Bronchioloalveolar carcinoma of the lung

Bronchioloalveolar carcinoma is a histologically distinct form of pulmonary adenocarcinoma representing an estimated 2–10 % of all primary lung cancers. Its varied appearances include focal masses, nodular patterns, and pneumonic and diffuse forms so that bronchioloalveolar carcinoma should be considered in the differential diagnosis of solitary or multiple pulmonary nodules and acute or chronic alveolar diseases. In this article we describe the different radiographic manifestations of bronchioloalveolar carcinoma with particular emphasis on CT findings and those signs that may help in identifying the lesion as bronchioloalveolar carcinoma. Received 15 September 1997; Revision received 17 November 1997; Accepted 17 November 1997     

CT differentiation of solitary from diffuse bronchioloalveolar carcinoma

The therapy and prognosis of bronchioloalveolar carcinoma vary greatly with the solitary versus the diffuse form of the disease. Solitary disease demonstrates a high resectability rate with good long term prognosis. This contrasts with the rapidly fatal course associated with the diffuse form. To date, categorization of patients into either the solitary or the diffuse form has been based solely on conventional radiography. Multiple authors have reported cases of disease not demonstrated radiographically but discovered at surgery or autopsy. With the superiority of chest computed tomography (CT) for demonstrating parenchymal abnormalities, we propose that preoperative CT may be crucial in the workup of patients with presumed solitary bronchioloalveolar cell carcinoma. Early identification of diffuse disease or confirmation of the presence of solitary disease by CT may allow the institution of proper therapy and better evaluation of patient prognosis.     

Lobar bronchioloalveolar cell carcinoma

Bronchioloalveolar cell carcinoma has a variety of radiographic appearances. Usually it is a localized, well circumscribed nodule in the lung periphery. Nodules of various sizes that appear to coalesce in one or both lungs characterize a diffuse pattern of this disease. Occasionally, chronic lobar consolidation simulating a bacterial pneumonia may be seen. The clinical and radiographic course of eight patients whose bronchioloalveolar cell carcinoma appeared initially as lobar consolidation was analyzed. Four tumors rapidly progressed to involved the opposite lung. Attempts should be made by radiographic and other means to establish inoperability, since surgery is rarely useful in this type of lung cancer.     

High-resolution CT findings of diffuse bronchioloalveolar carcinoma in 38 patients

OBJECTIVE: The purpose of this study was to analyze the high-resolution CT features of diffuse bronchioloalveolar carcinoma and determine the useful findings in differential diagnosis. MATERIALS AND METHODS: High-resolution CT scans of 38 patients with pathologically proven diffuse bronchioloalveolar carcinoma were reviewed. Sequential CT scans were obtained in 15 patients. The high-resolution CT findings were compared with those of eosinophilic pneumonia (n = 22), multiple pulmonary metastases (n = 12), and tuberculosis (bronchogenic: n = 22; miliary: n = 12). RESULTS: High-resolution CT findings of diffuse bronchioloalveolar carcinoma included ground-glass opacity (n = 29), consolidation (n = 29), nodules (n = 28), centrilobular nodules (n = 26), peripheral distribution (n = 19), and air bronchogram (n = 18). According to the major features, high-resolution CT findings of diffuse bronchioloalveolar carcinoma could be classified into three patterns: predominantly ground-glass (n = 4), consolidative (n = 22), and multinodular (n = 12). Most patients with diffuse bronchioloalveolar carcinoma had a mixture of these findings. The frequency of findings of diffuse bronchioloalveolar carcinoma on high-resolution CT was not different from that of tuberculosis, but the predominant distribution of the nodules and areas of ground-glass attenuation differed between the two. Difference in distribution between bronchioloalveolar carcinoma and bronchogenic tuberculosis included ground-glass opacity remote from the consolidation and a lower lung predominance. CONCLUSION: Although these high-resolution CT findings are not specific, the combination of consolidation and nodules and the coexistence of centrilobular nodules and remote areas of ground-glass attenuation are characteristic of diffuse bronchioloalveolar carcinoma.     

