Cancer Adenocarcinoma

Definition

Adenocarcinoma is a malignant condition of the epithelial lining of the airways, most commonly the peripheral airways, and is now the most common type of lung cancer, accounting for 30-40% of all cases.

The causative factors are not as clear as in squamous cell cancer, and the association with smoking although present, is not as strong as with squamous cell carcinoma.  It occurs in secretory cells. A subtype of adenocarcinoma is called bronchioalveolar cell carcinoma (BAC). Thus adenocarcinoma can originate from the bronchial mucosa, or from the acinus in which case it results in the bronchioloalveolar type. A pattern  from adenomatous hyperplasia, through pure bronchioloalveolar carcinoma to a combination of BAC and adenocarcinoma to adenocarcinoma is noted, similar to the hyperplasia, adenoma, dysplasia, malignancy pattern noted in colon carcinoma.

Structurally, it is characterized by its location in the periphery, and the occasional association with a known scar.  It rarely cavitates but it may calcify. At a histopathological level rosettes of glandular epithelium often with mucus are noted.

Adenocarcinomas tend to grow more slowly than squamous cell carcinomas.

It is complicated by early metastasis to local nodes and to distal parts of the body, commonly the pleura, brain, adrenals and bone.

Clinically adenocarcinoma tends to as peripherally placed tumors and hence they are often asymptomatic, but their relationship to the pleura, may incite pleuritic pain or pleural effusion.  Their initial silent nature often precludes early diagnosis and so presentation is relatively late and it is not uncommon for the patient to present with metastatic disease.

The diagnosis is made after endoscopic or CT guided biopsy, and after staging with PET scan or with additional biopsy of remote sites, treatment is initiated based on the staging.

Stage I, II, and IIIA are treated surgically with a hope of cure, and the more advanced stages are treated with combinations of radiotherapy and chemotherapy.

Peripheral Adenocarcinoma
This whole mount of a part of the periphery of the lung  reveals a peripherally located nodule without evidence puckering of overlying pleura. Microscopically this proved to be a papillary carcinoma.
Courtesy Armando Fraire MD. TheCommonVein.net 32812

 

Adenocarcinoma showing Glandular Formation
The histological section shows rosettes of malignant glandular epithelium surrounding their respective lumens (l). The malignant cells have dark nuclei, with the cells showing a high nuclear to cytoplasmic ratio consistent with carcinoma, and the rosette shape and the glandular appearance, characterize the section as an adenocarcinoma code lung cancer adenocarcinoma rosettes malignant lumen
Courtesy Armando Fraire MD.
TheCommonVein.net
32510b01
Mucus in the Lumen
Histological section of an adenocarcinoma of the lung showing accumulation of mucus globules in the lumina of the glands .
Courtesy Armando Fraire 
TheCommonVein.net
MD. 32512
Peripheral Carcinoma
The 3.5cms carcinoma is peripherally situated and is sub-pleural in location. It reveals fibroblastic (aka desmoplastic) effect as witnessed by the puckering of the pleura (arrow). It is remote from central bronchovascular structures and therefore remains relatively asymptomatic for an extended duration unless it causes pleuritic pain. The location and desmoplastic puckering of the pleura are characteristic of an adenocarcinoma.
Ashley Davidoff
TheCommonVein.net
32201b.81s
SBO and left Lower Lobe Mass
This plain film of the chest and abdomen shows is from a 51year old female who presented with nausea, vomiting, and abdominal distension. A loop of dilated small bowel is associated with absence of air in the decompressed colon and rectum. In addition a mass is seen in the left lower lobe (green overlay). A barium study showed thumb printing consistent with distal ischemia of the small bowel. The diagnosis in the lung was shown to be adenocarcinoma.
Courtesy Ashley Davidoff MD 
TheCommonVein.net
43459c01.8s
Adenocarcinoma – 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 3cms range is lobulated and peripherally located.  Pathology showed an adenocarcinoma.
Courtesy Ashley Davidoff MD 
TheCommonVein.net
43460c

Adenocarcinoma PET negative

Adenocarcinoma – Irregular Mass in RLL 18 months ago
Ashley Davidoff THECOMMONVEIN.net
Mucinous Adenocarcinoma  PET CT is negative 18 months ago 
Ashley Davidoff
THECOMMONVEIN.net
85 year old male with a mucin secreting adenocarcinoma associated with air bronchograms or findings of cavitation
Ashley Davidoff
TheCommonVein.net
118601

Adenocarcinoma with Air Bronchograms

Adenocarcinoma with Air Bronchograms likely with Lepidic Growth
Ashley Davidoff MD TheCommonVein.net
70m – adenocarcinoma-02
Air Bronchograms likely with Lepidic Growth
Ashley Davidoff MD TheCommonVein.net
70m – adenocarcinoma-02
Air Bronchograms likely with Lepidic Growth
Ashley Davidoff MD TheCommonVein.net
70m – adenocarcinoma-02
Invading the Chest Wall and Adrenal Metastases
68 year old male with adenocarcinoma of the lung invading the chest wall and involving both adrenal glands
Ashley Davidoff MD
TheCommonVein.net
Infiltrative Adenocarcinoma
This is an unusual appearance of an adenocarcinoma showing a large lobar consolidation without significant distortion of the vessels. The vessels in the infiltrated section (green overlay) are spread apart. Infiltrative adenocarcinoma was identified on biopsy.
Courtesy Ashley Davidoff MD 
TheCommonVein.net
46589c02.8s

56 year old male with mucinous adenocarcinoma

Mucinous adenocarcinoma presenting as an infiltrate
CXR showing right lower and middle lobe infiltrate
Ashley Davidoff MD TheCommonVein.net
56 pneumonic mucinous adenoca 001
Mucinous adenocarcinoma presenting as an infiltrate
CXR showing right lower and middle lobe infiltrate
Ashley Davidoff MD TheCommonVein.net
56 pneumonic mucinous adenoca 002
Mucinous adenocarcinoma presenting as an infiltrate
CT showing right lower and middle lobe infiltrate
Ashley Davidoff MD TheCommonVein.net
56 pneumonic mucinous adenoca 005

CT PET scan and MRI of an 80 year old male with primary adenocarcinoma of the lung show metastatic disease to the mediastinum, adrenals and brain
Ashley Davidoff
TheCommonVein.net
121893
Adenocarcinoma Presenting as an Infiltrate
75 year old female presents with a left lower lobe infiltrate on CT scan and PET CT positivity
Ashley Davidoff MD TheCommonVein.net

Links and References