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Byrne SC, Hunsaker AR, Hammer MM. Risk of Malignancy in Cystic Lung Lesions in a Lung Cancer CT Screening Program. Radiology 2025; 315:e243166. [PMID: 40392085 DOI: 10.1148/radiol.243166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2025]
Abstract
Background There is currently a lack of consensus regarding the risk of malignancy and the natural history of cystic lung lesions. Purpose To evaluate imaging characteristics associated with the risk of malignancy of cystic lung lesions in a lung cancer screening program. Materials and Methods This retrospective study included all CT lung cancer screening examinations performed from January 2015 to July 2023 in a large health care network. Radiology reports were queried for cystic lesions. Baseline CT images were reviewed, and lesion morphologic characteristics and size were recorded. All follow-up CT scans were evaluated for changes in the lesion. The risk of growth and diagnosis of cancer over time were analyzed with Kaplan-Meier curves. Results Among 15 762 patients, 235 were found to have cystic lung lesions; 33 (14%) of these patients were diagnosed with lung cancer arising from the cystic lesion. Increased risk of cancer was associated with nodular wall thickening (odds ratio [OR], 11; P = .002) and presence of a solid nodule (OR, 5.3; P < .001) alone or in combination with a ground-glass component (OR, 24; P < .001). Multilocularity was not associated with an increased risk of cancer (OR, 1.7; P > .2). There were no cases of malignancy in unilocular cystic lesions without wall thickening (n = 46). Lesion growth or increase in complexity over time was associated with an increased risk of malignancy (P < .001). The median time to lesion growth was 636 days. The median time to cancer diagnosis was 482 days, and 28 (85%) of the cancers were stage 0 or I. Conclusion Cystic lung lesions with nodular wall thickening had an increased risk of malignancy. Conversely, unilocular lesions without wall thickening had essentially no risk of malignancy. Most malignant cystic lung lesions exhibited indolent behavior, with slow growth and diagnosis at early stages. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Zagurovskaya in this issue.
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Affiliation(s)
- Suzanne C Byrne
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
- Harvard Medical School, Boston, Mass
| | - Andetta R Hunsaker
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
- Harvard Medical School, Boston, Mass
| | - Mark M Hammer
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
- Harvard Medical School, Boston, Mass
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Xu X, Zhang M, Guo J, Chen W, Dong Z, Song Q, Cai T, Sun L. The impact of cystic lesions on the postoperative prognosis of non-small cell lung cancer: a comparative study. Clin Radiol 2024; 79:842-850. [PMID: 39237391 DOI: 10.1016/j.crad.2024.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 08/07/2024] [Accepted: 08/08/2024] [Indexed: 09/07/2024]
Abstract
AIM Due to the rarity of lung cancer with cystic imaging manifestations, we explore the clinical features and survival prognosis of such tumors. MATERIALS AND METHODS Imaging characteristics were used to categorize 3,556 patients who underwent surgery for isolated primary lung cancer into one of three groups: those with cystic lung cancer (149), solid lung cancer (1,399), and ground-glass lung cancer (1,160). Propensity score matching by sex and age was performed to analyze the differences in clinical characteristics of lung cancer among the three groups and the correlation between clinical characteristics of cystic lesions and progression-free survival (PFS). RESULTS The three groups of patients differed in various aspects, including pathological type, smoking history, tumor stage, type of surgery, histological grading, and PFS (P < 0.05). The results of the multifactorial analysis indicated that lung cancer type, pathological type, lymph node metastasis, tumor stage, and histologic grading were independent prognostic factors for lung cancer (P < 0.05). After comparison, there was a difference in prognosis between cystic lung cancer and ground-glass lung cancer (P < 0.05). CONCLUSION The clinical features of cystic lung cancer are significantly different from those of ground-glass lung cancer and solid lung cancer. Cystic lesions are independent influencing factors affecting lung cancer, and the prognosis of cystic lung cancer is worse than that of ground-glass lung cancer.
