Faces of Adenocarcinoma of the Lung

Cigarettes and Adenocarcinoma

The Cause and the Effect in one Image
The CT scan through the chest of an 80 year old male shows a large lung mass in the posterior aspect of the right upper lobe (overlaid in green) and3 small nodules in the left upper lobe (overlaid in green). The patient is obviously a smoker and the incriminating pack of cigarettes is identified in his right shirt pocket containing 9 cigarettes. The lung cancer was shown to be an adenocarcinoma The pathology of the nodules may either represent metastatic disease or multicentric foci of bronchioloalveolar cell carcinoma. Associated finding of a thinned anterior junction line suggests hyperinflation and emphysema, and the thickened bronchial walls noted in the right lung suggest chronic bronchitis. Saber shaped trachea is also reminiscent of emphysema. The patient is emaciated, a finding that relates both to his chronic lung disease and his cancer.
Ashley Davidoff MD  87831c01b.8s
TheCommonVein.net

 

Parts
Size

Small
                Adenocarcinoma Near the Fissure
(See Below in “Time”  Section for Growth)
8mm Irregular Nodule LUL
(See Below in “Time”  Section for Growth)


Shape

Classical Lobulated Peripheral Nodule or Mass

Lobulated Peripheral Mass
Axial images of the case shown above through the lung mass in a 51-year-old female who presents with nausea vomiting and abdominal distension and who was shown to have a small bowel obstruction. The mass is situated in the left lower lobe and was an incidental asymptomatic finding.  It measures in the 3cm range, is lobulated and peripherally located.  Pathology showed an adenocarcinoma.
 Courtesy: Ashley Davidoff, M.D.TheCommonVein.net

Spiculated Nodule

Invasive Poorly Differentiated Adenocarcinoma in a 67F
Ashley Davidoff MD TheCommonVein.net
Adenocarcinoma 001 lung


Position

Classical Lobulated Peripheral Nodule or Mass

Lobulated Peripheral Mass
Axial images of the case shown above through the lung mass in a 51-year-old female who presents with nausea vomiting and abdominal distension and who was shown to have a small bowel obstruction. The mass is situated in the left lower lobe and was an incidental asymptomatic finding.  It measures in the 3cm range, is lobulated and peripherally located.  Pathology showed an adenocarcinoma.
 Courtesy: Ashley Davidoff, M.D.TheCommonVein.net

Can Be More Central

Lobulated Poorly Differentiated Adenocarcinoma
Ashley Davidoff MD TheCommonVein.net

MULTICENTRIC

Adenocarcinoma as an Consolidation Focal and Segmental 

Consolidation in Adenocarcinoma with Lepidic Growth
The focal nodules (middle row) and segmental consolidation in the right upper lobe (lower row) in this case  is  caused by total filling of the alveoli with malignant cells. This results in opacification of the alveoli and the “white” density in contrast to the “black” airways, enable the airways to be visualised as air bronchograms                                       
Ashley Davidoff MD TheCommonVein.net 87770c01


Character

 GGO

Ground Glass Nodule
Adenocarcinoma with Lepidic Growth 

Ground Glass Opacity and Adenocarcinoma with Lepidic Growth
The Ground Glass Opacity (GGO) in this case  is  caused by partial filling of the alveolus with malignant cells                                                                                                                                                        Ground glass opacification may be caused by partial filling of the alveolus with cellular material resulting in  partial replacement of air with solid material.  The net density is gray rather than white in the situation where the  alveolus is fully replaced with cells or fluid. There is blending of the black of the subtending airways and  the white of the vessels  with the gray density of the cellular infiltrate and hence the normal vessels are not visualized in ground glass opacities.
Ashley Davidoff MD TheCommonVein.net 134375b01

Papillary Adenocarcinoma with Lymphatic Invasion

Ground Glass Nodule with Small Solid Components

Heterogeneous appearance with retracted airways synchronous with a second lesion that looked the same In this instance it was acinar adenocarcinoma
Ashley Davidoff MD TheCommonVein.net 02 2nd site

Consolidation

Adenocarcinoma as an Consolidation Focal and Segmental 

Consolidation in Adenocarcinoma with Lepidic Growth
The focal nodules (middle row) and segmental consolidation in the right upper lobe (lower row) in this case  is  caused by total filling of the alveoli with malignant cells. This results in opacification of the alveoli and the “white” density in contrast to the “black” airways, enable the airways to be visualised as air bronchograms                                       
Ashley Davidoff MD TheCommonVein.net 87770c01