青年细支气管肺泡癌X线平片及CT表现分析

目的:研究青年细支气管肺泡癌的胸片与CT表现特征性和病理学发生基础及临床特点,提高对该病诊断认识水平。方法:回顾性对比分析24例。经纤支镜,穿刺活检,手术病理证实的细支气管肺泡癌的胸片及CT表现以及转移灶的特征表现,探讨各型病变的影像学特征。结果:根据大体病理及相对影像上病变形态和分布特点,可将细支气管肺泡癌分为孤立结节型5例占21%,多发结节型11例占46%,弥漫型8例占33%。其中孤立结节型相对特异型征象较多,如分叶征,支气管充气征,胸膜凹陷征;多发结节型;胸片表现为两肺中下叶棉球样征象,但CT显示为两肺弥漫多发结节状,碎路石征象,常伴有胸膜牵拉等征象;弥漫粟粒型:两肺中下叶呈粟粒样改变,部分病例有融合,实变现象,临床上易误诊为粟粒型肺结核,转移瘤或肺炎等疾病。另外,细支气管肺泡癌骨骼转移灶呈浸润性破坏,分布较广,以肋骨和锁骨侵犯为多见。结论:细支气管肺泡癌的影像表现复杂多样,对各型的征象表现进行深入细致地分析,结合临床特点,可提高对本病的诊断符合率。     

Bronchioloalveolar carcinoma: a review

The radiographs of 136 patients with bronchioloalveolar carcinoma were reviewed. The varied radiographic manifestations were a result of the characteristic peripheral location of the tumor, its tendency to infiltrate the local airways with mucus production and desmoplasia, and its variable aggressiveness resulting in a wide variation in rate of intrathoracic and extrathoracic spread. In the absence of surgical intervention, a localized lesion progressed to diffuse disease in every patient. The findings supported the concept of bronchioloalveolar carcinoma as a distinct clinical entity.     

细支气管肺泡癌的CT与病理对照研究

探讨细支气管肺泡癌的ＣＴ表现的病理基础。材料与方法：对７３例ＢＡＣ进行回顾分析。所有病例均经手术或活检得到组织病学证实。记录病灶边缘及内部特点,与病理切片对照。结论认识ＢＡＣ的Ｃ表现和病理基础,有助于提高诊断水平。     

Synchronous Bronchioloalveolar and Squamous Cell Lung Cancer With Different 18F-FDG Avidity on PET/CT

ABSTRACT: We report a case of synchronous multiple primary lung cancer diagnosed by F-FDG PET/CT. A 78-year-old man underwent staging FDG PET/CT that demonstrated intense tracer uptake in the primary, and a second lesion with low uptake. Histopathologic evaluation revealed synchronous squamous cell and bronchioloalveolar carcinoma, representing 2 distinct primaries. FDG PET/CT may identify and diagnose synchronous multiple primary lung cancer on the basis of different morphologic and metabolic features of distinct tumor entities. Moreover, pulmonary lesions with low FDG avidity may still represent malignant disease, even in the context of biopsy-proven FDG-avid lung cancer.     

细支气管肺泡癌的CT表现

目的：回顾性分析细支气管肺泡癌（ＢＡＣ）的ＣＴ表现：方法：４２例经病理证实的ＢＡＣ,根据ＣＴ表现分为结节型,实变型和多结节型,分别为２３,１６和３例;结合献资料分析各型肺泡癌的ＣＴ征角。结果;结节型ＢＡＣ主要表现为：肺外周（９５．７％）,分叶（６９．６％）,空泡征或细支气管气象（６５．２％）,密度不均（６５．２％）,胸膜牵引（６０．９％）和毛玻璃影（５２．２％）;     

肺外恶性肿瘤的部位和病理类型与其肺内孤立性病灶性质的相关性研究

目的　探讨不同部位的肺外恶性肿瘤与其肺内孤立性病灶(ETM SPL)为转移、原发性支气管肺癌和良性病灶的相关性。 资料与方法　搜集经证实的ETM SPL 103例,回顾性分析不同部位的肺外原发肿瘤病理类型与肺内孤立性病灶性质,结合肺内病灶的CT形态学特征等多因素统计学分析,评价其与肺内病灶性质的相关性和诊断意义。 结果　103例中原发性支气管肺癌48例,孤立性转移瘤48例,良性病灶7例。除2例炎性肉芽肿经临床证实外,其余均经病理证实。14例头颈部肿瘤中肺部孤立性病灶8例为原发性支气管肺癌,4例为转移癌,2例为肺结核。14例乳腺癌中,肺内病灶11例为原发性支气管肺癌,2例为转移癌,炎性肉芽肿1例。食管癌6例,其肺内病灶5例为原发性支气管肺癌,1例为良性病灶。贲门、胃和十二指肠癌17例,肺内病灶12例为原发性肺癌,5例为转移性癌。18例大肠癌中,肺内病灶13例为转移癌,4例为原发性肺癌,1例为炎性肉芽肿。8例肾细胞癌中 7例肺内病灶为转移,1例为右上肺泡细胞癌。肝细胞癌(5例)、胆总管高分化腺癌(1例)和胰头癌(1例),除1例肝左叶原发性肝腺癌患者,其右上肺为原发性鳞状细胞癌外,其余均属转移癌。4 例骨肉瘤和 1 例左大腿横纹肌肉瘤,除1例为错构瘤外,其余均为肺内孤立性转移瘤。6例淋巴瘤者,4例肺内孤立结节为淋巴瘤     

