CT Characteristics and Pathologic Basis of Solitary Cystic Lung Cancer

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.

Computed Tomography Morphological Classification of Lung Adenocarcinoma and Its Correlation with Epidermal Growth Factor Receptor Mutation Status: A Report of 1075 Cases

“…The mechanism underlying the formation is unclear, although the check-valve mechanism, wherein the tumor originates from the alveolar wall and produces abundant fibrous tissue, causing focal stenosis of the airway and formation of a unidirectional check-valve, has been proposed. 14,15 Tan et al reported morphological features that are indicative of cystic lung cancer including nonuniform cyst walls, septation within the cyst, wall nodules, GGO around the cyst, and irregular margins, which were in agreement with our study. 15 Clinicians should be aware that LADC can present with such signs initially, and lesions can enlarge over time with wall thickening and an increase in solid components.…”

Pulmonary mucosa‐associated lymphoid tissue lymphoma: CT findings and pathological basis

“…The formation of a cyst might be a check valve mechanism. The lymphoid infiltration derives from MALT that beneath areas of mucous layer epithelium, leading to airway stenosis of the corresponding lung tissue 21 …”

Management of screen-detected lung nodules: A Canadian partnership against cancer guidance document

“…Cystic lesions with asymmetric thickening of the wall of an air cyst or a cyst with a nodular exophytic or endophytic component has been added as a fourth nodule type as they are associated with a higher malignancy risk than simple air cysts. [28][29][30][31] For nodules <10 mm, reporting the average maximal long-axis and perpendicular maximal short-axis diameter in the same axial plane is recommended. For larger nodules and masses, reporting both long-and short-axis diameter is recommended.…”