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Affiliation(s)
- X Xu
- Department of Pulmonary and Critical Care Medicine, The 1(st) Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, PR China.
| | - M Zhang
- Department of Pulmonary and Critical Care Medicine, The 1(st) Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, PR China.
| | - J Guo
- School of Public Health, Jiangxi Medical College, Nanchang University, PR China; Jiangxi Provincial Key Laboratory of Preventive Medicine, Jiangxi Medical College, Nanchang University, Nanchang 330006, PR China.
| | - W Chen
- Department of Pulmonary and Critical Care Medicine, The 1(st) Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, PR China; Jiangxi Institute of Respiratory Disease, The 1(st) Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, PR China; Jiangxi Hospital of China-Japan Friendship Hospital, Nanchang, Jiangxi, 330006, PR China.
| | - Z Dong
- Department of Pulmonary and Critical Care Medicine, The 1(st) Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, PR China.
| | - Q Song
- Department of Pulmonary and Critical Care Medicine, The 1(st) Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, PR China.
| | - T Cai
- Department of Information, The 1(st) Affiliated Hospital of Nanchang University, Jiangxi 330006 Nanchang, PR China.
| | - L Sun
- Department of Pulmonary and Critical Care Medicine, The 1(st) Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, PR China; Jiangxi Hospital of China-Japan Friendship Hospital, Nanchang, Jiangxi, 330006, PR China; Jiangxi Clinical Research Center for Respiratory Diseases, Nanchang, Jiangxi, 330006, PR China.
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Lee J, Park E. Overdiagnosing giant bullous emphysema as metastatic adenocarcinoma: a case report. J Cardiothorac Surg 2024; 19:564. [PMID: 39354557 PMCID: PMC11443899 DOI: 10.1186/s13019-024-03112-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 09/15/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Giant bullous emphysema is characterized by large bullae occupying at least one-third of the hemithorax and leading to compression of the surrounding lung parenchyma. Overdiagnosis can occur because of the atypical appearance of hyperplastic type II pneumocytes, which may be mistaken for malignant cells. CASE PRESENTATION A 48-year-old male with a history of smoking and occupational exposure presented with dyspnea and drowsiness. Initial chest X-ray revealed a tension pneumothorax, and subsequent chest CT revealed extensive bullous emphysema and lung cancer in the right middle lobe (RML). Pathologic examination initially indicated resected bullae to metastatic adenocarcinoma, but upon review, it was determined that the reactive alveolar cells were misdiagnosed as malignant. CONCLUSIONS This case emphasizes the need for thorough histopathological assessment and prudent interpretation of atypical cellular morphology.
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Affiliation(s)
- Jiyun Lee
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Eunsu Park
- Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Iwamura M, Nishimori M, Iwasa H, Otani M, Nakaji K, Nitta N, Miyatake K, Yoshimatsu R, Yamanishi T, Matsumoto T, Iguchi M, Okada H, Yamagami T. A case of pulmonary pleomorphic carcinoma associated with cystic airspace. Radiol Case Rep 2023; 18:2692-2696. [PMID: 37273726 PMCID: PMC10238256 DOI: 10.1016/j.radcr.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
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.
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Affiliation(s)
- Mamiko Iwamura
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Miki Nishimori
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hitomi Iwasa
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Michimi Otani
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Kosuke Nakaji
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Noriko Nitta
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Kana Miyatake
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Rika Yoshimatsu
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Tomoaki Yamanishi
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Tomohiro Matsumoto
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Mitsuko Iguchi
- Department of Diagnostic Pathology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, Japan
| | - Hironobu Okada
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, Japan
| | - Takuji Yamagami
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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Shen YY, Jiang J, Zhao J, Song J. Lung squamous cell carcinoma presenting as rare clustered cystic lesions: A case report and review of literature. World J Clin Cases 2022; 10:13006-13014. [PMID: 36569005 PMCID: PMC9782924 DOI: 10.12998/wjcc.v10.i35.13006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related death. Early diagnosis is critical to improving a patient’s chance of survival. However, lung cancer associated with cystic airspaces is often misdiagnosed or underdiagnosed due to the absence of clinical symptoms, poor imaging specificity, and high risk of biopsy-related complications.
CASE SUMMARY We report an unusual case of cancer in a 55-year-old man, in which the lesion evolved from a small solitary thin-walled cyst to lung squamous cell carcinoma (SCC) with metastases in both lungs. The SCC manifested as rare clustered cystic lesions, detected on chest computed tomography. There were air-fluid levels, compartments, and bronchial arteries in the cystic lesions. Additionally, there was no clear extrathoracic metastasis. After chemotherapy, the patient achieved a partial response, type I respiratory failure was relieved, and the lung lesions became a clustered thin-walled cyst.