 

AIR
“Pseudocavitation”
Caused by Encasement of Several Bronchioles

Adenocarcinoma – “Pseudocavitation” Caused by Encasement of Several Bronchioles
Ashley Davidoff TheCommonVein.net adenocarcinoma-pseudocavitation-000a
Adenocarcinoma – “Pseudocavitation” Caused by Encasement of Several Bronchioles
Ashley Davidoff TheCommonVein.net adenocarcinoma-pseudocavitation-000b
Adenocarcinoma – “Pseudocavitation” Caused by Encasement of Several Bronchioles
Ashley Davidoff TheCommonVein.net adenocarcinoma-pseudocavitation-001
Adenocarcinoma – “Pseudocavitation” Caused by Encasement of Several Bronchioles
Ashley Davidoff TheCommonVein.net adenocarcinoma-pseudocavitation-001
Adenocarcinoma – “Pseudocavitation” Caused by Encasement of Several Bronchioles
Ashley Davidoff TheCommonVein.net adenocarcinoma-pseudocavitation-002


CALCIFICATION

Nodule or Mass with Eccentric Calcification

Poorly Differentiated Adenocarcinoma
Spiculated mass with eccentric calcification and nodal involvement
Ashley Davidoff MD TheCommonVein.net adenocarcinoma 001
Poorly Differentiated Adenocarcinoma
Spiculated mass with eccentric calcification and nodal involvement
Ashley Davidoff MD TheCommonVein.net adenocarcinoma 001b


Time

Time 1 Year

1 Year Prior Negative
1 Year Later 8mm Irregular Nodule
PET scan
Biopsy and Placement of Fiduciary Markers

 

Spiculated Spiculated Nodule Another Case Over Time

Growth of a Spiculated Nodule of  Mucinous Adenocarcinoma Over 1 year
1 year Ago Mucinous Adenocarcinoma
5 Months Ago Mucinous Adenocarcinoma
Current Mucinous Adenocarcinoma

Small Smooth Peripheral Nodule with 1 year Growth

Growth of Adenocarcinoma Over 2 years
                       2 years ago Adenocarcinoma
                                7 months ago Adenocarcinoma
                                Current -Adenocarcinoma

 

Associated Findings

Satellite Nodule

Spiculated Consolidation and a Satellite Nodule

Carcinoma
The plain film (top left) and CT (top right, bottom right) features of this mass in a 66-year-female who is a smoker are concerning, with size being greater than 3cm, and the shape having spiculated borders and satellite nodules seen in the top right image.  The PET scan (bottom left) was positive and biopsy confirmed the diagnosis. The (bottom right) was performed during a CT biopsy and the patient is lying prone.
Ashley Davidoff, M.D. TheCommonVein.net Lung cancer P 036
Poorly Differentiated Adenocarcinoma
Spiculated mass with eccentric calcification and nodal involvement
Ashley Davidoff MD TheCommonVein.net adenocarcinoma 001c

Adenocarcinoma with Lepidic Growth

Adenocarcinoma as an Consolidation Focal and Segmental 

Consolidation in Adenocarcinoma with Lepidic Growth
The focal nodules (middle row) and segmental consolidation in the right upper lobe (lower row) in this case  is  caused by total filling of the alveoli with malignant cells. This results in opacification of the alveoli and the “white” density in contrast to the “black” airways, enable the airways to be visualised as air bronchograms                                       
Ashley Davidoff MD TheCommonVein.net 87770c01
face carcinoma adenocarcinoma lepidic growth 78f
Ashley Davidoff TheCommonVein.net

 

87755.8s The CT is from a 51 year old male who is a smoker who shows three areas areas of ground glass opacity in the right lower lobe, two that measure close to 2cms each and a third more anterior that measures about 8mms. This case represents multicentric adenocarcinoma with lepidic growth (aka BAC). lung cancer GGO ground glass opacity multicentric malignant BAC bronchioloalveolar carcinoma bronchiolocarcinoma CTscan Courtesy Ashley Davidoff MD TheCommonVein.net

Minimal Changes in a GGO Adenocarcinoma with Lepidic Growth

Minimal Changes in a GGO Adenocarcinoma with Lepidic Growth
1 year prior
Ashley Davidoff MD
TheCommonVein.net
Minimal Changes in a GGO Adenocarcinoma with Lepidic Growth
1 year prior
Ashley Davidoff MD
TheCommonVein.net
Minimal Changes in a GGO Adenocarcinoma with Lepidic Growth
Current
Ashley Davidoff MD
TheCommonVein.net
Minimal Changes in a GGO Adenocarcinoma with Lepidic Growth
Current

