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

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

AIR
“Pseudocavitation”
Caused by Encasement of Several Bronchioles

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

CALCIFICATION

Nodule or Mass with Eccentric Calcification

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

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

Adenocarcinoma with Lepidic Growth

Adenocarcinoma as an Consolidation Focal and Segmental

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

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 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