CONCLUSION Pulmonary cystic lesions require regular imaging follow-up. Lung SCC should be a diagnostic consideration in cases of thin-walled cysts as well as multiple clustered cystic lesions.
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Affiliation(s)
- Yu-Yao Shen
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, Shandong Province, China
| | - Jing Jiang
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, Shandong Province, China
| | - Jing Zhao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jie Song
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, Shandong Province, China
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Xie Y, Zhang D, Zhao H, Lei S, Zhang H, Zhang S. Case Report: Misdiagnosis of Lung Carcinoma in Patients with Shrunken Lung Cyst After High Altitude Travel. Cancer Manag Res 2022; 14:2373-2377. [PMID: 35967751 PMCID: PMC9371466 DOI: 10.2147/cmar.s373068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Yibing Xie
- Department of Graduate School, Hebei North University, Zhangjiakou, People’s Republic of China
- Department of Radiology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Dongmei Zhang
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Huanfen Zhao
- Department of Pathology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Shaoyang Lei
- Department of Radiology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Hua Zhang
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Shuqian Zhang
- Department of Radiology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
- Correspondence: Shuqian Zhang, Department of Radiology, Hebei General Hospital, 348 Heping West Road, Shijiazhuang, 050051, People’s Republic of China, Tel +8615930153668, Email
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7
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Shen Y, Zhang Y, Guo Y, Li W, Huang Y, Wu T, Jiang G, Dai J. Prognosis of lung cancer associated with cystic airspaces: A propensity score matching analysis. Lung Cancer 2021; 159:111-116. [PMID: 34325317 DOI: 10.1016/j.lungcan.2021.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Yingran Shen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Yunfei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Yanhua Guo
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Weitong Li
- Department of Medical Imaging, Shishi Hospital, Fujian 362700, China
| | - Yan Huang
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Tong Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.
| | - Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.
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8
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Honda Y, Oka S, Chikaishi Y, Inoue M, Yoshida J, Yasuda D. Mediastinal lymph node metastases in lung cancer presenting as pure ground-glass nodules: A surgical case report. Int J Surg Case Rep 2020; 70:5-7. [PMID: 32334177 PMCID: PMC7183094 DOI: 10.1016/j.ijscr.2020.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Generally, lung cancer representing as Ground-glass nodules is associated with an early stage and good prognosis. However, we herein report a rare case of pure ground-glass nodules with mediastinal lymph node metastases. PRESENTATION OF CASE A 69-year-old man underwent video assisted thoracic surgery right upper lobectomy with mediastinal lymph node dissection due to multifocal Ground-glass nodules in the right upper lobe of the lung. Histopathologically, six lung adenocarcinomas were present simultaneously. Furthermore, we detected mediastinal lymph nodes metastases that contain micropapillary component. The lung lesion containing micropapillary component was a pure Ground-glass nodule that adjoining pulmonary bulla on CT findings. DISCUSSION Generally, lung cancer presenting as pure ground-glass nodules is associated with an early stage and good prognosis. However, the necessity of evaluating the mediastinal lymph nodes in pure ground-glass nodules is controversial. It is reported that lung cancer adjoining the wall of a bulla tends to have a poor prognosis, even when small in size. Therefore, Ground-glass nodules with metastases might have a different pathogenesis than other nodules. CONCLUSION Adenocarcinoma appearing as pure Ground-glass nodules is associated with early stage lung cancer and a good prognosis. However, the findings in our patient indicate the importance and necessity of evaluating the mediastinal lymph nodes for metastases intraoperatively.
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Affiliation(s)
- Yohei Honda
- Thoracic Surgery, Shimonoseki City Hospital, Shimonoseki, Japan.