弥漫型肺泡癌的高分辨CT特征分析

目的 :回顾性分析弥漫型肺泡癌的高分辨CT(HRCT)表现特征。方法 :总结 12例经临床和病理证实的弥漫型肺泡癌HRCT表现。结果 :12例弥漫型肺泡癌可见磨玻璃影者 11例 ,实变 9例 ,多发结节 7例 ,“碎石路样”表现者 2例 ,其中 11例为混合表现。 6例有支气管气像 ,9例病变呈均匀或不均匀低密度 ,2例出现“血管造影征” ,2例伴少量胸腔积液 ,1例纵隔淋巴结肿大。结论 :弥漫型肺泡癌的HRCT表现多种多样 ,最常见的表现是多发结节、实变和磨玻璃影的混合影。HRCT片上出现实变和结节共存、伴磨玻璃影的小叶中心结节和远离实变的磨玻璃影时 ,则强烈提示弥漫型肺泡癌。     

多层CT对肺孤立性病灶支气管改变的评价

目的:探讨肺孤立性病灶支气管改变的MSCT表现及其诊断价值.方法:回顾性分析27例经病理或随访证实的肺孤立性病灶支气管改变的CT表现.结果:CT显示支气管截断征14例(51.9%),其中周围型腺癌8例,鳞癌1例,腺鳞癌1例,恶性淋巴瘤1例,转移性恶性黑色素瘤1例,结核和炎性肉芽肿各1例;含气支气管征16例(59.3%),其中以腺癌最多见(10例);支气管在病灶边缘走行4例(14.8%),其中腺癌2例,肺泡癌1例,炎性肉芽肿1例;支气管受病灶牵拉移向病灶3例(11.1%),包括鳞癌1例,腺鳞癌1例,结核1例.结论:MSCT能够很好地评价肺孤立性病灶的支气管改变,对肺癌的诊断和鉴别诊断有重要的临床价值.     

Solitary bronchioloalveolar carcinoma: CT criteria

The computed tomographic (CT) scans of 30 patients with solitary bronchioloalveolar carcinoma were reviewed. Common features at CT included the peripheral or subpleural location of a pulmonary mass (25 cases), pseudocavitation (18 cases), heterogeneous attenuation (17 cases), irregular margins forming a star pattern (22 cases), and pleural tags (21 cases). Using these CT criteria, four independent observers attempted to identify cases of bronchioloalveolar carcinoma from a larger sample of lung cancers and benign lesions by categorizing a series of test cases into four probability categories. Although the bronchioloalveolar carcinomas were correctly ranked in the two highest probability categories 75% of the time (in 45 of 60 cases), there was considerable overlap with other lung lesions, particularly with adenocarcinoma and large cell undifferentiated carcinoma. However, even though the typical features of bronchioloalveolar carcinoma are not invariable or highly specific, they are characteristic enough to suggest the diagnosis.     

细支气管肺泡癌的CT表现

目的:探讨细支气管肺泡癌的CT表现特点。方法:收集经手术或肺穿刺活检病理证实的细支气管肺泡癌25例,男性15,女性10例,年龄从39～74岁,平均55岁。均行螺旋CT检查,其中HRCT检查7例,增强扫描15例,根据临床、CT表现进行分析。结果:孤立结节型14例,结节中心距胸膜均小于3.1cm,病灶直径为1.4～3.5cm,CT表现有边缘光滑2例,呈分叶征6例,短毛刺征5例,胸膜凹陷征11例,含气支气管征6例,空泡征12例;炎症型或实变型5例,病变呈多个肺段或肺叶的炎症样实变,见支气管气相4例,以及蜂房状含气腔3例;弥漫结节型6例,弥漫分布粟粒状与结节状致密影,大小不等,分布不均。结论:细支气管肺泡癌影像表现复杂,需结合临床及多种影像检查结果,认真细致地综合分析,才能提高本病的诊断符合率。     

CT and radiographic assessment of tube thoracostomy

The problem of multiple primary bronchogenic carcinomas in a single patient is not well known to radiologists. Six patients who exemplified the clinical, radiographic, and pathologic difficulties in diagnosis are reported. The most frequent pathologic associations are squamous carcinoma and squamous carcinoma, squamous carcinoma and small-cell carcinoma, and squamous carcinoma and adenocarcinoma. The previously undescribed association of small-cell carcinoma and bronchioloalveolar cell carcinoma was present in one of six patients. While many patients have a synchronous presentation, the tumors are metachronous in 66%. Since the incidence of second primary carcinoma increases with time, close long-term monitoring is recommended.     

