Highlights
- •Lung cancers associated with cystic –airspaces may appear as simple lung cysts, lung cysts with slightly irregular walls or characteristic multicystic bubbly air spaces with internal complete and incomplete septations.
- •Development of ground-glass change, diffuse wall nodularity, eccentric nodule or increasing complexity within a cystic airspace are indicators of malignancy. These indicators should prompt cancer workup including biopsy.
- •Lung cancers associated with cystic airspaces are more commonly adenocarcinomas on pathology.
- •Association with emphysema and smoking is common.
- •These are slow growing tumors and hence long-term follow-up of cystic airspaces is required.
Abstract
Purpose
To familiarize the reader with the entity ‘lung cancer associated with cystic airspaces’
(LC-CAS) and create an awareness about the potential for slow progressive development
of cancer within these nonaggressive appearing cystic airspaces (CAS) encountered
in routine radiology practice.
Material and methods
Morphological appearances of (n = 11) LC-CAS detected during routine radiological
reporting of chest CT scans were studied. Patient demographics, clinical history,
characteristics of LC-CAS including location, size, wall thickening, diffuse nodularity,
eccentric nodule, ground glass change, emphysema and pathology results were collected
from the hospital's internal database.
Results
Patients with LC-CAS (9F/2M) were between 49 and 77 years (mean 63.18 years). All
patients (n = 11) had a history of smoking. LC-CAS had a characteristic multicystic
bubbly appearance. Average size of CAS at initial detection of LC was 2.52 cm (range
1.3–4 cm). Lesions were located in the RLL (n = 4), RML (n = 2), RUL (n = 1), LLL
(n = 1) and LUL (n = 3) with no lobar predilection and were more commonly peripheral
(n = 7) than central (n = 4). Ground glass change (n = 2), extrinsic nodules (n = 4),
diffuse wall nodularity (n = 3) and intrinsic nodules (n = 2) were observed and prompted
biopsy. Lesions ranged between T1a to T4. Most cancers were T1a N0 (n = 5). Adenocarcinomas
formed the majority of cases (n = 9).
Conclusion
LC-CAS present as new development of diffuse nodularity, eccentric nodules or ground
glass change associated with CAS. These are more commonly adenocarcinomas on histology.
Recognition of CAS and appropriate malignancy workup when suspicious features are
observed is essential to enable early detection of lung cancer.
Keywords
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Article info
Publication history
Published online: February 20, 2019
Accepted:
February 19,
2019
Received in revised form:
February 10,
2019
Received:
February 25,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