| | - Soichi Oka
- Thoracic Surgery, Shimonoseki City Hospital, Shimonoseki, Japan
| | | | - Masaaki Inoue
- Thoracic Surgery, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Junichi Yoshida
- Thoracic Surgery, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Daisei Yasuda
- Pathology, Shimonoseki City Hospital, Shimonoseki, Japan
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Pérez-Accino J, Liuti T, Pecceu E, Cazzini P. Endogenous lipoid pneumonia associated with pulmonary neoplasia in three dogs. J Small Anim Pract 2020; 62:223-228. [PMID: 31943233 DOI: 10.1111/jsap.13101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 10/26/2018] [Accepted: 01/02/2019] [Indexed: 12/17/2022]
Abstract
Endogenous lipoid pneumonia is a poorly characterised condition in veterinary medicine, particularly in dogs, but it is well recognised in association with lung neoplasia in humans. This case series describes three unique cases of endogenous lipoid pneumonia associated with lung neoplasia, including clinical, imaging, cytological findings and outcome. Clinical presentation and imaging lesions can appear non-specific and may be obscured by neoplastic infiltrate and so diagnosis requires cytology or histopathology. Awareness of endogenous lipoid pneumonia in dogs with pulmonary neoplasia has an impact on staging and monitoring, treatment of clinical signs and quality of life and also aids appropriate use of antimicrobials.
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Affiliation(s)
- J Pérez-Accino
- Hospital for Small animals, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Roslin, EH25 9RG, UK
| | - T Liuti
- Hospital for Small animals, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Roslin, EH25 9RG, UK
| | - E Pecceu
- Hospital for Small animals, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Roslin, EH25 9RG, UK
| | - P Cazzini
- Easter Bush Pathology, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Roslin, EH25 9RG, UK
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10
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Lung cancer associated with cystic airspaces: Characteristic morphological features on CT in a series of 11 cases. Clin Imaging 2019; 56:102-107. [DOI: 10.1016/j.clinimag.2019.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 02/10/2019] [Accepted: 02/19/2019] [Indexed: 12/17/2022]
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11
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Snoeckx A, Reyntiens P, Carp L, Spinhoven MJ, El Addouli H, Van Hoyweghen A, Nicolay S, Van Schil PE, Pauwels P, van Meerbeeck JP, Parizel PM. Diagnostic and clinical features of lung cancer associated with cystic airspaces. J Thorac Dis 2019; 11:987-1004. [PMID: 31019789 DOI: 10.21037/jtd.2019.02.91] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
"Lung cancer associated with cystic airspaces" is an uncommon manifestation, in which lung cancer presents on imaging studies with a cystic area with associated consolidation and/or ground glass. With the widespread use of computed tomography (CT), both in clinical practice and for lung cancer screening, these tumors are being more frequently recognized. An association of this entity with smoking has been established with the majority of cases reported being in former and current smokers. The true pathogenesis of the cystic airspace is not yet fully understood. Different causes of this cystic airspace have been described, including a check-valve mechanism obstructing the small airways, lepidic growth of adenocarcinoma on emphysematous lung parenchyma, cyst formation of tumor and tumor growth along the wall of a pre-existing bulla. Adenocarcinoma is the commonest histological type, followed by squamous cell carcinoma. Two classification systems have been described, based on morphological features of the lesion, taking into account both the cystic airspace as well as the morphology of the surrounding consolidation or ground glass. The cystic component may mislead radiologists to a benign etiology and the many different faces on imaging can make early diagnosis challenging. Special attention should be made to focal or diffuse wall thickening and consolidation or ground glass abutting or interspersed with cystic airspaces. Despite their atypical morphology, staging and management currently are still similar to that of other lung cancer types. Although the rarity of this entity will hamper larger studies, numerous aspects regarding this particular lung cancer type still need to be unraveled. This manuscript reviews the CT-imaging findings and gives an overview of available data in the English literature on pathogenesis, histopathology and clinical findings. Differential diagnosis and pitfalls are discussed as well as future directions regarding staging and management.
