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Lung cancer associated with cystic airspaces: Characteristic morphological features on CT in a series of 11 cases

Published:February 20, 2019DOI:https://doi.org/10.1016/j.clinimag.2019.02.015

      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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