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Evolution of Peripheral Lung Adenocarcinomas

CT Findings Correlated with Histology and Tumor Doubling Time

¹ Department of Radiology, University of Occupational and Environmental Health School of Medicine, Yahatanishi-ku, Kitakyushu-shi, 807-8555 Japan.
² Department of Pathology and Oncology, University of Occupational and Environmental Health School of Medicine, Kitakyushu-shi, 807-8555 Japan.
³ Department of 2nd Surgery, University of Occupational and Environmental Health School of Medicine, Kitakyushu-shi, 807-8555 Japan.
⁴ Department of Respiratory Disease, University of Occupational and Environmental Health School of Medicine, Kitakyushu-shi, 807-8555 Japan.

View larger version (85K): [in a new window]   Fig. 1A. —Type A adenocarcinoma in 53-year-old man (tumor doubling time, 662 days). High-resolution CT scan shows 12 x 12 mm area completely occupied by ground-glass opacity.

View larger version (113K): [in a new window]   Fig. 2A. —Type B adenocarcinoma in 74-year-old woman (tumor doubling time, 695 days). High-resolution CT scan shows 18 x 24 mm area with marked ground-glass opacity containing focal area of increased attenuation. Single pleural tag and air bronchogram are also present.

View larger version (96K): [in a new window]   Fig. 3A. —Type C adenocarcinoma in 72-year-old woman (tumor doubling time, 249 days). High-resolution CT scan shows 20 x 28 mm nodule with ground-glass opacity only at periphery. Three pleural tags and air bronchogram are visible.

View larger version (125K): [in a new window]   Fig. 4A. —Type D adenocarcinoma in 67-year-old woman (tumor doubling time, 245 days). High-resolution CT scan shows 20 x 24 mm nodule with mostly solid attenuation and well-defined margin.

View larger version (178K): [in a new window]   Fig. 1B. —Type A adenocarcinoma in 53-year-old man (tumor doubling time, 662 days). Photomicrograph of histologic specimen reveals localized bronchioloalveolar carcinoma growing by replacement of alveolar lining cells. Note minimal thickening of alveolar septa.

View larger version (198K): [in a new window]   Fig. 2B. —Type B adenocarcinoma in 74-year-old woman (tumor doubling time, 695 days). Photomicrograph of histologic specimen reveals replacement growth pattern with fibrotic foci as result of collapse of alveolar structure in center.

View larger version (201K): [in a new window]   Fig. 3B. —Type C adenocarcinoma in 72-year-old woman (tumor doubling time, 249 days). Photomicrograph of histologic specimen shows replacement growth pattern at periphery with cellular growth pattern in central zone.

View larger version (179K): [in a new window]   Fig. 4B. —Type D adenocarcinoma in 67-year-old woman (tumor doubling time, 245 days). Photomicrograph of histologic specimen reveals solid growth and distinct boundary between tumor and nontumorous parenchyma.

View larger version (12K): [in a new window]   Fig. 5. —Graph shows tumor doubling times according to tumor type. Difference in tumor doubling time between group of types A and B and group of types D, E, and F was significant (p < 0.01). Those of type C varied widely, ranging from 42 to 1346 days.

View larger version (95K): [in a new window]   Fig. 6A. —Type B adenocarcinoma in 74-year-old man (tumor doubling time, 750 days). Initial CT scan shows localized 22 x 22 mm ground-glass opacity in left lower lobe of lung.

View larger version (114K): [in a new window]   Fig. 6B. —Type B adenocarcinoma in 74-year-old man (tumor doubling time, 750 days). CT scan obtained 349 days after initial CT scan shows increase in size (to 23 x 26 mm) and development of vascular convergence. Attenuation at center of tumor is slightly increased.

View larger version (106K): [in a new window]   Fig. 7A. —Type C adenocarcinoma in 64-year-old man (tumor doubling time, 447 days). Initial CT scan shows tiny solid nodule (arrow) with minimal adjacent ground-glass opacity (15 x 10 mm) in right middle lobe.

View larger version (111K): [in a new window]   Fig. 7B. —Type C adenocarcinoma in 64-year-old man (tumor doubling time, 447 days). CT scan obtained 1137 days after initial CT scan shows increase in size (25 x 20 mm) and vascular convergence. Area of solid attenuation is also increased.

View larger version (91K): [in a new window]   Fig. 8A. —Type F adenocarcinoma in 75-year-old woman (tumor doubling time, 124 days). Initial CT scan shows 4 x 5 mm solid nodule in lingula.

View larger version (102K): [in a new window]   Fig. 8B. —Type F adenocarcinoma in 75-year-old woman (tumor doubling time, 124 days). CT scan obtained 374 days after initial CT scan shows that nodule is larger (13 x 9 mm) and still solid. Pleural tag and vascular convergence also developed.

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