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Affiliation(s)
- Annemie Snoeckx
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Pieter Reyntiens
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Maarten J Spinhoven
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Haroun El Addouli
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Astrid Van Hoyweghen
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Simon Nicolay
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Patrick Pauwels
- Department of Pathology Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Jan P van Meerbeeck
- Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Paul M Parizel
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
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Higuchi R, Nakagomi T, Shikata D, Yokoyama Y, Oyama T, Goto T. Lingular segmentectomy and left lower lobectomy via unique bronchial dissection. J Thorac Dis 2018; 10:E420-E425. [PMID: 30069396 DOI: 10.21037/jtd.2018.05.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rumi Higuchi
- Department of General Thoracic Surgery, Yamanashi Central Hospital, Yamanashi, Japan
| | - Takahiro Nakagomi
- Department of General Thoracic Surgery, Yamanashi Central Hospital, Yamanashi, Japan
| | - Daichi Shikata
- Department of General Thoracic Surgery, Yamanashi Central Hospital, Yamanashi, Japan
| | - Yujiro Yokoyama
- Department of General Thoracic Surgery, Yamanashi Central Hospital, Yamanashi, Japan
| | - Toshio Oyama
- Department of Pathology, Yamanashi Central Hospital, Yamanashi, Japan
| | - Taichiro Goto
- Department of General Thoracic Surgery, Yamanashi Central Hospital, Yamanashi, Japan
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Snoeckx A, Dendooven A, Carp L, Desbuquoit D, Spinhoven MJ, Lauwers P, Van Schil PE, van Meerbeeck JP, Parizel PM. Wolf in Sheep’s Clothing: Primary Lung Cancer Mimicking Benign Entities. Lung Cancer 2017; 112:109-117. [DOI: 10.1016/j.lungcan.2017.07.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 07/24/2017] [Accepted: 07/31/2017] [Indexed: 12/12/2022]
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Kimura H, Saji H, Miyazawa T, Sakai H, Tsuda M, Wakiyama Y, Marushima H, Kojima K, Nakamura H. Worse survival after curative resection in patients with pathological stage I non-small cell lung cancer adjoining pulmonary cavity formation. J Thorac Dis 2017; 9:3038-3044. [PMID: 29221277 PMCID: PMC5708480 DOI: 10.21037/jtd.2017.08.42] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/27/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND A few investigators have suggested an association between lung cancer and pulmonary cavity. However, this clinical association and its carcinogenic correlations are not well recognized. This study aimed to clarify the clinical features and to demonstrate the associated survival outcomes after curative surgery in patients with early non-small cell lung cancer (NSCLC) adjoining pulmonary cavity formation. METHODS We retrospectively reviewed 275 patients with pathological stage I NSCLC by re-evaluating their chest computed tomography images. Among them, we detected NSCLC adjoining pulmonary cavity formation in 12 (4.4%) patients. RESULTS The median follow-up period for all 275 patients was 43.2 (range, 6.0-86.0) months. Of these patients, 6 (50.0%) in group CF (patients with NSCLC adjoining pulmonary cavity formation) and 19 (7.2%) in group C (the control group, n=263) died during the study period. Besides, 6 (50.0%) and 32 (12.2%) patients in groups CF and C, respectively, exhibited recurrence of the primary lung cancer. The cumulative overall survival (OS) in groups CF and C at 5 years was 37.0% and 91.7%, respectively (P<0.0001); the recurrence-free survival (RFS) in these groups at 5 years was 55.0% and 86.7%, respectively (P=0.001). Univariate analysis showed that male sex, smoking habits, non-adenocarcinoma, and presence of pulmonary cavity formation were associated with poor OS (P=0.008, P=0.001, P<0.0001, and P<0.0001, respectively). Multivariate analysis demonstrated that smoking, non-adenocarcinoma, and pulmonary cavity formation were independent prognostic factors predicting poor survival (P=0.043, P=0.004 and P<0.0001, respectively). CONCLUSIONS Our results suggest that patients with early-stage NSCLC adjoining pulmonary cavity formation have an increased risk of poor OS and RFS after surgical resection. Further prospective, multi-institutional investigations and substantial clinical studies are warranted.
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Affiliation(s)
- Hiroyuki Kimura
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Tomoyuki Miyazawa
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hiroki Sakai
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masataka Tsuda
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yoichi Wakiyama
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hideki Marushima
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Koji Kojima
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Haruhiko Nakamura
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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A combination of preoperative CT findings and postoperative serum CEA levels improves recurrence prediction for stage I lung adenocarcinoma. Eur J Radiol 2015; 84:178-184. [DOI: 10.1016/j.ejrad.2014.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 10/13/2014] [Indexed: 12/17/2022]
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16
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Missed cancers in lung cancer screening--more than meets the eye. Eur Radiol 2014; 25:89-91. [PMID: 25189153 DOI: 10.1007/s00330-014-3395-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 08/11/2014] [Indexed: 12/17/2022]
Abstract
In lung cancer, early detection and diagnosis is of paramount importance. In 2011 the National Lung Screening Trial (NLST) demonstrated the effectiveness of computed tomography (CT) screening for lung cancer in reducing mortality, and results from other ongoing trials are expected to be published in the near future. A topic that has not been widely researched to date, however, is the cause for screening failure and missed lung cancers. In this issue of European Radiology, Scholten et al. describe a number of causes for false-negative screens. Some of the implications for CT screening and nodule management raised by this report are discussed. Key Points • Many causes exist for missed lung cancers in CT screening trials • Endobronchial structures, the hila and mediastinum are blind spots on screening CTs • The management of atypical nodular opacities on thoracic CT may be challenging.