 

Bronchocentric or Pseudocavitation

Adenocarcinoma Acinar Predominant

Acinar Adenocarcinoma
The mass seems to have incorporated and constricted several small airways
Ashley Davidoff MD TheCommonVein.net 78f 001
Acinar Adenocarcinoma
The mass seems to have incorporated and constricted several small airways
Ashley Davidoff MD TheCommonVein.net 78f 002
Acinar Adenocarcinoma
The mass seems to have incorporated and constricted several small airways
Ashley Davidoff MD TheCommonVein.net 78f 003
Hetrogeneous appearance with retracted airways synchronous with a second lesion that looked the same In this instance it was acinar adenocarcinoma
Ashley Davidoff MD TheCommonVein.net

Moderately differentiated Adenocarcinoma with Bronchiectasis

Moderately differentiated adenocarcinoma with bronchiectasis
Ashley Davidoff MD The CommonVein.net adenocarcinoma 01 CT
Moderately differentiated adenocarcinoma with bronchiectasis
Ashley Davidoff MD The CommonVein.net adenocarcinoma 02 CT
Moderately differentiated adenocarcinoma with bronchiectasis
Ashley Davidoff MD The CommonVein.net adenocarcinoma 03 CT
Moderately differentiated adenocarcinoma with bronchiectasis
Ashley Davidoff MD The CommonVein.net adenocarcinoma 04 CT

Bubble Lucencies – Pseudocavitation

Cavitating Squamous Cell Carcinoma
65 year male with peripheral lung nodule characterized by cavitation that was not present 2 years earlier . Pathology revealed squamous cell carcinoma
Ashley Davidoff
TheCommonVein.net

Mixed Lepidic and Acinar Carcinoma with Pseudocavitation
Ashley Davidoff MD TheCommonVein.net
Mixed Lepidic and Acinar Carcinoma with Pseudocavitation
Ashley Davidoff MD TheCommonVein.net
Mixed Lepidic and Acinar Carcinoma with Pseudocavitation
Ashley Davidoff MD TheCommonVein.net
Mixed Lepidic and Acinar Carcinoma with Pseudo cavitation
Ashley Davidoff MD TheCommonVein.net

Adenocarcinoma with “Pseudocavitation” Minimal PET Activity

Adenocarcinoma with “Pseudocavitation” Minimal PET Activity
Ashley Davidoff TheCommonVein.net pseudocavitation-001-CT

 

Adenocarcinoma with “Pseudocavitation” Biopsy with hemorrhage Minimal PET Activity
Ashley Davidoff TheCommonVein.net pseudocavitation-002-CT

 

Bronchovascular Infiltrate

Adenocarcinoma
Atypical presentation along the bronchovascular bundle
Ashley Davidoff TheCommonVein.net

Extreme Form of Pseudocavitation

Growth of an Unusual Appearing Adenocarcinoma Over 9 Months
                      9 months ago Invasive-Adenoca
                            5 Months ago Invasive-Adenoca

Current Invasive-Adenoca

Adenocarcinoma Presenting as an Infiltrate

Adenocarcinoma presenting as an Infiltrate
Ashley Davidoff MD TheCommonVein.net
adenocarcinoma 79M

 

Hard to See Lesion Next to Vessels
Coronal Image on a HArd to See Lesion Made Much easier
Ashley Davidoff MD TheCommonVein.net
Coronal Image on a HArd to See Lesion Made Much easier
Ashley Davidoff MD TheCommonVein.net

Positive PET Scan

 