FDG-PET imaging in lung cancer: how sensitive is it for bronchioloalveolar carcinoma?

While characterization of lung lesions and staging of lung cancer with fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is an established clinical procedure, a lower diagnostic accuracy of FDG-PET for diagnosis and staging of so-called bronchioloalveolar carcinoma (BAC) has been reported. Therefore, the accuracy of PET for diagnosing and staging of BAC was investigated. We studied 41 patients eventually found to have adenocarcinoma with a bronchioloalveolar growth pattern who were referred for characterization or staging of lung lesions with whole-body FDG-PET between January 1998 and March 2001: there were 11 males (27%) and 30 females (73%), with a mean age of 66.0+/-10.9 (range =44-84 years). Patients were imaged using ECAT EXACT or HR+ systems. All patients had non-attenuation-corrected scans, while transmission data for attenuation correction were also available for 12 patients (29%). PET correctly identified BAC in 41 of the 46 (89%) lesions and 39 of the 41 patients (95%). By pathology, 25 patients (61%) were found to have unifocal or nodular lesions; this pattern was correctly identified by PET in 20 patients (80%) and by CT in 18 (72%). PET correctly identified 7 (44%) of 16 patients (39%) who had multicentric or diffuse BAC, and CT identified 11 (69%). Of the 35 patients whose lymph node status was verified pathologically, PET was correct in 27 (77%) and CT in 24 (69%). PET missed 67% of the rare tumors that had a pure BAC pattern with no invasive component. It is concluded that the diagnostic performance of whole-body FDG-PET is similar in most patients with lesions with a BAC pattern and in other non-small cell lung cancer types. PET is less accurate in patients with rare BAC tumors that have no invasive component.     

细支气管肺泡癌的影像学分型及动态变化

目的　探讨细支气管肺泡癌 (BAC)的影像学分型及其动态变化规律。方法　收集经病理手术证实的BAC共 3 2例 ,依首诊胸片、CT的形态分为单发结节 ;单发肺段、肺叶实变 ;多发肺段、叶实变 ;多发弥漫结节 ;同时记录肺内播散情况 ,然后观察随访胸片及CT图像病变的发展过程及形态变化 ,分析各型病变的变化规律。结果　单发结节逐渐增大 ,边缘变模糊 ,形成片状阴影 ;单发肺叶、段实变范围渐增大 ,最后肺叶完全实变 ,最终单发病变发生两肺点状或斑片状播散形成多发病变 ;多发肺叶、段实变病变由肺叶、段外围向中心发展 ,同时出现两肺肺炎样浸润播散 ;多发弥漫结节则呈现病灶由小到大逐渐融合的发展规律。结论　BAC各型存在着一定的发展规律 ,最终发展为原发病灶与各种途径播散灶并存     

Bronchiolo-alveolar carcinoma. Radiological and clinical diagnostic considerations

The authors present 42 cases of histologically confirmed bronchioloalveolar carcinoma. The purpose of the study is to investigate the possibility to improve bronchioloalveolar carcinoma diagnosis by radiological-clinical correlations. Results indicate the importance of clinical findings especially in the diffuse multinodular variety.     

The solitary alveolar cell carcinoma

Alveolar-cell carcinoma was first described by Malassez in 1876. It contributes 5 per cent to all malignant tumors of the lung. In a retrospective study 75 patients with alveolar-cell carcinoma were analyzed. Clinical symptoms are non-specific and the tumor will often be discovered on the occasion of a routine chest X-ray as a small peripheral and infiltrative lesion. The most frequent form is a nodule which generally shows a regular and well defined outline, but may sometimes be irregular and have spiky margins too. Very often an air bronchogram and the tail sign can be seen so the combination seems typical of solitary alveolar-cell carcinoma. In the case material investigated the authors found it in 36 per cent. The early stage of localized alveolar-cell carcinoma has a good prognosis when treated by surgery. Multilocular and advanced cases, however, have a very poor prognosis. Therefore, early radiological diagnosis is most important. The value of needle aspiration biopsy in the diagnosis of alveolar-cell carcinoma is emphasized.     

脉络膜转移癌的MRI诊断(附4例报告)

目的　探讨脉络膜转移癌的临床与MRI特点。方法　对经病理证实的 4例脉络膜转移癌患者的临床和MRI表现进行回顾性分析。结果　 4例脉络膜转移癌的原发灶均为肺癌 ,MRI表现为眼环广泛性或局限性增厚 ,呈等T1 、等或高T2 信号 ,1例合并肿物向眼球内突入。结论　脉络膜转移癌的MRI表现具有一定特征性 ,MRI是诊断脉络膜转移癌的有效方法