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Scholten ET, Horeweg N, de Koning HJ, Vliegenthart R, Oudkerk M, Mali WPTM, de Jong PA. Computed tomographic characteristics of interval and post screen carcinomas in lung cancer screening. Eur Radiol 2014; 25:81-8. [DOI: 10.1007/s00330-014-3394-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 08/02/2014] [Accepted: 08/11/2014] [Indexed: 12/14/2022]
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Yamazaki M, Ishikawa H, Kunii R, Tasaki A, Sato S, Ikeda Y, Yoshimura N, Aoyama H. Relationship between CT features and high preoperative serum carcinoembryonic antigen levels in early-stage lung adenocarcinoma. Clin Radiol 2014; 69:559-66. [DOI: 10.1016/j.crad.2013.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 12/05/2013] [Accepted: 12/12/2013] [Indexed: 12/17/2022]
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Guo J, Liang C, Sun Y, Zhou N, Liu Y, Chu X. Lung cancer presenting as thin-walled cysts: An analysis of 15 cases and review of literature. Asia Pac J Clin Oncol 2013; 12:e105-12. [PMID: 24354425 DOI: 10.1111/ajco.12126] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM Lung cancer presenting as cysts is a rare entity in clinical practice. Differential diagnosis is difficult in the benign-like cyst. METHODS We conducted a retrospective analysis of the clinical records of 15 patients who underwent surgery for primary lung cancer presenting as cysts (wall thickness <5 mm) in our department between 2007 and 2012. The whole group underwent postoperative follow-up. RESULTS The subjects' age ranged from 18 to 80 years with a median age of 58.3 years. Eight cases presented with respiratory symptoms while seven showed abnormal shadows on a chest computed tomography without symptoms. Histological analysis showed that 10 cases were of adenocarcinoma, two of squamous cell carcinoma and one of large cell carcinoma. Two patients died at 13 and 26 months and the remaining 13 patients are alive and disease free at 3-38 months. CONCLUSION Cystic lung cancer should be considered in the differential diagnosis of focal benign cyst. Cystic lung cancer could achieve a good outcome if early diagnosis can be obtained.
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Affiliation(s)
- Juntang Guo
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, China
| | - Chaoyang Liang
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, China
| | - Yu'e Sun
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, China
| | - Naikang Zhou
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, China
| | - Yang Liu
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, China
| | - Xiangyang Chu
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, China
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Yu Y, Shi M, Chen L, Chen L, Zhao X, Deng Z. [Bullae-associated lung cancer: two case reports and literature review]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2011; 14:763-6. [PMID: 21924047 PMCID: PMC5999614 DOI: 10.3779/j.issn.1009-3419.2011.09.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE Most of lung cancers present with a parenchymal mass. Lung cancers that present as bullae under imaging are unusual. The aim of the current article is to raise awareness regarding bullae-associated lung cancer through two case reports and their corresponding review of literature. METHODS The clinical, auxiliary examination data, and the diagnosis of two patients with bullae-associated lung cancer are presented and the relevant literature are reviewed. RESULTS Most cases of bullae-associated lung cancer are male heavy smokers. Considering the incidence of pulmonary carcinoma associated with bullous disease is high, radiographic findings would aid in the early detection of a malignant lesion. CONCLUSION Bullous lung disease is a risk factor for lung cancer, and male, middle-age patients with bullae who smoke should be followed up by chest computed tomography and further examination. If the bullae may be diagnosed as lung cancer, an exploratory thoracotomy should be performed as early as possible.
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Affiliation(s)
- Yiming Yu
- Department of Respiratory Medicine, Affiliated Hospital of Medical College of Ningbo University, Ningbo 315020, China
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