Necrotic Mass

53 year old male with history of smoking presents with a cough Axial CT scan with soft tissue windows shows a 8.5 cm mass in the left upper lobe
Diagnosis – adenocarcinoma of the lung with extensive necrosis of the tumor
Ashley Davidoff MD The CommonVein.net
53 year old male with history of smoking presents with a cough Axial CT scan with lung windows shows the mass with surrounding ground glass changes with thickening of interlobular septa and thickening of adjacent airways reminiscent of lymphangitis
Diagnosis – adenocarcinoma of the lung with extensive necrosis of the tumor
Ashley Davidoff MD The CommonVein.net
53 year old male with history of smoking presents with a cough PET CT shows a large 8.9 cm left upper lobe apical lung mass which  is peripherally intensely hypermetabolic, centrally photopenic there is suspicious for lung malignancy with central necrosis  The tumor circumferentially abuts the pleura and abuts the anterior and posterior upper ribs and upper T-spine without low-dose CT evidence of erosion.
Diagnosis – adenocarcinoma of the lung with extensive necrosis of the tumor
Ashley Davidoff MD The CommonVein.net
53 year old male with history of smoking presents with a cough PET CT shows a large 8.9 cm left upper lobe apical lung mass which  is peripherally intensely hypermetabolic, centrally photopenic there is suspicious for lung malignancy with central necrosis  The tumor circumferentially shows mild tracer uptake and becomes suspicious for lymphangitis carcinomatosa
Diagnosis – adenocarcinoma of the lung with extensive necrosis of the tumor
Ashley Davidoff MD The CommonVein.net

Cavitating Well Differentiated Mucinous Adenocarcinoma

Cavitating Adenocarcinoma
The mass was not present on this image taken 2 years prior. Patient had a history of TB Lesion was biopsied and showed well differentiated mucinous adenocarcinoma
Ashley Davidoff MD TheCommonVein.net adencacinoma-005
Cavitating Adenocarcinoma
Patient had a history of TB Lesion was biopsied and showed well differentiated mucinous adenocarcinoma
Ashley Davidoff MD TheCommonVein.net adencacinoma-0046 biopsy
Cavitating Adenocarcinoma
Patient had a history of TB Lesion was biopsied and showed well differentiated mucinous adenocarcinoma
Ashley Davidoff MD TheCommonVein.net adenocarcinoma biopsy

Cystic Adenocarcinoma

Presenting as Multiple Nodules

Adenocarcinoma as Multiple
Well Defined Solid Multicentric Nodules

CT scan I of an 51 year old female with multicentric nodules shown at pathology to represent adenocarcinoma wit lepidic growth
Ashley Davidoff TheCommonVein.net 134362

Adenocarcinoma as Multiple
Well Defined and Poorly Defined Solid Multicentric Nodules

63 year old male with diffuse bilateral infiltrates reflecting an unusual form of adenocarcinoma
Ashley Davidoff MD TheCommonVein.net 134336

Some of the Nodules are Centrilobular

63 year old male witdiffuse bilateral infiltrates reflecting an unusual form of adenocarcinoma with lepidic growth
The lower panels demonstrate centrilobular distribution of someof the nodules
Ashley Davidoff MD
TheCommonVein.net
134336c

Following Treatment

Post Radiation


Radiation Pneumonitis with bronchiectasis 3 months post treatment. Note the straight lateral border inkeeping with the path of the radiation beam
Ashley Davidoff MD TheCommonVein.net post XRT 001

 

Recurrence Along Surgical Margins

Alongside a scar

Previous resection of a Stage 1 Adenocarcinoma – now with lower Lobe with PET positive CT recurrence along the suture margin.
Ashley Davidoff MD TheCommonvein.ne

Cancer Look Alikes

5 months prior

Cancer look alike 5 months prior
Ashley Davidoff MD TheCommonVein.net

3 months prior

Cancer look alike 3 months prior
Ashley Davidoff MD TheCommonVein.net

Current

Cancer look alike current
Ashley Davidoff MD TheCommonVein.net

TB

Unusual case of TB presenting as a bronchovascular infiltrate with extension into the small airways in the Right Upper Lobe
Ashley Davidoff TheCommonVein.net

After TB Treatment

Unusual case of TB presenting as a bronchovascular infiltrate with extension into the small airways in the Right Upper Lobe with Tree in Bud Changes
Ashley Davidoff TheCommonVein.net

Metastatic Disease to Adrenal and Brain

CT PET scan of an 80 year old male with primary adenocarcinoma of the lung metastattic to right hilum and mediastinum ( upper panel) and metastatic disease to the left adrenal (lower panel)
Ashley Davidoff TheCommonVein.net 292Lu 121892
MRI Adenocarcinoma of the Lungs Metastatic to the Brain
MRI of an 80 year old male with primary adenocarcinoma of the lung show metastatic disease to the brain. I mage a is a non contrast T1 weighted image prior to contrast administration. Images b, c ad are sagittal images of the brain following gadolinium administration and shows multiple enhancing lesions in the frontal parietal and temporal lobes consistent with metastatic disease
Ashley Davidoff MD TheCommonVein.net  292Lu 121893cL