of adenocarcinoma that can appear as airspace opacities on computed tomography (CT). In daily practice, we have occasionally encountered spontaneous regression of airspace opacities (SRAs) without treatment on serial CTs in patients with IMAs, which has not previously been described in the literature. Here, we describe serial CT findings with emphasis on SRAs in relation to clinicopathological features and treatment outcomes in patients with IMAs. Methods: A total of 46 patients with pathologically-confirmed IMAs of the lung from January 2013 to June 2018 were included. Serial CT scans were reviewed and the patients were classified into SRA and no-SRA groups according to the presence of SRA. Radiological features, clinicopathological characteristics, and treatment outcomes were compared between the SRA and no-SRA groups. Results: A total of 32 patients were included in the no-SRA group and 14 patients in the SRA group. IMAs in the SRA group were mostly pneumonic (P < 0.001), larger (P < 0.001), multifocal (P = 0.001), and showed higher stage (P < 0.001) on initial CT. Of seven patients who died during follow-up, six were from the SRA group (P < 0.001). Mean overall survival for all IMAs was 86.6 months (range, 0-110 months), and the SRA group showed significantly worse overall survival (P < 0.001). Conclusions: IMAs of the lung showing SRAs on serial CTs are larger and multifocal, and tend to be pneumonic in type on initial CT. Patients present at a higher stage of disease, with higher mortality rate and reduced overall survival.

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“…Because of substantially overlapping clinical characteristics, including symptoms such as cough and sputum, differentiation of invasive mucinous adenocarcinoma and pneumonia is not always easy [2–4]. When invasive mucinous adenocarcinoma presents as multifocal lesions, it can mimic pneumonia, and delayed diagnosis with progression could result after treatment with antibiotics.…”

Section: Discussionmentioning

confidence: 99%

“…This entity differs from the mucinous type of adenocarcinoma in situ or minimally invasive adenocarcinoma by having a focus of invasion >5-mm and size >3-cm [1]. Because of the bronchogenic dissemination and air space spread of the invasive mucinous adenocarcinoma, it is not easily differentiated radiologically from pneumonia [2–4]. Even in terms of clinical characteristics, the substantially overlapping conditions are always challenging for clinicians and radiologists.…”

Section: Introductionmentioning

confidence: 99%

Computerized margin and texture analyses for differentiating bacterial pneumonia and invasive mucinous adenocarcinoma presenting as consolidation

Koo

Sung

et al. 2017

PLoS ONE

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Radiologists have used margin characteristics based on routine visual analysis; however, the attenuation changes at the margin of the lesion on CT images have not been quantitatively assessed. We established a CT-based margin analysis method by comparing a target lesion with normal lung attenuation, drawing a slope to represent the attenuation changes. This approach was applied to patients with invasive mucinous adenocarcinoma (n = 40) or bacterial pneumonia (n = 30). Correlations among multiple regions of interest (ROIs) were obtained using intraclass correlation coefficient (ICC) values. CT visual assessment, margin and texture parameters were compared for differentiating the two disease entities. The attenuation and margin parameters in multiple ROIs showed excellent ICC values. Attenuation slopes obtained at the margins revealed a difference between invasive mucinous adenocarcinoma and pneumonia (P<0.001), and mucinous adenocarcinoma produced a sharply declining attenuation slope. On multivariable logistic regression analysis, pneumonia had an ill-defined margin (odds ratio (OR), 4.84; 95% confidence interval (CI), 1.26–18.52; P = 0.02), ground-glass opacity (OR, 8.55; 95% CI, 2.09–34.95; P = 0.003), and gradually declining attenuation at the margin (OR, 12.63; 95% CI, 2.77–57.51, P = 0.001). CT-based margin analysis method has a potential to act as an imaging parameter for differentiating invasive mucinous adenocarcinoma and bacterial pneumonia.

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Bronchioloalveolar Carcinoma With Fluctuating Extent of Consolidation on Chest Radiography

Cited by 8 publications

References 13 publications

Bronchioloalveolar Cell Carcinoma Presenting as a “Non-Resolving Consolidation” for Two Years

Bronchioloalveolar Cell Carcinoma Presenting as a “Non-Resolving Consolidation” for Two Years

Invasive mucinous adenocarcinoma of the lung: Serial CT findings, clinical features, and treatment and survival outcomes

Computerized margin and texture analyses for differentiating bacterial pneumonia and invasive mucinous adenocarcinoma presenting as consolidation

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